1 / 29

Botulism

Botulism. Dr/ Mona M. Awny Assistant lecturer of forensic medicine & clinical toxicology. Food poisoning. Most common bacterial food-borne pathogens: Clostridium botulinum Clostridium perfringens Escherichia coli Staphylococcus aureus Bacillus cereus Vibrio cholera.

chiquita
Télécharger la présentation

Botulism

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Botulism Dr/ Mona M. Awny Assistant lecturer of forensic medicine & clinical toxicology

  2. Food poisoning Most common bacterial food-borne pathogens: • Clostridium botulinum • Clostridium perfringens • Escherichia coli • Staphylococcus aureus • Bacillus cereus • Vibrio cholera

  3. Clostridium botulinum? • Gram +ve anaerobic bacillus that release neurotoxin “Botulin”.

  4. Clostridium botulinum: • Toxin types: • A / B / C alpha / C beta • D / E / F / G • Physical properties: - Spores withstand 100 c for hours. - Toxins are heat-labile and destroyed by boiling for 10 min. or heating at 80 c for 30 min.

  5. Food sources Mainly not exposed to heat: Salted fish “Fesikh” Honey Uncooked cold meat “Beef” Home canned food

  6. BotulismFatal condition caused by ingestion of improperly preserved or canned food Types of Botulism • Food related botulism: Classic botulism and Infant botulism • Wound botulism

  7. Dissemination of toxins • Toxins are distributed to target sites via hematogenous dissemination

  8. Mechanism of action “Neurotoxicity” • Toxins act on the presynaptic part of neuromuscular junctions leading to decreasing the amount of ACH release

  9. Clinical presentation • Symptoms & signs develop within 12 – 36 hrs after ingestion • Severity of disease depends on type of toxin (type A gives most severe picture) • GIT symptoms • Anticholinergic symptoms • Neurological symptoms

  10. Initial vague & GIT symptoms: • Malaise, weakness, dizziness, diplopia & blurred vision • Nausea, vomiting, diarrhea or constipation

  11. Anticholinergic manifestations:

  12. Dry mucous membranes • Markedly dilated pupils & blurred vision • Urinary retention (palpable urinary bladder) • Absent bowel sounds & abdominal distention • Nohyperthermia or tachycardia

  13. Neurological manifestations: • Cranial nerve palsy • Bilateral symmetrical descending flaccid paralysis of: 1. Bulbar musculature 2. Limbs 3. Resp. muscles & diaphragm • No sensory loss • Normal mental status

  14. Cranial nerve palsy

  15. Motor cortex Bulb/brainstem Bulbar musculature Bulbar musculature • Eye movement • M. of facial expression • Speaking & swallowing

  16. Symmetrical descending flaccid paralysis

  17. Diaphragm

  18. No sensory loss • Normal mental status • Death from respiratory failure

  19. Investigations • General tests: • ECG • Abdominal U/S • CSF • Pulmonary function tests • ABG

  20. Investigations • Toxin-specific tests: • C. botulinum toxin or sporesin serum, stool, gastric contents or wound specimens • Electromyography (EMG): • Shows a defect in transmission at the neuromuscular junction

  21. Differential diagnosis • Guillian-Barre syndrome: • Ascending paralysis, ↑CSF protein, normal EMG • Cerebrovascular stroke: • Asymmetric • Poliomyelitis: • Fever & meningeal signs • Anticholinergic poisoning: • Fever & altered mental status

  22. Management • General: • ABC’s (early elective tracheostomy & mechanical ventilation) • Emesis & gastric lavage • Nasogastric suction (ileus) • Foley catheterization (urine retention)

  23. Management • Toxin-specific measures: • Trivalent ABE antiserum • Sensitivity test • Dose:1 vial IM & 1 vial IV • A dose/ 4hrs if serum toxin persists

  24. Follow-up & disposition • Admission to ICU • Monitoring of vital capacity & vital signs • Prolonged hospitalization • Slow recovery • Rehabilitation program • Complete recovery of paralysis takes up to 6 months

  25. Wound botulism • Soil • Symptoms • Wound swab • Antitoxin, debridement, high-dose IV penicillin

  26. Prevention

More Related