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At least 145 records · Page 8Linked to original sources
PubMed2005

Acute paralysis following "a bad potato": a case of botulism.

PURPOSE: Intensivists often encounter patients with respiratory failure as a result of neuromuscular disease, however, acute neuro-muscular syndromes are less common. We present a case of food borne Clostridium botulism and discuss the diagnostic and therapeutic considerations. CLINICAL FINDINGS: A 35-yr-old healthy male presented with abdominal pain and blurred vision 12 hr after ingesting a "bad" potato. During the next 17 hr, the patient demonstrated a gradual descending paralysis which ultimately resulted in no cranial nerve function and 0/5 strength in all extremities. Sensation was intact. The patient required intubation and mechanical ventilation. His blood count, biochemical profile, computerized tomography and magnetic resonance imaging of the head were normal. A lumbar puncture revealed no abnormalities. Due to the rapid deterioration and presentation of 'descending' paralysis, botulism was suspected. The patient was treated empirically with botulinum anti-toxin. Samples of blood, stool and gastric contents were cultured for the presence of Clostridium botulinum and its toxin and these tests were positive for botulinum toxin A 12 days later. The patient's neuromuscular function gradually improved over a prolonged period of time. Six and one-half months after his initial presentation, the patient was discharged home after completing an aggressive rehabilitation program. CONCLUSIONS: Botulism is a rare syndrome and presents as an acute, afebrile, descending paralysis beginning with the cranial nerves. If suspected, botulinum anti-toxin should be considered, particularly within the first 24 hr of onset of symptoms. Confirmation of the presence of botulinum requires days therefore the diagnosis and management rely on history and physical examination.

Acute Disease↗
PubMed2005

[Botulism caused by consumption of smoked salmon].

Fresh fish products are exquisitely prone to be the source for food botulism because of primary contamination with Clostridium botulinum spores, lack of heat inactivation of C. botulinum spores, frequently used air-tight packaging, lack of preservatives, lack of heat inactivation of already produced botulinum toxin and because of substantial low temperature resistance of C. botulinum type E typically found in fish botulism. We can reporting a 25-year-old patient with food botulism presenting with an anticholinergic syndrome with mydriasis, accommodation difficulties, dryness of mouth, reduced sweating, constipation and reduced heart rate variance and only discrete involvement of striate muscles with ptosis, diplopia and generalised fatigue, all of which developed 12 h after the consumption of airtight sealed smoked salmon. The salmon was consumed 3 days after the 'use by' date had expired.

Adult↗
PubMed2000

[Descending paralysis caused by wound botulism. A case report].

We report on the history and clinical findings of an injecting drug abuser in the Canton of Zurich who presented with multiple deep abscesses in the arms and legs. A diagnosis of wound botulism was made based on his clinical presentation with a rapidly progressing descending paralysis starting at the cranial nerves, a neuromuscular junction disorder on neurophysiologic testing, and normal findings on lumbar puncture. Several cases of wound botulism have occurred in i.v. drug abuse in Switzerland since 1997. We suspect subcutaneous injections of contaminated heroin containing Clostridium spores as sites of entry. Wound botulism caused by Clostridium botulinum is a rare cause of rapidly progressing, generalized, flaccid paralysis and should be considered in patients with a history of i.v. drug abuse presenting with descending paralysis.

Adult↗
PubMed2002

A case if infant botulism due to neurotoxigenic Clostridium butyricum type E associated with Clostridium difficile colitis.

Reported here is the sixth case of intestinal toxemia botulism caused by Clostridium butyricum type E in Italy since 1984. In this case, the patient was concomitantly affected with colitis due to Clostridium difficile toxin. A review of previously reported cases revealed that some of these patients may also have had intestinal toxemia botulism associated with Clostridium difficile colitis, based on the reported symptoms. Given that this association has been shown to exist not only in Italy but also in the USA, it is recommended that individuals with intestinal botulism and symptoms of colitis undergo testing for Clostridium difficile and its toxins in fecal samples.

Anti-Bacterial Agents↗
PubMed2003

Nine cases of foodborne botulism type B in France and literature review.

Presented here is an outbreak of nine cases of type B botulism that occurred in France in 2000 followed by a review of the relevant literature. The outbreak resulted from the consumption of home-canned asparagus and required the intubation of six patients. Despite complications, all patients recovered completely. Specific antitoxin treatment was not administered because it is no longer manufactured in France. The literature review covers the epidemiologic data reported from Europe and the USA to date and an assessment of the treatment options for botulism. The usefulness of establishing a European network to provide access to botulism antitoxins is discussed. Although their efficacy is not unanimously accepted, they remain the only specific treatment now known.

Adult↗
PubMed2003

Botulism type B presenting as pure autonomic dysfunction.

