Leave a comment

Botulinum

Botulinum

Diagnosis

1.
Bulbar palsies i.e. blurred vision due to mydriasis, diplopia, ptosis, dysarthria, dysphonia, and dysphagia prominent early

2.
Generalized weakness, dizziness, dry mouth and throat, constipation, urinary retention

3.
Flaccid descending, symmetrical paralysis and development of respiratory failure

4.
Suspect biowarfare if multiple casualties present with progressive descending bulbar, muscular, respiratory weakness

5.
Mouse neutralization (bioassay) most sensitive test
History

1.
Researched by Iraq in 1991

2.
Weaponized & deployed in over 100 munitions in 1995 by Iraq
Pathophysiology

1.
Botulinum toxins, 7 neurotoxins, produced by Clostridium botulinum

2.
Block acetylcholine release

3.
Aerosol inhalation or foodborne

4.
Symptoms in 24-36 hrs

5.
Infective dose: 0.001 mcg/kg

6.
Incubation: 1-5 d

7.
Duration: death in 24-72 hrs if lethal

8.
Lethality: high without respiratory support

9.
Stable for wks in non-moving water & food
Prevention

1.
DOD pentavalent toxoid for serotypes A-E: 0.5 ml SQ at 0, 2 & 12 wks; yrly boosters

2.
CDC carries large quantity of antitioxin
Isolation/Decontamination

1.
Standard precautions for healthcare workers

2.
Toxin not dermally active

3.
Hypochlorite (0.5% for 10-15 mins) and/or soap and water
Treatment

1.
Skin testing for horse serum sensitivity prior to antitoxin

2.
DOD heptavalent equine antitoxin for serotypes A-G: 10 ml IV

3.
CDC trivalent equine antitoxin for serotypes A, B, E

4.
Ventilatory support due to resp failure
Disposition

1.
Admit

2.
Intensive & prolonged nursing care for wks to mths

3.
Notify CDC & local health dept

* Material is taken from the PEPID database
* Copyrighted material – All Rights Reserved
* For more information visit http://www.pepid.com

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: