Botulism Information - symptom, cause, picture, treatment of
The toxin of Clostridium botulinum prevents the release of acetylcholine at neuromuscular junctions and autonomic synapses. Botulism occurs most commonly following the ingestion of contaminated home-canned food and should be suggested by the development of sudden, fluctuating, severe weakness in a previously healthy person. Symptoms begin within 72 hours following ingestion of the toxin and may progress for several days. Typically, there is diplopia, ptosis, facial weakness, dysphagia, and nasal speech, followed by respiratory difficulty and finally by weakness that appears last in the limbs. Blurring of vision (with unreactive dilated pupils) is characteristic, and there may be dryness of the mouth, constipation (paralytic ileus), and postural hypotension. Sensation is preserved, and the tendon reflexes are not affected unless the involved muscles are very weak. If the diagnosis is suspected, the local health authority should be notified and a sample of serum and contaminated food (if available) sent to be assayed for toxin. Support for the diagnosis may be obtained by electrophysiologic studies; with repetitive stimulation of motor nerves at fast rates, the muscle response increases in size progressively.
Patients should be hospitalized in case respiratory assistance becomes necessary. Treatment is with trivalent antitoxin, once it is established that the patient is not allergic to horse serum. Guanidine hydrochloride (25–50 mg/kg/d in divided doses) to facilitate release of acetylcholine from nerve endings sometimes helps to increase muscle strength. Anticholinesterase drugs are of no value. Respiratory assistance and other supportive measures should be provided as necessary. Further details are provided in Infectious Diseases: Bacterial & Chlamydial.