Botulism

Etiology

  • Toxin produced by Clost Botulinum (GPR)
  • Toxin inhibits (pre-synaptic) ach release at NMJ--> flaccid paralysis

Risk Factors

  • Dirty wounds
  • Bioterrorism
  • Acquired via food (improperly canned)
  • Injection of contaminated black tar heroin (skin popping)
  • Overdose/misplaced injection of cosmetic botox

Symptoms

  • Dysphonia
  • Double vision
  • Blurred vision
  • Acute onset→ 8-36h
  • Affects cranial nerves first and then typically descends
  • Symptoms are usually symmetric
  • Dysphagia, difficulty swallowing secretions
  • SOB/difficulty breathing
  • Abdominal cramps, constipation, urinary retention
  • Degree of symptoms varies with quantity of exposure to toxin

Physical Exam Findings

  • Afebrile
  • Ptosis
  • Abnormal voice
  • Normal mental status
  • Weakness/paralysis starts w/CNs→ spreads symmetrically to limbs
  • Impaired extra-occular movements
  • Sometimes dilated pupils
  • Muscle fatigability, which can be demonstrated by having patient look upwards x 10 sec (brings out ptosis); repeated muscle testing of an affected group (e.g. limb) results in weakness, which improves w/rest
  • With increased muscle weakness, reflexes decrease/disappear
  • No sensory findings