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Continuing Education in Anaesthesia, Critical Care & Pain 2008 8(1):21-25; doi:10.1093/bjaceaccp/mkm051
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© The Board of Management and Trustees of the British Journal of Anaesthesia [2008]. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Botulism

Tim Wenham, MBChB FRCA
SpR, Intensive Care
St James's University Hospital
Beckett Street
Leeds LS9 7TF
UK

Andrew Cohen, MBChB FRCA
Consultant
Anaesthesia and Intensive Care
St James's University Hospital
Beckett Street
Leeds LS9 7TF
UK
Tel: +44 (0)113 206 6184 Fax: +44 (0)113 206 4141 E-mail: a.t.cohen@leeds.ac.uk

Key Words: Wound botulism is increasing in the UK and occurs most frequently in injecting drug users. Food-borne botulism should be suspected in patients who may have consumed poorly preserved food. • The clinical syndrome produced by botulinum toxin is an afebrile, descending, symmetrical, flaccid paralysis of motor and autonomic nerves. • Respiratory failure can be rapid and may occur before other symptoms or signs become apparent. • It has been suggested that patients suspected of having botulism should be managed in a critical care environment. • Management is largely supportive together with administration of antitoxin.

The first 150 words of the full text of this article appear below.

Botulism is a rare, naturally occurring disease that can also be caused by accidental or deliberate exposure to botulinum toxins. Clostridium botulinum (C. botulinum) is a gram stain positive anaerobic organism and forms spores that can be found in soil, dust and aquatic sediments. Under suitable conditions, serologically distinct neurotoxins may be produced (A to G). Almost all human cases are caused by the A, B or E serotype; types C, D and E cause disease in mammals, birds and fish. These toxins are highly toxic and as little as 100 ng can be lethal.

There are three naturally occurring forms of illness: (i) food-borne botulism, caused by ingestion of pre-formed toxin; (ii) wound botulism, caused by growth of the bacterium and production of toxin in traumatic wounds; and (iii) intestinal colonization botulism, usually seen in infants (rarely in adults) caused by growth of bacterial cells and production of toxin in . . . [Full Text of this Article]


   Epidemiology
 
Food-borne botulism

Wound botulism

Intestinal colonization botulism

C. botulinum as a bioweapon

Accidental botulism


   Clinical features
 
Differential diagnosis

Diagnosis


   Management
 
Specific therapy


   Prognosis
 

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