Clostridium botulinum: Difference between revisions

Revision as of 22:14, 16 June 2020

Background

Microbiology

Gram-positive anaerobic bacillus with a subterminal spore
Produces seven toxin types, A through G

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

@@ Line 1: / Line 1: @@
+==Background==
-== Clinical Presentation ==
+===Microbiology===
+* Gram-positive anaerobic bacillus with a subterminal spore
+* Produces seven toxin types, A through G
+==Pathophysiology==
-* Typically involves symmetric descending paralysis, starting with cranial nerves and often involving respiratory muscles
+* Botulinum toxins are zinc-dependent metalloproteinases, and inhibit the release of acetylcholine from the presynaptic neuron
+==Clinical Presentation==
-=== Foodborne botulism ===
+* 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
-=== Wound botulism ===
+===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
-=== Infant botulism ===
+===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===
-=== Adult intestinal toxemia ===
+* 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===
 {{DISPLAYTITLE:''Clostridium botulinum''}}