Clostridium botulinum - Revision history

Aidan: /* Microbiology */

2020-10-15T13:49:37Z

Microbiology

← Older revision		Revision as of 13:49, 15 October 2020
Line 8:		Line 8:

	*Large [[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[Shape::bacillus]] with a subterminal spore		*Large [[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[Shape::bacillus]] with a subterminal spore
			**Lipase positive and lecithin negative on egg yolk agar
	*Diverse species whose defining trait is the production of botulinum toxin		*Diverse species whose defining trait is the production of botulinum toxin
	*Subdivided into four groups based on biochemical tests		*Subdivided into four groups based on biochemical tests
Line 31:		Line 32:
	*Circulates primarily in birds and non-human mammals		*Circulates primarily in birds and non-human mammals

	=== Epidemiology ===		===Epidemiology===

	* Spores are found worldwide in soil and water		*Spores are found worldwide in soil and water
	* Disease commonly occurs in outbreaks related to contaminated food		*Disease commonly occurs in outbreaks related to contaminated food
	* ~~More~~ common in ~~certain areas~~ ~~due~~ to ~~local~~ ~~food~~ ~~practices~~		**A is most common in North America and is commonly associate
			**E is associated with marine animals and fish, and is common in outbreaks amongst Inuit people
			*More common in certain areas due to local food practices

	==Clinical Manifestations==		==Clinical Manifestations==
Line 53:		Line 56:
	**Autonomic neuropathies, causing dry mouth, fixed or dilated pupils, blurred vision, and hypotension		**Autonomic neuropathies, causing dry mouth, fixed or dilated pupils, blurred vision, and hypotension
	**Upper and lower extremity weakness		**Upper and lower extremity weakness
			**May appear calm despite significant respiratory distress, due to the paralysis
	*GI symptoms include constipation, nausea, and vomiting; occasionally abdominal cramps and diarrhea		*GI symptoms include constipation, nausea, and vomiting; occasionally abdominal cramps and diarrhea
	*Usually fatigue, and occasionally sore throat and dizziness		*Usually fatigue, and occasionally sore throat and dizziness
Line 88:		Line 92:
	*Typical symptoms of botulism		*Typical symptoms of botulism

	=== Iatrogenic Botulism ===		===Iatrogenic Botulism===

	* May occur during use of therapeutic botulinum toxin (e.g. Botox)		*May occur during use of therapeutic botulinum toxin (e.g. Botox)

	=== Prognosis ===		===Prognosis===

	* Mortality with appropriate treatment is 5 to 8% in adults and 1% in infants		*Mortality with appropriate treatment is 5 to 8% in adults and 1% in infants
	*Takes weeks to months to recover and may have fatigue and weakness for more than one year		*Takes weeks to months to recover (admissions lasting 1 to 3 months) and may have fatigue and weakness for more than one year

	==Differential Diagnosis==		==Differential Diagnosis==

			=== Adults ===
⚫	*[[Myasthenia gravis]]: lacks autonomic features

⚫	*[[Lambert-Eaton myasthenic syndrome]]
	*[[Guillain-Barré syndrome]] (acute inflammatory demyelinating polyneuropathy): asymmetric, ascending, and involves sensory nerves; or ataxia, in the Miller-Fisher variant that involves cranial nerves		* [[Guillain-Barré syndrome]] (acute inflammatory demyelinating polyneuropathy): asymmetric, ascending, and involves sensory nerves; or ataxia, in the Miller-Fisher variant that involves cranial nerves
		⚫	* [[Lambert-Eaton myasthenic syndrome]]
⚫	*[[Tick paralysis]]: [[Dermacentor]] tick still attached
		⚫	* [[Myasthenia gravis]]: lacks autonomic features
⚫	*[[~~Polio~~]]: febrile and asymmetric
	*~~Others:~~ [[~~diphtheria~~]], ~~[[organophosphate toxicity]],~~ [[brainstem stroke]]		* [[Stroke]], especially [[brainstem stroke]]
			* Bacterial or chemical [[food poisoning]]
		⚫	* [[Tick paralysis]]: [[Dermacentor]] tick still attached
			* Chemical intoxication: [[carbon monoxide poisoning]], [[organophosphate toxicity]]
			* [[Mushroom poisoning]]
		⚫	* [[Poliomyelitis]]: typically febrile and asymmetric
			* Psychiatric illness

