Botulism
Botulism Complications
Botulism can lead to death due to respiratory failure. However, in the past 50 years, the proportion of patients with botulism who die has fallen from about 50% to 8% due to improved treatment and supportive care. A patient with a severe case of botulism may require a breathing machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid them in their recovery. Infant botulism has no long-term side effects, but can be worsened by nosocomial adverse events. The fatality rate is less than 1% for hospitalized infants with botulism.
Botulism Definition
Botulism (from the Latin word, botulus, meaning "sausage") is a rare, but serious paralytic illness caused by a toxin, botulin, that is produced by the bacteria Clostridium botulinum. Botulinic toxin is one of the most powerful known toxins: about one microgram is deadly to humans. It acts by blocking nerve function and leads to respiratory and musculoskeletal paralysis to the individual.
Botulism Symptoms and Signs
Normal symptoms of food-borne botulism usually occur between 12?36 hours after ingesting the botulinum toxin. However, they can occur as early as 6 hours or as late as 10 days after consumption. Wound botulism has a much longer incubation period, usually between 4?14 days. Normal symptoms usually include dry mouth, difficulty swallowing, drooping eyelids, double or blurred vision, muscle weakness, difficult breathing, slurred speech, vomiting, bladder and sometimes diarrhea. These symptoms may continue to result to paralytic ileus with severe constipation, and will lead to body paralysis. The respiratory muscles are affected as well, which may cause death which results from respiratory failure. These are all symptoms of the muscle paralysis that the bacterial toxin causes. In all cases illness is caused by the toxin produced by C. botulinum, not because of the bacterium itself. The pattern of damage occurs due to the toxin affecting nerves that are firing more often.
Botulism Treatment
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine for long periods of time, plus intensive medical and nursing care. After several weeks, the paralysis gradually improves. If diagnosed early, foodborne and wound botulism can be treated by inducing passive immunity with a horse-derived antitoxin, which hinders the action of toxin circulating in the blood. This can prevent patients from becoming worse, but recovery still takes many weeks. Physicians may try to remove contaminated food still inside the gut by inducing vomiting or by using enemas. Wounds should be treated, typically surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all types of botulism.