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Case presentation- Botulism

Case presentation- Botulism. Agatha Stanek. Case presentation. Mother rushes into ER with her 3 ½ month old infant who is very weak Reports constipation, loss of head control, and loss of suck Also notice loss of facial expression and verbalization. Patient hx. Medical hx

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Case presentation- Botulism

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  1. Case presentation- Botulism Agatha Stanek

  2. Case presentation Mother rushes into ER with her 3 ½ month old infant who is very weak Reports constipation, loss of head control, and loss of suck Also notice loss of facial expression and verbalization

  3. Patient hx Medical hx full- term infant from uncomplicated pregnancy and delivery Immunizations? No known allergies yet

  4. Family hx • Healthy parents • Uncle had Guillain-Barre syndrome • Maternal grandmother died from breast cancer Social Hx • Mother is on maternity leave from being a teacher at a nearby elementary school but was staying with sister for a few days; father is an engineer • Have a 16 year-old babysitter watching the infant twice a week • Live in downtown Ottawa core in a townhouse

  5. Physical Exam • .... Diet: • Child is still being breast- fed • Pureed food- fruits • Honey (from babysitter) mother called sitter while talking to you

  6. Differential Diagnosis?

  7. Laboratory tests • Check for hypokalemia • CSF- differentiate from Guillain- Barre • Blood, feces, suspected food and containers

  8. Diagnostic Procedures • Electromyogram: low voltage compound motor- unit, small amplitude, overly abundant action potentials, incremental response to repetitive stimulation

  9. Special Tests • Stool sample- contains organism, toxin

  10. Diagnosis? • Infantile botulism. • Define: • Paralytic disease caused by neurotoxins of Clostridium botulinum. • Mechanism? Prevents acetylcholine release at presynaptic membranes, thus blocking neuromuscular transmission in cholinergic nerve fibers.

  11. Treatment • Inpatient care- monitor respiratory failure in particular General measures: Airway management Monitor pulmonary function Physical therapy- motion exercise

  12. Treatment cont’d • Surgical measures Wound excision debridement Activity: bed rest initially Diet: Nasogastric feedings, restrict fluids if? Pressure cooking for 30 min at 120 C or boil or cook food for at least 10 min. Avoid honey in the first year of life!

  13. Medications • Enemas may assist in removal of toxins (release of toxins in the gut may worsen symptoms of infantile botulism by bacterial lysis)

  14. Follow-up • Monitor cardiorespiratory systems during illness Prevention and Avoidance - Do not give honey to infants, or eat food from bulging cans, off-smelling food

  15. Possible complications • Aspiration pneumonia • Nosocomial infection • Hypoxic tissue damage • Death

  16. Prognosis • Mortality is <10% • Extended recovery period and sequelae as above

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