Botulism

Question 1

47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans. The disease was complicated by autonomic changes like hypertension, febrile temperatures, and a paralytic ileus.

Answer 1

A) What is the most probable diagnosis and the causative agent?
*Diagnosis: Foodborne botulism
Causative agent: Clostridium botulinum, a gram-positive, anaerobic, spore-forming bacillus that produces botulinum neurotoxin (BoNT).

Question 2

B) How is this disease diagnosed?

Answer 2

Diagnosis is clinical, supported by:

1. History:
   *Ingestion of home-canned food.
   *Neurologic symptoms within 12–72 hours.
2. Clinical features:
   *Cranial nerve palsies (e.g., ptosis, diplopia, dysphagia, facial weakness).
   *Descending symmetric flaccid paralysis.
   *Autonomic signs: dry mouth, ileus, urinary retention, mydriasis.
3. Confirmatory tests:
   *Mouse bioassay (gold standard): detects toxin in serum, stool, or food.
   *Toxin detection by ELISA or PCR.
   *Culture of C. botulinum from stool, serum, or suspected food (though not always positive).
   جملة للتاريخ
   Note: Treatment should not be delayed for lab confirmation.

Question 3

C) What is the management strategy?

Answer 3

1-Immediate supportive care:
*Hospitalization and ICU monitoring.
*Mechanical ventilation may be required (respiratory failure is common).
*Monitor autonomic instability (e.g., BP, arrhythmias).
2. Antitoxin administration:
*Botulinum antitoxin (equine-derived heptavalent antitoxin):
*Neutralizes circulating toxin.

*Most effective when given early (within 24 hours of symptom onset).
3. Gastrointestinal decontamination (if within hours of ingestion):
*Activated charcoal.
4-Avoid antibiotics in foodborne botulism unless secondary infections are present.
4. Treatment of complications:
Management of paralytic ileus, urinary retention, aspiration risk, etc.
5. Public health reporting: أهم حاجة

Botulism is a notifiable disease.

Public health authorities should be contacted for investigation and to obtain antitoxin.

Question 4

) Which is most likely the cause of her presentation?

Question 5

DD
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قول بتوع RBies

Answer 5

1-Guillain-Barré syndrome (GBS) – ascending paralysis, areflexia, no fever or encephalopathy.
2–Myasthenia gravis (in children)
3-Transverse myelitis – motor and sensory deficits below the lesion.
4-Acute disseminated encephalomyelitis (ADEM) – post-infectious or post-vaccination demyelination
5-Poliomyelitis – asymmetric flaccid paralysis, often with fever.
6-Botulism – descending paralysis, cranial nerve involvement
7-Brucella: Neurobrucellosis