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 full- term infant from uncomplicated pregnancy and delivery Immunizations? No known allergies yet

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

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

Differential Diagnosis?

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

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

Special Tests Stool sample- contains organism, toxin

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.

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

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!

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

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

Possible complications Aspiration pneumonia Nosocomial infection Hypoxic tissue damage Death

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