Botulism

Question 1

What causes botulism?

Answer 1

Clostridium botulinum, due to the release of neurotoxin which irreversibly blocks the release of acetycholine

Question 2

What are the risk factors for botulism?

Answer 2

• can be food-borne - particularly home-preserved foods
• from wound contamination: IVDU, biological weapons

Question 3

What are the most common group of patients who present with botulism?

Answer 3

intravenous drug users

Question 4

What is the presentation of botulism?

Answer 4

• fully conscious with no sensory disturbance
• present with visual disturbance and dysphagia
• progress to descending weakness and flaccid paralysis
• respiratory failure in some cases

Question 5

How is a diagnosis of botulism made?

Answer 5

detection of toxin in serum, urine, stool or gastric fluid/vomit

Question 6

What is the management of botulism? 2 aspects

Answer 6

1. Supportive management
2. Use of botulinum antitoxin

Question 7

What type of bacteria is Clostridium botulinum?

Answer 7

gram positive anaerobic bacillus

Question 8

How many serotypes of Clostridium botulinum are there and what are they?

Answer 8

7, A-G

Question 9

Which 2 aspects of the nervous/muscular system are most affected by botulinum toxin?

Answer 9

• bulbar muscles
• autonomic nervous system

Question 10

When is antitoxin only effective?

Answer 10

only effective if given early; once toxin has bound its actions cannot be reversed

Question 11

What are common adverse reactions to the botulinum antitoxin?

Answer 11

20% experience hypersensitivity reactions, including serum sickness and anaphylaxis

Question 12

How long does recovery from botulism take?

Answer 12

weeks to months

Question 13

What is the fatality rate of botulism?

Answer 13

5-10%

Question 14

What are 7 clinical features of botulism?

Answer 14

1. visual disturbance e.g. diplopia
2. dysphagia
3. bulbar palsy
4. descending weakness
5. flaccid paralysis
6. ataxia
7. respiratory failure