Background
• Caused by neurotoxin produced by anaerobic gram-positive rod C. botulinum
• Spore-forming bacterium found in soil & water, particularly in CA, UT, PA
• Blocks ACh release at neuromuscular jxn & autonomic ganglions (nicotinic receptors)
Approach
• Early airway management & ventilatory support
• Contact CDC Botulism center (404-639-2206/3311) for antitoxin
History
• 3 main etiologies: Infant, foodborne, or wound; also potential for bioterrorism
• Infant: Consumption of unpasteurized honey or likely exposure to endemic spores (feeding through a nipple dropped on the ground, sucking on fingers after playing in dirt)
• Foodborne (adult): Ingestion of food contaminated w/ spores, usually home-canned goods
• Wound: Spores infiltrate skin wounds, germinate, & release toxin into the bloodstream
Findings
• Weakness, flaccid paralysis, respiratory arrest, autonomic Dysfxn; CN affected 1st
• Infant: Weak cry, poor sucking, flaccid/hypotonic muscles
• Foodborne (12–36 h) & wound (several days): Autonomic Dysfxn, descending symmetric motor paralysis, nl sensorium
Evaluation
• None needed prior to intervention
• Collect serum, stool, wound, & food samples for CDC testing
Treatment
• ABCs, intubation or supplemental O2
• Administer antitoxin 1 vial IV to adults & children
• Infants need only supportive care, no antitoxin
Disposition
• Admission to ICU for ventilatory support
Pearls
• Consider botulism in all infant sepsis workups
• Artificially induced hypothermia does not improve outcome
• Aminoglycosides, magnesium contraindicated as they potentiate neuromuscular blockade
• Recovery of strength may take ∼4 mo; may require respiratory support for months