UMEM Educational Pearls

Title: Deadly nacho cheese? Cases of foodborne botulism in Northern California

Keywords: foodborne botulism (PubMed Search)

Posted: 5/25/2017 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

Question

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

Answer

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

Early GI symptoms: nausea, vomiting and abdominal pain/discomfort (about 12-24 hours).
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.

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

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