ODR - Botulism Flashcards

1
Q

Causative organism

A

C. botulinum

Spore forming, gram positive anaeorobic rod shapred bacillus

Found in soil, marine sediments, mammal guts

Produces neurotoxins A-H or which A B and E are important

Rare life threatening neuroparalytic syndrome by a neurotoxin

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2
Q

How does it cause effect

A

Botulinum forms spores, develop toxin producing bacilli.

Toxins target synaptic vesicle receptors in pre-synapse on NMJ

Leads to irreversible failure to release ACh.

Disrupts transmision at NMJ, autnonomic ganglia.

Cranial nerves preferentially affect –> binds to sites of rapid depolarisation

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3
Q

Risk factors for bolutism

A

ivDU
Crush injury
Consumption of contaminated food stuff (honey, fermented)
Abdo bowel injury –> distribution of flora
Cosmetic bolutinum toxin
Soil ingestion
Reptile exposure

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4
Q

Types of botulism syndromes

A

Wound - most common. Toxin in wound or abcess from spores. IVDU and skin pop.

Infant - toxin absorbed from intestines of babies colonised to c.bot

Food bourne - ingestion of contaminated food.

Adult intestinal - rare, adult bowel absorbs toxin

Iatrogenic - therapeutic botulism

Inhalational - biological weapons.

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5
Q

Clinical features

A

Prodrome: n/v/dry mouth abdo distention

Symmetrical descending flaccid paralysis –> neck, shoulders, upper limb, cant hold head
Deep tendon reflexes lost

Sensation INTACT

Cranial nerve palsies –> oculobulbar weakenss. Cornal and gag spared

Autonomic –> urinary retnetion constipation etc

Resp failure

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6
Q

DD of botulism

A

Motor neuropathy:
GBS
MG
Lambert Eaton

Infection
Polio, Diptheria, Paralytic Rabies

Poison
Organophosphate
Tetrodotoxin
Shellfish poisoning

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7
Q

Investigation

A

Cranial nerve abnormalities plus symmetrical descending weakness

Culture - food samples, gastric aspirate, stool (if food bourn/infant)

Mouse bioassay identifies toxin in serum, secretion, stoool

Neurophysiology –> normal velocity but redices amplitude

ELISA for botulism in specialist centres

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8
Q

Treatment - specific

A

Specific:
Trivalent ABE equine anti-toxin EARLY

Neutralises free toxin

Skin testing before as anaphylaxis is common

Infants/allergy - Human derive botulinum Ig.

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9
Q

Treatmetn - supportive

A

Resp failure - monitor FVC, ETT is <15/kg
Sats, ABGs,
Observe bulbar function

Would debridement and send for culture
Ben pen or metronidazole for wound infection

AMINOGLYCOSIDES POTENTITATE THE EFFECTS

food - gastric lavage, enemas and laxative to remove toxin

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10
Q

Prognosis and long term outcomes

A

Mortality 3-5%
Increased over 60

Lethargy, weakness, SOB, MH issues

Prognosis poor: need MV, severe weakness, the elderly

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