Clostridium botulinum - MegaMicro

1.      Toxin stays at the neuromuscular junction

2.      Toxin cleaves SNARE proteins that release acetylcholine at peripheral cholinergic synapses

3.      Block neurotransmission at these synapses

4.      Ach is necessary for excitation of muscle

5.      Toxin causes a flaccid paralysis

1.      Foodborne

a.       Ingestion of pre formed toxin

2.      Infant

a.       Caused by ingestion of spore which makes toxin in the GI tract

3.      Wound

a.       Spores in the wound

4.      Inhalation

a.       Possibly used as bioterrorism

ii.      Symptoms

1.      Begins 1-3 days post exposure

2.      Symmetric cranial neuropathies

a.       Ptosis or diplopia is one of the first signs

3.      Constipation, abdominal pain

4.      Respiratory dysfunction

5.      Descending flaccid paralysis

6.      In neonates called “Floppy Baby Syndrome”

iii.      Diagnosis:

1.      History and clinical exam

2.      Find Toxin in stool, serum or food

3.      Culture organism from stool, serum, or food

iv.      Differential diagnosis:

a. Other forms of paralysis

b. Guillan-Barre syndrome is and Ascending Paraylysis

                      c. Botulism is a Descending Paralysis -  likely to affect cranial nerves first

v.      Therapy

1.      Requires regeneration of new nerve endings

2.      Antitoxin

3.      Antibiotics

a.       Metronidazole or penicillin

vi.      Prevention and control

1.      Following proper food canning protocol through USDA

2.      Boiling home canned food to destroy toxin

3.      Acid pH and cold temperatures prevent spore formation

4.      Avoid honey in children younger than 1 years old

5.      Clean infected wounds of IV drug users