			=== Infants ===

			* [[Sepsis in children\|Sepsis]]
			* [[Meningitis in children\|Meningitis]]
			* Electrolyte imbalance
			* [[Reye syndrome]]
			* [[Congenital myopathy]]
			* [[Werdnig-Hoffman disease]]
			* [[Leigh disease]]

	==Diagnosis==		==Diagnosis==
Line 125:		Line 145:
	**For infants up to 1 year old, BabyBIG (BIG-IV) 50 mg/kg		**For infants up to 1 year old, BabyBIG (BIG-IV) 50 mg/kg
	***Human-derived		***Human-derived
			***Only manufactured in California, so difficult to access urgently
	**For children over 1 year and adults, heptavalent botulinum antitoxin (HBAT)		**For children over 1 year and adults, heptavalent botulinum antitoxin (HBAT)
	***Horse-derived antitoxin to toxins A through G		***Horse-derived antitoxin to toxins A through G (7,500 U anti-A; 5,500 U anti-B; 5,000 U anti-C; 1,000 U anti-D; 8,500 U anti-E; 5,000 U anti-F; and 1,000 U anti-G)
	***Risk of sensitization or anaphylaxis to horse proteins		***Risk of sensitization or anaphylaxis to horse proteins
	*Antibiotics		*Antibiotics
	**Unclear benefit, but often [[penicillin G]] or [[metronidazole]] are used for wound botulism		**Unclear benefit, but often [[penicillin G]] or [[metronidazole]] are used for wound botulism
	**Aminoglycosides and tetracyclines can worsen the paralysis of infant botulism, possibly by lysis of ''Clostridium botulinum'' in the gut		**[[Aminoglycosides]] and [[tetracyclines]] can worsen the paralysis of infant botulism, possibly by lysis of ''Clostridium botulinum'' in the gut

			== Prevention ==

			* Food safety practices
			** Safe canning and fermentation practices
			** Toxin is heat labile, though, so cooking food will deactivate the toxin
			* Avoiding honey in infants less than 1 year old
			** Possibly also avoiding raw sugar (but not refined sugar), molasses, herbal (chamomile) tea26 and other herbal preparations

	==Further Reading==		==Further Reading==

Aidan at 01:30, 15 October 2020

2020-10-15T01:30:59Z

Show changes

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-08T14:52:45Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 14:52, 8 October 2020
Line 7:		Line 7:
	===Microbiology===		===Microbiology===

	*[[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[~~Cellular shape~~::bacillus]] with a subterminal spore		*[[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[Shape::bacillus]] with a subterminal spore
	*Diverse species whose defining trait is the production of botulinum toxin		*Diverse species whose defining trait is the production of botulinum toxin
	*Subdivided into four groups based on biochemical tests		*Subdivided into four groups based on biochemical tests

Aidan at 23:49, 18 September 2020

2020-09-18T23:49:00Z

← Older revision		Revision as of 23:49, 18 September 2020
Line 27:		Line 27:
	*This presentation contrasts with [[polio]], which can be asymmetric and often has fever		*This presentation contrasts with [[polio]], which can be asymmetric and often has fever

	===Foodborne ~~botulism~~===		===Foodborne Botulism===

	*Symptoms start 12 to 36 hours after ingestion		*Symptoms start 12 to 36 hours after ingestion
Line 34:		Line 34:
	*Descending flaccid paralysis, with:		*Descending flaccid paralysis, with:
	**Acute onset bilateral cranial neuropathies, causing diplopia, dysphagia, and dysarthria		**Acute onset bilateral cranial neuropathies, causing diplopia, dysphagia, and dysarthria
	**Autonomic neuropathies, causing dry mouth, fixed or dilated pupils, and hypotension		**Autonomic neuropathies, causing dry mouth, fixed or dilated pupils, blurred vision, and hypotension
			**Upper and lower extremity weakness
⚫	*No cognitive or sensory effects
			*GI symptoms include constipation, nausea, and vomiting; occasionally abdominal cramps and diarrhea
			*Usually fatigue, and occasionally sore throat and dizziness
		⚫	*No cognitive or sensory effects (rarely paresthesias)

	===Wound ~~botulism~~===		===Wound Botulism===

	*Incubation period of t to 14 days		*Incubation period of 4 to 14 days
	*May have fever secondary to an infected wound, although the wound can rarely appear to be healing well		*May have fever secondary to an infected wound, although the wound can rarely appear to be healing well
	*Can produce abscesses		*Can produce abscesses

