UMEM Educational Pearls

Takeaways

Botulism is a rare neurologic condition characterized by GI symptoms that progressed to cranial nerve dysfunction and symmetric descending paralysis. Foodborne botulism is due to ingestion of botulinum toxin that is produced by clostridium botulinum, an ubiquitous bacterium in our environment. 

Bottom line:

  • Foodborne botulism presents with GI symptoms that is followed by symmetric descending flaccid paralysis.
  • Botulinum antitoxin prevents further progression of neurologic deficit; it does not reverse the neurologic deficit that is present prior to administration. 
  • Contact your local poison center, and state health department & CDC regarding management and access to botulinum antitoxin.

Maryland Department of Health and Mental Hygiene

  • During business hours: 410-767-6700
  • After hours: 410-795-7365

CDC Emergency Operations Center: 770-488-7100

In-Depth

  • Majority of botulism cases occur in infants, but food and wound botulisms are also frequently reported.
  • Botulinum toxin blocks the release of acetylcholine from presynaptic membranes of neuromuscular junction resulting in paralysis.

Foodborne botulism is characterized by

  1. Early GI symptoms: nausea, vomiting and abdominal pain/discomfort (about 12-24 hours).
  2. Neurologic symptoms
  • Diplopia/lateral rectus palsy, blurred vision, impaired accommodation
  • Dysarthria/dysphonia, dysphagia
  • Symmetric bulbar paralysis progressing to limbs (descending paralysis).
  • Diminished deep tendon reflexes.
  1. Mental status and sensory remain normal/intact.
  • Management is primarily supportive. Heptavalent botulinum antitoxin can be made available through communication with state health department and CDC.
  • Antitoxin is administered to prevent further deterioration of clinical status, i.e. limit the progression of paralysis.
  • However, it does not reverse the neurologic deficit that is present prior to antitoxin administration.  

References

  1. Carrillo-Marquez MA, Botulism. Pediatr Rev. 2016;35:183-192
  2. Goldfrank's Toxicologic Emergencie. 10th ed. Ch 41. Botulism.