Case presentation- Botulism

Agatha Stanek

Case presentation•Mother rushes into ER with her 3 ½ month old infant who is very weak•Reports constipation, loss of head control, and loss of suck •Also notice loss of facial expression and verbalization

Patient hx

Medical hxfull- term infant from uncomplicated pregnancy

and deliveryImmunizations?

No known allergies yet

Family hx

• Healthy parents• Uncle had Guillain-Barre syndrome• Maternal grandmother died from breast cancer

Social Hx• Mother is on maternity leave from being a teacher at a

nearby elementary school but was staying with sister for a few days; father is an engineer

• Have a 16 year-old babysitter watching the infant twice a week

• Live in downtown Ottawa core in a townhouse

Physical Exam

• ....

Diet:• Child is still being breast- fed• Pureed food- fruits• Honey (from babysitter) mother called sitter while

talking to you

Differential Diagnosis?

Laboratory tests

• Check for hypokalemia• CSF- differentiate from Guillain- Barre• Blood, feces, suspected food and containers

Diagnostic Procedures

• Electromyogram: low voltage compound motor- unit, small amplitude, overly abundant action potentials, incremental response to repetitive stimulation

Special Tests

• Stool sample- contains organism, toxin

Diagnosis?

• Infantile botulism.

• Define:- Paralytic disease caused by neurotoxins of Clostridium

botulinum.

- Mechanism?Prevents acetylcholine release at presynaptic

membranes, thus blocking neuromuscular transmission in cholinergic nerve fibers.

Treatment

• Inpatient care- monitor respiratory failure in particular

General measures:Airway managementMonitor pulmonary functionPhysical therapy- motion exercise

Treatment cont’d

• Surgical measuresWound excision debridement

Activity: bed rest initially

Diet: Nasogastric feedings, restrict fluids if?Pressure cooking for 30 min at 120 C or boil or cook food

for at least 10 min. Avoid honey in the first year of life!

Medications

• Enemas may assist in removal of toxins (release of toxins in the gut may worsen symptoms of infantile botulism by bacterial lysis)

Follow-up

• Monitor cardiorespiratory systems during illness

Prevention and Avoidance- Do not give honey to infants, or eat food from

bulging cans, off-smelling food

Possible complications

• Aspiration pneumonia• Nosocomial infection• Hypoxic tissue damage• Death

Prognosis

• Mortality is <10%• Extended recovery period and sequelae as

above