Upload
alana-saldana
View
955
Download
4
Embed Size (px)
DESCRIPTION
Case study involving Clostridium botulinum
Citation preview
Case STUDYAlana Saldana
Patient
A six month old male
3 day history of increasing hypotonia
1 day history of dehydration
4 week history of constipation
3 day history of decreased suck while breastfeeding with decreased intake of fluids
2 day history of generalized weakness with decreased movement and difficulty sitting up
Trouble with gurgling in the back of the throat, very poor head control, and increased floppiness
Physical examination
Generalized hypotonia
Head lag
Dehydration
Cerebrospinal fluid was normal
Treatment
Admitted to PICU
Intubated because of increasing respiratory difficulty
Extubated on day 7
Discharged on day 11
What is the clinical condition of this child?
This patient has infant botulism
Rare
Infant Botulism
Clinical manifestations are attributed to sepsis, CNS infections, or more esoteric diagnoses
Guillain-Barre syndrome
Inborn errors of amino acid metabolism
Characterized by descending paralysis
Initial signs:
Constipation
Poor suck
Increasing hypotonia
What is the organism causing this condition?
The patient is infected with Clostridium botulinum
Clostridium botulinum
Gram positive bacillus
Obligate anaerobe
Sporeformer
Produces a neurotoxin called botulinum toxin
The most potent biologic toxin known to mankind
One billionth of a gram can paralyze a person
There are seven different types of botulinum toxin designated A to G
Types A, B, and E are responsible for human disease
Clostridium botulinum
Most commonly seen form of botulism in the U.S.
Highest incidences of disease are seen in California and in the Delta Valley area of Pennsylvania and New Jersey
Toxin A producing strains are the predominant type found in soil in California
Toxin B producing strains are the predominant type found east of the Mississippi River
Clostridium botulinum
This disease occurs sporadically
No outbreaks of infant botulism have been reported
Spores are ingested either in foodstuffs or from dust
Honey and corn syrup
Produces toxin in the GI tract which is absorbed into the blood stream and binds to the presynaptic nerve endings
Laboratory Diagnosis
Routine lab tests are not helpful
Initial diagnosis is based on clinical symptoms
Treatment should not wait for laboratory confirmation
Two step process
Direct toxin analysis
Extraction of toxin directly
from the fecal specimen
Culture the specimen
Treatment
Antitoxin
Call state health department’s emergency number
State health department contacts CDC to report suspected botulism case
Clinical consultation by telephone between the treating physician and the CDC
Request release of botulinum antitoxin
Mechanical ventilatory support is essential
Death is due to respiratory arrest
Why is there increased concern about this organism among governmental agencies such as the Department of Defense, the Centers for Disease Control, and the Federal Bureau of Investigation
Concern continued
Potential weapon of bioterrorists
Botulinum toxin has been weaponized by several countries
During the Gulf War, missels with warheads containing botulinum toxin were reported to have been produced by Iraq
In crude form, this toxin is easily produced
Toxin enters the bloodstream following inhalation, it is possible to deliver this agent through aerosol
1 or 2 grams of botulinum put into a city’s water supply could kill 50% of the population
References
Gilligan, P. H., Smiley, L. M., & Shapiro, D. S. (2003). Cases in medical microbiology and infectious disease. (3rd ed.). Washington D.C.: ASM Press
Bhargava, Pushpa M. (2008). The Growing Planetary Threat from Biological Weapons and Terrorism. India: The Tribune