Botulism

- presynaptic neuromuscular junction disorder caused by anaerobic Clostridium botulinum
- transmitted through food contaminated with toxin / IVDU
- blocks release of acetylcholine from motor nerve terminal
- incubation period from 4-14days
- 2 forms: food borne or wound botulism
- presents with cranial neuropathies, autonomic dysfunction (dry mouth, urinary retention), descending limb weakness and depressed reflexes
- NO sensory signs
- respiratory failure is a common complication
- diagnosis: demonstrate toxins in serum, stool or vomitus
- edrophonium test false positive in 1/3 cases
- repetitive nerve stimulation: progressive increase in amplitude of potentials
- treatment: supportive, Botulinum antitoxin (trivalent antiserum), guanidine hydrochloride, penicillin and metronidazole