Botulism nowadays is a rare mostly food-borne disease caused by the toxin of Clostridium botulinum. On the other hand, botulinum toxin blocking cholinergic transmission has become a most powerful treatment option for many focal movement disorders and is increasingly used to treat autonomic disorders [2, 7, 8]. Although muscle weakness is the hallmark of botulism, autonomic dysfunction may be the leading clinical symptom in rare cases and should be included in the differential diagnosis of pure dysautonomia. Here, we describe a patient with autonomic dysfunction as the leading symptom of botulism type B.

Adult↗
PubMed2005

[A case of type A botulism].

The neurotoxin produced by Clostridium botulinum, is responsible for botulism. The clinical signs are digestive disorders, pupillar alterations, and peripheral muscular weakness. The failure of thoracic muscles is responsible for the severity of botulism. We describe a case of a 74 year old woman who presented a severe form of botulism, requiring a prolonged intensive care unit stay.

Aged↗
PubMedDate not supplied

Clostridium botulinum and the ophthalmologist: a review of botulism, including biological warfare ramifications of botulinum toxin.

The anaerobic bacterium Clostridium botulinum causes disease by elaborating an extremely potent neurotoxin that inhibits release of acetylcholine at presynaptic nerve endings, thereby resulting in a descending flaccid paralysis and autonomic nervous system dysfunction. Possible ophthalmological effects of this neurotoxin are many and typically constitute the earliest manifestations of botulism. This review summarizes the medical literature on botulism with regard to historical perspective, epidemiology, clinical manifestations, and treatment. Ophthalmological findings of botulism are tabulated and their frequencies are provided. Finally, the bioterrorism/biologic warfare ramifications of botulinum toxin are briefly discussed.

Biological Warfare↗
PubMed1975

A continuing common-source outbreak of botulism in a family.

In December, 1974, three cases of botulism occurred in a family; two were fatal. The first patient died after a 10-day illness without botulism being suspected. 4 days later, after a 2-day illness, the second patient was diagnosed as having botulism after a cardiorespiratory arrest; she died 3 days later. In the third patient, the only symptom was dysphagia. Clostridium botulinum type B was found in stool specimens from all three patients. Home-canned (bottled) mushrooms, which were found to contain C. botulinum type B and its toxin, were believed to be responsible for the outbreak; mushrooms were found at necropsy in the gastrointestinal tracts of both patients who died. Heat treatment of the mushrooms during canning had been inadequate.

Adult↗
PubMed1997

Botulism.

Equine botulism is being recognized with increasing frequency by veterinarians throughout North America. Muscular weakness and dysphagia that progress during a period of 1 to 4 days, in the absence of laboratory derangements that indicate the presence of systemic disease, are suggestive of botulism. A tentative diagnosis usually is based on the presence of the following findings on physical examination: delayed pupillary light response, mydriasis, ptosis, generalized weakness, decreased tail tone, and slow prehension of feed. Definitive diagnosis requires detection of botulinum toxin in plasma, serum, gastrointestinal contents, or body tissues. Early treatment with antitoxin generally results in a favorable outcome. Botulism in foals and adult horses can be prevented by vaccination.

Animals↗
PubMed2005

[Foodborne botulism, epidemiologic aspects].

With a mean of 30 cases reported per year, following Italy, France ranks second in the European countries in terms of incidence of botulism. Food stuff of commercial origin, of artisanal or industrial manufacture fabrication, is increasingly implicated in the genesis of outbreaks of botulism. Moreover, the modern methods of conserving food (vacuum packed food, frozen food...) allow the development of Clostridium bacteria. The diversification of the risks related to the type of products incriminated and to the new conservation methods, associated with the extension of commercial exchanges, result in the risk of widespread internationally outbreaks of botulism.

Botulism↗
PubMed2000

Biphasic course of infant botulism.

The syndrome of infant botulism, characterized by constipation, poor feeding, hypotonia, poor head control, and bulbar involvement, is typically a monophasic disease. We describe a 7-month-old infant with a recurrence of illness 13 days after resolution of the presenting signs. The source of infection was unknown and the only potential risk factors were exclusive breastfeeding and decreased bowel movements, which by themselves cannot explain the recurrence. Although treatment with botulism immunoglobulin is now suggested for the acute phase of infantile botulism, its use for recurrence is controversial.

Botulism↗
PubMed2001

[Type B botulism: a family outbreak].

