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General Medicine

Botulism

Tyler R. Reese, MD and Nicholas C. DeStefano, MD Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A paralytic illness caused by a neurotoxin produced by the anaerobic bacterium Clostridium botulinum

  • Characterized by acute onset of cranial nerve dysfunction (diplopia, difficulty sw...

DIAGNOSIS

HISTORY

  • Adults

    • Acute onset of cranial nerve dysfunction

    • IV drug use, skin-popping, or cocaine use (wound botulism)

    • Retains normal mental state; no fever or sensory dysfunction

  • Infant botulism: Pr...

TREATMENT

MEDICATION

First Line

  • Antitoxin therapy with trivalent A-B-E antitoxin (4)[A]

    • Initiate botulinum antitoxin therapy based on symptoms and physical examination findings.

    • Early administration is im...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Outpatient follow-up with physical/occupational therapy, nutrition specialist, and psychiatry, as needed 

Patient Monitoring

  • Pulmonary function testing

  • Cardiorespira...

REFERENCES

1
Centers for Disease Control and Prevention. Botulism facts for healthcare providers. http://www.bt.cdc.gov/agent/Botulism/clinicians/epidemiology.asp. Accessed July 11, 2015.
2
Centers for D...

ADDITIONAL READING

Hill SE, Iqbal R, Cadiz CL, et al. Foodborne botulism treated with heptavalent botulism antitoxin. Ann Pharmacother.  2013;47(2):e12. 

SEE ALSO

Food Poisoning, Bacterial 

CODES

ICD10

  • A05.1 Botulism food poisoning

  • A48.52 Wound botulism

  • A48.51 Infant botulism

ICD9

  • 005.1 Botulism food poisoning

  • 040.42 Wound botulism

  • 040.41 Infant botulism

SNOMED

  • 398565003 Infection due to clostrid...

CLINICAL PEARLS

  • Botulism is diagnosed primarily on clinical suspicion.

  • Administer botulinum antitoxin as soon as disease is clinically suspected.

  • Contact state health authorities to report suspected cas...

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Clostridial diseases. Clostridia in the vegetative form inhabit the gastrointestinal tract of humans and animals. Spores pass in the feces, contaminate soil and plant materials, and are ingested or enter sites of penetrating wounds. Under anaerobic conditions they revert to vegetative forms. Plasmids in the vegetative forms elaborate toxins that cause several clostridial diseases. Food poisoning and necrotizing enteritis. Meat dishes left to cool at room temperature grow large numbers of cl...
Clostridial diseases. Clostridia in the vegetative form inhabit the gastrointestinal tract of humans and animals. Spores pass in the feces,...
Figure 15-20 Mechanisms of bacterial enterocolitis. Diarrhea can be caused by (A) bacterial toxin formed in food before ingestion, (B) toxin formed in the intestinal tract after infection, or (C) direct invasion of infective organisms in the bowel wall.
Figure 15-20 Mechanisms of bacterial enterocolitis. Diarrhea can be caused by (A) bacterial toxin formed in food before ingestion, (B) toxi...
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