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- Maria A. Carrillo-Marquez, MD*
- *Department of Pediatrics, Pediatric Infectious Diseases Division, University of Tennessee Health Science Center, Memphis, TN.
AUTHOR DISCLOSURE
Dr Carrillo-Marquez has disclosed no financial relationships relevant to this article. This commentary does not contain discussion of an unapproved/investigative use of a commercial product or device.
Practice Gap
Prompt clinical identification of botulism is vital to provide timely therapy to improve patients’ outcomes.
Objectives
After completing this article, the reader should be able to:
Recognize signs and symptoms of botulism and its different clinical syndromes.
Understand the mode of acquisition of botulism and preventive measures.
Understand the epidemiology, risk factors, and management of botulism.
Become familiar with the resources to obtain diagnostic aid and antitoxin, when indicated.
Introduction
Botulism is a rare, severe, and potentially lethal condition caused by the botulinum toxin. It is characterized by symmetric cranial nerve palsy, commonly followed by symmetric, descending, flaccid paralysis of involuntary muscles, which may result in respiratory compromise and death. (1) The sensorium remains intact because the botulism toxin does not cross the blood-brain barrier. (2) Fever is notoriously absent, except in cases complicated with secondary nosocomial infections. (3)
The botulinum toxin, which is recognized as one of the most potent neurotoxins, is produced by a few clostridial species but most commonly by Clostridium botulinum.
There are 4 recognized clinical syndromes: foodborne botulism, wound botulism, infant botulism, and intestinal toxemia. Inhalational botulism could result from aerosolization of botulinum toxin, but it does not occur naturally and has been associated with potential bioterrorism. Iatrogenic botulism can result from injection of the toxin. (1)(4)(5) All forms of botulism exhibit the same distinct neurologic syndrome of symmetric cranial nerve palsy followed by symmetric flaccid paralysis of voluntary muscles with subsequent respiratory compromise.
The mainstays of treatment are early diagnosis, intensive supportive care, and timely botulinum antitoxin administration. As a rare condition, botulism may be challenging for the clinician to recognize, …
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