CASE REPORTS: Three cases of an outbreak of familial foodborne botulism are reported. The food incriminated could not be identified despite a careful investigation into the food history of the patients. The outcome was good following endotracheal ventilation and botulism antitoxin trivalent therapy. CONCLUSION: In France, foodborne botulism is an uncommon public health disease, and with a good prognosis when the diagnosis is promptly performed. The value of emergency electromyographic findings is emphasized, particularly when the repetitive stimulation of the motor nerve shows a presynaptic block of neuromuscular transmission. Management depends on the symptomatology, and trivalent antitoxin therapy is the only specific treatment.

Adult↗
PubMed2003

Considering the antimicrobial sensitivity of the intestinal botulism agent Clostridium butyricum when treating concomitant infections.

In Italy, neurotoxigenic Clostridium butyricum has been reported as a new agent of intestinal toxemia botulism, and most of the cases have been associated with enterocolitis. Although infections concomitant with botulism must be treated with antibiotics, this can increase the severity of botulism. We discuss the sensitivity of this agent to certain antibiotics, compared to findings on the sensitivity of C. botulinum.

Anti-Bacterial Agents↗
PubMed1999

Botulism with respiratory insufficiency requiring extra corporeal carbon dioxide removal.

Despite a low incidence of botulism in the industrialized world some cases occasionally occur in Germany after eating contaminated food. Because botulism is rarely seen, most physicians are unfamiliar with its early recognition and treatment. However, immediate intensive care treatment is important. We report the case of a previously healthy 54-year-old female who developed signs of botulism after eating vacuum packed smoked fish and developed severe respiratory insufficiency with difficult carbon dioxide elimination in the days following.

Botulism↗
PubMed2006

Two cases of foodborne botulism with home-preserved asparagus.

Botulism is a rare but potentially fatal disease caused by toxins produced by Clostridium botulinum. We report botulism in two adult females, one of them just tasting from "bad" asparagus and the other eating the full portion. Both patients survived after intermittent mechanical ventilation and trivalent antitoxin administration. The diagnosis was confirmed by detection of botulinum toxin. Acute onset of bilateral cranial neuropathies associated with symmetric descending weakness as well as some key features of the botulism syndrome including absence of fever, symmetric neurologic deficits, the patients remaining responsive and no sensory deficits, with the exception of blurred vision, led to the clinical diagnosis in the first presenting case which was then easily made in the second. Despite the fact that amount of toxin ingested, time-to-symptom development, and time-to-recovery markedly differed in the two patients, their maximal disease severity was similar.

Adult↗
PubMed2004

A case of type F botulism in southern California.

BACKGROUND: Botulism caused by type F botulinum toxin accounts for less than 0.1% of all human botulism cases and is rarely reported in the literature. CASE REPORT: A 45-year-old woman presented to an emergency department complaining of blurred vision, difficulty focusing, and dysphagia. The treating physician initially considered the possibility of paralytic shellfish poisoning due to a report of shellfish ingestion, which was later determined to be frozen shrimp and a can of tuna, but no gastroenteritis or paresthesias were present. During the emergency department observation, the patient developed respiratory distress with hypercapnea and required intubation and mechanical ventilation. Within hours, ptosis, mydriasis, and weakness in the arms and legs developed. Bivalent (A, B) botulinum antitoxin was administered approximately 24 h from the onset of initial symptoms, but over the next two days complete paralysis progressed to the upper and lower extremities. Shortly thereafter a stool toxin assay demonstrated the presence of type F botulinum toxin. The patient subsequently received an experimental heptavalent botulinum antitoxin on hospital day 7 but paralysis was already complete. Her three-week hospital course was complicated by nosocomial pneumonia and a urinary tract infection, but she gradually improved and was discharged to a rehabilitation facility. Anaerobic cultures and toxin assays have yet to elucidate the source of exposure. CONCLUSION: We report a rare case of type F botulism believed to be foodborne in etiology. Administration of bivalent botulinum antitoxin did not halt progression of paralysis.

Animals↗
PubMed2000

Wound botulism in California, 1951-1998: recent epidemic in heroin injectors.

California has reported most of the world's wound botulism (WB) cases and nearly three-fourths of the cases reported in the United States. We reviewed the clinical, epidemiologic, and laboratory features of WB. From the first case in 1951, through 1998, a total of 127 cases were identified-93 in the last 5 years. The dramatic increase has been due to an epidemic (of WB) in people who inject black tar heroin. Whereas early cases of WB occurred after gross trauma, all but 1 of the last 102 cases occurred in drug users, primarily those who inject drugs subcutaneously ("skin poppers"). Cases are occurring disproportionately in Hispanics and women. Misdiagnosis and diagnostic delays of up to 64 days have occurred. This unprecedented, ongoing epidemic is now being reported in other states. We discuss the clinical and laboratory features that distinguish botulism from conditions that can mimic it, the relative yield of various diagnostic laboratory tests for botulism, and its treatment.

Adolescent↗