BOTULISM

• Botulism


  Rare but severe form of poisoning caused by a gram-positive, anaerobic bacteria
• Botulism


  • Illness of descending paralysis and autonomic dysfunction due to a neurotoxin
• Causative Agent


  Clostridium Botulinum
• Types of Botulism


  • Foodborne Botulism
  • Wound Botulism
  • Infant Botulism
• Sources of Infection


  • Untreated water
  • Undercooked and improperly preserved canned foods, especially those with a low acid content
  • Home-canned vegetables
  • Cured pork and ham
  • Smoked or raw fish
  • Honey and corn syrup
• Mode of Transmission


  Ingestion (or injection) of preformed toxin<|>Spores may resist 100 degree Celsius for many hours<|>Inhalation of toxin may also cause disease<|>Introduction of spores into the wound
• Incubation Period


  12 to 72 hours but extremes of 2 hours to 10 days are reported
• Clinical Manifestations


  • Double or blurred vision
  • Droopy eyelids
  • Dry mouth
  • Difficulty swallowing and talking
  • Difficulty breathing
  • Flaccid paralysis (descending)
  • Deep tendon reflexes are decreased or absent
  • Initial vomiting or diarrhea followed by constipation
• Diagnostic Tests


  • Toxicity screen may identify C. botulinum
  • Stool culture may identify C. botulinum
  • The suspected food may also be cultured to isolate C. botulinum
  • Electromyography will show little response to nerve stimulation
  • Mouse-inoculation test will be positive
• Diagnostic tests should be conducted as needed to rule out diseases that may be confused with botulism, such as myasthenia gravis and Guillain-Barre syndrome
• Complications


  • Aspiration
  • Weakness and nervous system problems can be permanent
  • Death
• Treatment Modalities


  • Botulinus antitoxin- IV, IM
  • Infants-inducing vomiting or giving an enema
  • IV fluid can be administered
  • Nasogastric tube
  • Endotracheal intubation - respiratory distress
• Nursing Considerations


  • Obtain a careful history of foods eaten in the past several days
  • Monitor respiratory and cardiac function carefully
  • Perform frequent neurologic checks
  • Purge the GI tract as ordered
  • If giving the botulinus antitoxin, check the patient's allergies, perform a skin test first
  • Educate the patient and family about the importance of proper hand hygiene
  • Teach the patient and family to cook food thoroughly before ingesting
  • Instruct the patient who eats home canned food to boil the food for 10 minutes before eating to ensure that it is safe to consume
  • Teach patient and families to see their doctors promptly for infected wounds and to avoid injectable street drugs
• Suggested on-call action


  • Ensure that the case is admitted to hospital
  • Obtain food history as a matter of urgency
  • Obtain suspect foods
  • Identify others at risk
  • Inform appropriate local and national authorities