	===Infant ~~botulism~~===		===Infant Botulism===

	*Classically after ingesting unpasteurized honey		*Classically after ingesting unpasteurized honey
Line 52:		Line 55:
	*Relapses are possible		*Relapses are possible

	===Adult ~~intestinal~~ ~~toxemia~~===		===Adult Intestinal Toxemia===

	*Rare form of botulism associated with colonisation of the GI tract		*Rare form of botulism associated with colonisation of the GI tract
	*Onset is more gradual and disease less severe than foodborne botulism		*Onset is more gradual and disease less severe than foodborne botulism
	*Risk factors are gastrointestinal surgery or illness, such as inflammatory bowel disease		*Risk factors are gastrointestinal surgery or illness, such as inflammatory bowel disease

			=== Inhalation Botulism ===

			* Incubation period of 12 hours to 3 days
			* Typical symptoms of abotulism

	==Differential Diagnosis==		==Differential Diagnosis==

Aidan: /* Management */ link

2020-08-27T16:02:28Z

Management: link

← Older revision		Revision as of 16:02, 27 August 2020
Line 77:		Line 77:
	==Management==		==Management==

	*Call the Botulism Reference Service for Canada (or equivalent): office (613) 957-0902; laboratory (613) 957-0885; after-hours (613) 296-1139		*Call the [https://www.canada.ca/en/health-canada/services/science-research/activity-highlights/microbial-research-activities/botulism-reference-service-canada.html Botulism Reference Service for Canada] (or equivalent): office (613) 957-0902; laboratory (613) 957-0885; after-hours (613) 296-1139
	*Supportive care		*Supportive care
	**Intubation and ventilation if necessary		**Intubation and ventilation if necessary

Aidan: /* Pathophysiology */

2020-08-18T12:17:10Z

Pathophysiology

← Older revision		Revision as of 12:17, 18 August 2020
Line 1:		Line 1:
	==Background==		==Background==

	=== History ===		===History===

	* Named for sausages due to a historical association with improperly-cooked sausages		*Named for sausages due to a historical association with improperly-cooked sausages

	===Microbiology===		===Microbiology===
Line 15:		Line 15:

	*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron		*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron
			*Affects cholinergic nerve terminals, including neuromuscular junction and the autonomic nervous system

	===Life Cycle===		===Life Cycle===
Line 31:		Line 32:
	*Nausea, diarrhea, and dry mouth		*Nausea, diarrhea, and dry mouth
	**Of note, diarrhea is not caused by the toxin but by other ingested contaminants		**Of note, diarrhea is not caused by the toxin but by other ingested contaminants
			*Descending flaccid paralysis, with:
			**Acute onset bilateral cranial neuropathies, causing diplopia, dysphagia, and dysarthria
			**Autonomic neuropathies, causing dry mouth, fixed or dilated pupils, and hypotension
			*No cognitive or sensory effects

	===Wound botulism===		===Wound botulism===

Aidan: /* Background */

2020-08-18T12:10:04Z

Background

← Older revision		Revision as of 12:10, 18 August 2020
Line 1:		Line 1:
	==Background==		==Background==

			=== History ===

			* Named for sausages due to a historical association with improperly-cooked sausages

	===Microbiology===		===Microbiology===

Line 11:		Line 16:
	*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron		*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron

	=== Life Cycle ===		===Life Cycle===

	* Circulates primarily in birds and non-human mammals		*Circulates primarily in birds and non-human mammals

	==Clinical Manifestations==		==Clinical Manifestations==

Aidan: /* Background */

2020-08-14T10:20:59Z

Background

← Older revision		Revision as of 10:20, 14 August 2020
Line 7:		Line 7:
	*These strains produce eight toxin types, A through H, that are identified by serology; some strains produce two different toxins		*These strains produce eight toxin types, A through H, that are identified by serology; some strains produce two different toxins

	==Pathophysiology==		===Pathophysiology===

	*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron		*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron

			=== Life Cycle ===

			* Circulates primarily in birds and non-human mammals

	==Clinical Manifestations==		==Clinical Manifestations==
Line 83:		Line 87:
	*Takes weeks to months to recover and may have weakness for more than one year		*Takes weeks to months to recover and may have weakness for more than one year

