Ophthalmologic Manifestations of Botulism Treatment & Management

  • Author: Bhupendra Patel, MD, FRCS; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Feb 15, 2012
 

Medical Care

  • Supportive care for the duration of the paralytic illness, with extensive nursing support, is the mainstay of treatment.
    • Ventilatory support: In adults, ventilatory support will be needed in as many as one third of cases. Pulse oximetry, arterial blood gas analysis, and spirometry should be monitored. Mechanical ventilation is considered when vital capacity is less than 30% of predicted.
    • Parenteral nutrition may be required in view of gastrointestinal disturbance.
    • Urinary catheterization may be required for urinary retention.
  • Antitoxin: In food-borne illness, trivalent (types A, B, and E) equine antitoxin should be administered, with antitoxin neutralizing botulinum toxin not yet bound to nerve terminals. Therefore, the antitoxin should be given as soon as possible, prior to receiving laboratory confirmation of diagnosis. Antitoxin has not been shown to be beneficial in infant botulism. Human botulism immune globulin is being evaluated for infant botulism.
  • Antibiotics may be helpful in the eradication of C botulinum in wound botulism, but they appear to have no role in infant botulism or in botulism of food poisoning. Remember that aminoglycoside antibiotics and tetracyclines may increase neuromuscular blockade by impairment of neuronal calcium entry.
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Surgical Care

  • In wound botulism, exploration and extensive surgical debridement of infected wounds is required.
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Contributor Information and Disclosures
Author

Bhupendra Patel, MD, FRCS  Professor of Ophthalmic Plastic and Facial Cosmetic Surgery, Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine

Bhupendra Patel, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Surgeons of England, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Simon F Taylor, MBBS, FRANZCO, FRACS  Clinical Senior Lecturer, Oculoplastic Surgery, Save Sight Institute, University of Sydney, Australia

Simon F Taylor, MBBS, FRANZCO, FRACS is a member of the following medical societies: Australian Medical Association and Royal Australasian College of Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew W Lawton, MD  Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Brian R Younge, MD  Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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  2. Fach P, Micheau P, Mazuet C, Perelle S, Popoff M. Development of real-time PCR tests for detecting botulinum neurotoxins A, B, E, F producing Clostridium botulinum, Clostridium baratii and Clostridium butyricum. J Appl Microbiol. Mar 9 2009;[Medline].

  3. Hatheway CL. Botulism: the present status of the disease. Curr Top Microbiol Immunol. 1995;195:55-75. [Medline].

  4. Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. Nov 2008;23(11):1336-46. [Medline].

  5. Mitchell WG, Tseng-Ong L. Reviews of infant botulism at childrens hospital los angeles. J Child Neurol. Aug 2008;23(8):968. [Medline].

  6. Centers for Disease Control and Prevention. Botulism in the United States, 1899-1996. Handbook for epidemiologists, clinicians, and laboratory workers. Atlanta, Ga: 1998:1-43. [Full Text].

  7. Teismann IK, Steinstraeter O, Warnecke T, et al. Cortical recovery of swallowing function in wound botulism. BMC Neurol. May 7 2008;8:13. [Medline].

  8. Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. Nov 2008;23(11):1336-46. [Medline].

  9. König H, Gassman HB, Jenzer G. Ocular involvement in benign botulism B. Am J Ophthalmol. Sep 1975;80(3 Pt 1):430-2. [Medline].

  10. Albert DM, Jakobiec FA. Systemic bacterial infections and the eye. In: Ryan ET, Sullivan BA, eds. Principles and Practice of Ophthalmology: Clinical Practice. WB Saunders Co; 1994:3006-10.

 
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