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1. Toxin stays at the neuromuscular junction2. Toxin cleaves SNARE proteins that release acetylcholine at peripheral cholinergic synapses3. Block neurotransmission at these synapses4. Ach is necessary for excitation of muscle5. 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 bioterrorismii. Symptoms
1. Begins 1-3 days post exposure2. Symmetric cranial neuropathies
a. Ptosis or diplopia is one of the first signs
3. Constipation, abdominal pain4. Respiratory dysfunction5. Descending flaccid paralysis6. In neonates called “Floppy Baby Syndrome”iii. Diagnosis:1. History and clinical exam2. Find Toxin in stool, serum or foodiv. Differential diagnosis:3. Culture organism from stool, serum, or food
a. Other forms of paralysisb. Guillan-Barre syndrome is and Ascending Paraylysis
c. Botulism is a Descending Paralysis - likely to affect cranial nerves first
v. Therapy1. Requires regeneration of new nerve endings2. Antitoxin3. Antibiotics
a. Metronidazole or penicillin
vi. Prevention and control1. Following proper food canning protocol through USDA2. Boiling home canned food to destroy toxin3. Acid pH and cold temperatures prevent spore formation4. Avoid honey in children younger than 1 years old5. Clean infected wounds of IV drug users