	== Further Reading ==		==Further Reading==

	* [https://www.canada.ca/en/health-canada/services/food-nutrition/legislation-guidelines/guidance-documents/botulism-guide-healthcare-professionals-2012.html Botulism Reference Service for Canada]		*[https://www.canada.ca/en/health-canada/services/food-nutrition/legislation-guidelines/guidance-documents/botulism-guide-healthcare-professionals-2012.html Botulism Reference Service for Canada]
	{{DISPLAYTITLE:''Clostridium botulinum''}}		{{DISPLAYTITLE:''Clostridium botulinum''}}
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-15T12:14:45Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 12:14, 15 July 2020
Line 11:		Line 11:
	*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron		*Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron

	==Clinical ~~Presentation~~==		==Clinical Manifestations==

	*Typically involves ''symmetric'' descending paralysis, starting with cranial nerves and often involving respiratory muscles		*Typically involves ''symmetric'' descending paralysis, starting with cranial nerves and often involving respiratory muscles

Aidan: added Further Reading

2020-07-14T00:28:39Z

added Further Reading

← Older revision		Revision as of 00:28, 14 July 2020
Line 53:		Line 53:
	*Others: [[diphtheria]], [[organophosphate toxicity]], [[brainstem stroke]]		*Others: [[diphtheria]], [[organophosphate toxicity]], [[brainstem stroke]]

	== Diagnosis ==		==Diagnosis==

	* Gold standard is the '''mouse bioassay'''		*Gold standard is the '''mouse bioassay'''
	** A mouse is injected with a sample (serum, gastric secretions, stool, or food) and are monitored for paralysis		**A mouse is injected with a sample (serum, gastric secretions, stool, or food) and are monitored for paralysis
	** Toxin type is determined by administering type-specific antitoxin and monitoring for improvement		**Toxin type is determined by administering type-specific antitoxin and monitoring for improvement
	* Anaerobic cultures of serum, stool, or food, though low sensitivity		*Anaerobic cultures of serum, stool, or food, though low sensitivity
	* EMG may show small decrement in motor response or brief small abundant motor unit action potentials (BSAP)		*EMG may show small decrement in motor response or brief small abundant motor unit action potentials (BSAP)

	== Management ==		==Management==

	* Call the Botulism Reference Service for Canada (or equivalent): office (613) 957-0902; laboratory (613) 957-0885; after-hours (613) 296-1139		*Call the Botulism Reference Service for Canada (or equivalent): office (613) 957-0902; laboratory (613) 957-0885; after-hours (613) 296-1139
	* Supportive care		*Supportive care
	** Intubation and ventilation if necessary		**Intubation and ventilation if necessary
	** Bowel routine including enemas if constipated but without severe ileus		**Bowel routine including enemas if constipated but without severe ileus
	* Antitoxin		*Antitoxin
	** For infants up to 1 year old, BabyBIG (BIG-IV) 50 mg/kg		**For infants up to 1 year old, BabyBIG (BIG-IV) 50 mg/kg
	*** Human-derived		***Human-derived
	** For children over 1 year and adults, heptavalent botulinum antitoxin (HBAT)		**For children over 1 year and adults, heptavalent botulinum antitoxin (HBAT)
	*** Horse-derived		***Horse-derived
	*** Including antitoxins to toxin types A through G		***Including antitoxins to toxin types A through G
	*** Risk of sensitization or anaphylaxis to horse proteins		***Risk of sensitization or anaphylaxis to horse proteins
	* Antibiotics		*Antibiotics
	** May cause more toxin to be released from dying bacteria, so generally avoided		**May cause more toxin to be released from dying bacteria, so generally avoided
	** Aminoglycosides and tetracyclines can worsen the paralysis of infant botulism		**Aminoglycosides and tetracyclines can worsen the paralysis of infant botulism

	== Prognosis ==		==Prognosis==

	* Mortality with appropriate treatment is 5 to 8% in adults and 1% in infants		*Mortality with appropriate treatment is 5 to 8% in adults and 1% in infants
	* Takes weeks to months to recover and may have weakness for more than one year		*Takes weeks to months to recover and may have weakness for more than one year

			== Further Reading ==

			* [https://www.canada.ca/en/health-canada/services/food-nutrition/legislation-guidelines/guidance-documents/botulism-guide-healthcare-professionals-2012.html Botulism Reference Service for Canada]
	{{DISPLAYTITLE:''Clostridium botulinum''}}		{{DISPLAYTITLE:''Clostridium botulinum''}}
	[[Category:Gram-positive bacilli]]		[[Category:Gram-positive bacilli]]