RT Book, Section
A1 Rao, Agam K.
A1 Maslanka, Susan
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1155966540
T1 Botulism
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1155966540
RD 2024/04/17
AB Botulism,  recognized  at  least  since  the  eighteenth  century,  is  a  neuroparalytic  disease  caused  by  botulinum  toxin,  one  of  the  most  toxic  substances  known.  While  initially  thought  to  be  caused  only  by  the  ingestion  of  botulinum  toxin  in  contaminated  food  (food-borne  botulism),  three  additional  forms  caused  by  in  situ  toxin  production  after  germination  of  spores  in  either  a  wound  or  the  intestine  are  now  recognized  worldwide:  wound  botulism,  infant  botulism,  and  adult  intestinal-colonization  botulism.  In  addition  to  occurring  in  these  recognized  natural  forms  of  the  disease,  botulism  symptoms  have  been  reported  in  patients  receiving  higher  than  recommended  doses  of  botulinum  toxin  (iatrogenic  botulism)  for  therapeutic  or  cosmetic  purposes.  Moreover,  botulism  was  once  reported  after  possible  inhalation  of  botulinum  toxin  in  a  laboratory  setting.  Botulism  manifests  as  a  clinical  syndrome  of  bilateral  cranial-nerve  palsies  that  may  progress  to  respiratory  compromise,  a  descending  bilateral  flaccid  paralysis  of  voluntary  muscles,  and  even  death.  Patients  exposed  to  the  same  contaminated  food  may  have  a  varying  constellation  of  cranial  nerve  palsies  and  varying  illness  severity.  Cases  are  known  to  be  misdiagnosed  or  suspected  late  in  a  hospital  course.  The  mainstays  of  therapy  are  meticulous  intensive  care  and  treatment  with  antitoxin  early  in  the  clinical  course  while  alternative  diagnoses  are  still  being  worked  up.  Early  suspicion  of  botulism  and  empirical  treatment  are  critical  to  favorable  clinical  outcomes.