BotulismandTetanus.docVIP

Causative organisms Clostridium botulinum Gram positive bacilli Spore producing Produced under anaerobic conditions Botulinum toxin: Mechanism of action at presynaptic nerve terminals2 Overall action: Blocks neurotransmitter release of acetylcholine at peripheral cholinergic nerve terminals arresting their function. Neuromuscular junction Autonomic nerve terminals: Sympathetic Parasympathetic Botulism: Clinical features Time course Incubation period: Average: 18 to 38 hours Extremes: 2 hours to 1 week Weakness Diffuse; Usually symmetric; Proximal Distal Bulbar: Dysphagia; Dysarthria Extraocular: Ptosis; Extraocular muscle weakness Sensory loss: Never prominent Tendon reflexes Reduced ? Less involved with type E Autonomic Cholinergic Pupils Dilated Blurred vision Many, but not all, patients Bradycardia Hypotension Skin: Hypohydrosis Urinary retention Gastrointestinal Nausea vomiting associated with contaminated food Constipation: Frequently first sign, especially in infants; Common late Diarrhea may occur early Botulism: Prevention Canning or preserving foods with appropriate heat, pressure, low pH Spores Survive 2 hr at 100 °C Inactivated at 120 °C Boiling food before canning at high elevations may not inactivate the spores Factors favoring spore germination: Low acidity (pH 5.0); Low O2; High water content Toxin: Inactivated after 1 minute at 85 °C, or 5 minutes at 80 °C Avoid exposure of infants to honey (may contain Clostridium botulinum spores) Botulinum intoxication: No immunity from subsequent episodes Immunization Pentavalent toxoid Used only for high risk personnel: Laboratory workers; Military Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, to the throat, chest and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhib