Botulism with Unusual Rapid Progression to Complete Paralysis in a Child

High risk and low prevalence diseases: Botulism

INTRODUCTION

Botulism is a serious condition that carries with it a high rate of morbidity and mortality.

OBJECTIVE

This review highlights the pearls and pitfalls of botulism, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

Botulism is a neuromuscular disorder caused by toxin production of clostridium species bacteria and is a challenging diagnosis that mimics several other conditions. Children account for the majority of patients, with a foodborne source most common, followed by wound sources, typically from intravenous drug injection. Classically, patients with botulism develop bilateral cranial nerve palsies and symmetric, bilateral, descending paralysis. However, patients may initially present with vague symptomatology, such as weakness and dry mouth, which can make diagnosis challenging. A careful history elucidating exposures such as intravenous drug use or consumption of non-commercial canned products can help differentiate botulism from other disorders causing neuromuscular weakness. If suspected, the Centers for Disease Control should be notified to mobilize antitoxin for treatment as soon as the diagnosis is suspected even prior to confirmatory testing. Antibiotics should be avoided in these patients, as they can potentiate toxin release, unless there is a concomitant infection requiring antibiotic therapy. Patients with botulism can develop respiratory compromise requiring emergent airway management. Prolonged neuromuscular blockade from botulism will lead to a variety of symptoms that require comprehensive intensive care unit level care.

CONCLUSION

An understanding of botulism and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.

The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey

Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.

Infant botulism: review and clinical update

Botulism is a rare neuromuscular condition, and multiple clinical forms are recognized. Infant botulism was first identified in the 1970s, and it typically occurs in infants younger than 1 year of age who ingest Clostridium botulinum spores. A specific treatment for infant botulism, intravenous botulism immunoglobulin (BIG-IV or BabyBIG®), was developed in 2003, and this treatment has substantially decreased both morbidity and hospital costs associated with this illness. This article will review the pathogenesis of infant botulism as well as the epidemiology, clinical manifestations, diagnosis, and treatment of this condition.