Clostridium botulinum: Difference between revisions

Revision as of 01:23, 13 July 2020

Background

Microbiology

Gram-positive anaerobic bacillus with a subterminal spore
Diverse species whose defining trait is the production of botulinum toxin
Subdivided into four groups based on biochemical tests
These strains produce eight toxin types, A through H, that are identified by serology; some strains produce two different toxins

Pathophysiology

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

Clinical Presentation

Typically involves symmetric descending paralysis, starting with cranial nerves and often involving respiratory muscles
Afebrile with normal or slow heart rate despite hypotension, and sparing the sensory nerves
This presentation contrasts with polio, which can be asymmetric and often has fever

Foodborne botulism

Symptoms start 12 to 36 hours after ingestion
Nausea, diarrhea, and dry mouth
- Of note, diarrhea is not caused by the toxin but by other ingested contaminants

Wound botulism

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

Infant botulism

Feeding difficulties, hypotonia, drooling, and weak cry
Upper airway obstruction may require intubation
Typically worsens over 1 to 2 weeks, then stabilizes for 2 to 3 weeks, then recovers
Relapses are possible

Adult intestinal toxemia

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

@@ Line 1: / Line 1: @@
 ==Background==
 ===Microbiology===
-* [[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[Cellular shape::bacillus]] with a subterminal spore
+*[[Stain::Gram-positive]] [[Cellular respiration::anaerobic]] [[Cellular shape::bacillus]] with a subterminal spore
-* Produces seven toxin types, A through G
+*Diverse species whose defining trait is the production of botulinum toxin
+*Subdivided into four groups based on biochemical tests
+*These strains produce eight toxin types, A through H, that are identified by serology; some strains produce two different toxins
 ==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
 ==Clinical Presentation==
-* 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
-* Afebrile with normal or slow heart rate despite hypotension, and sparing the sensory nerves
+*Afebrile with normal or slow heart rate despite hypotension, and sparing the sensory nerves
-* 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===
-* Symptoms start 12 to 36 hours after ingestion
+*Symptoms start 12 to 36 hours after ingestion
-* 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
 ===Wound botulism===
-* Incubation period of t to 14 days
+*Incubation period of t 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===
-* Feeding difficulties, hypotonia, drooling, and weak cry
+*Feeding difficulties, hypotonia, drooling, and weak cry
-* Upper airway obstruction may require intubation
+*Upper airway obstruction may require intubation
-* Typically worsens over 1 to 2 weeks, then stabilizes for 2 to 3 weeks, then recovers
+*Typically worsens over 1 to 2 weeks, then stabilizes for 2 to 3 weeks, then recovers
-* Relapses are possible
+*Relapses are possible
 ===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
 {{DISPLAYTITLE:''Clostridium botulinum''}}