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Clostridium botulinum

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Clostridium botulinum 

  • Characteristics
    • Common to all bacteria in Clostridia family
    • Gram + rods
    • Obligate anaerobe
    • Spore-forming
  • Produces heat-labile exotoxin (botulinum)
    • Blocks acetylcholine release in presynaptic neurons
      • Cleaves SNARE proteins involved in neurotransmission
      • This neurotoxin inhibits acetylcholine release from the nerve terminals at neuromuscular junctions and causes a descending flaccid paralysis.
  • Exposure
    • ingestion of preformed toxin in home-canned food in adults
    • ingestion of spores in honey in infants
    • Local botox injections used to treat focal dystonia, achalasia, and muscle spasms
      • Also used for cosmetic reduction of facial wrinkles
  • Presentation: botulism
    • Descending flaccid paralysis in adults
      • Usually begins with cranial nerves and descends down to skeletal muscle
        • Contrast w Guillain-Barre syndrome - ascending paralysis 
      • Absent deep tendon reflexes
      • 4 D’s
        • Diplopia
        • Dysarthria
        • Dysphagia
        • Dyspnea
    • Floppy baby syndrome in infants
      • Constipation, weakness, lethargy, reduced feeding
  • Treatment
    • Treat with human botulinum immunoglobulin