Tuesday, 16 November 2010

MRCP revision battle 51.5: Botulism

Botulism is caused by clostridium botulinum (gram positive rod)

The toxin causes a descending flaccid paralysis by binding irreversibly to the presynaptic membranes of the neuromuscular junction, blocking acetylcholine release.

Signs include:
  • flaccid paralysis
  • dysarthria
  • ptosis
  • fixed/dilated pupils
  • dry mouth
  • respiratory arrest

Botulism may be caused by food or by wound infection.  Heroin users are at high risk.
All commericial canned food has to undergo a 'botulum cook' at 121C.
Honey can contain botulum and as a result it is not recommended to give honey to infants under 1 yr of age.

Botulism may cause a false positive tensilon result.

Treatment is with an antitoxin and ITU support.

Next up: hypertrophic cardiomyopathy