Botulism Follow-up

  • Author: Kirk M Chan-Tack, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: May 19, 2011
 

Further Inpatient Care

  • Recovery of ventilatory and upper airway muscle strength in patients who develop respiratory failure is most significant over the first 12 weeks. The time for recovery typically ranges from 30-100 days. Artificial respiratory support may be required for months in severe cases.
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Further Outpatient Care

  • The most significant improvements in ventilatory and upper airway muscle strength occur over the first 12 weeks, and, in some patients, recovery may not be complete for as long as a year. Close follow-up is crucial.
  • Follow-up with other consultants, such as physical medicine and rehabilitation specialists, physical and occupational therapists, nutritionists, and psychiatrists, should be obtained as needed.
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Inpatient & Outpatient Medications

  • When botulism develops following a wound infection, antibiotic therapy and meticulous debridement of the wound are essential.
    • Penicillin is the drug of choice.
    • Clindamycin and chloramphenicol are reasonable second-line agents.
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Transfer

  • Transfer is indicated if the patient's condition continues to deteriorate or if the initial hospital is unable to manage the complexities involved.
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Deterrence/Prevention

  • Prompt notification of public health authorities regarding a suspected case of botulism may prevent further consumption of a contaminated home-canned or commercial food product.
  • Foodborne botulism is best prevented by strict adherence to recommended home-canning techniques. High-temperature pressure cooking is essential to ensure spore elimination from low-acid fruits and vegetables. Although boiling for 10 minutes kills bacteria and destroys the heat labile botulism toxin, the spores are resistant to heat and can survive boiling for 3-5 hours. Food contaminated by botulism toxins usually has a putrefactive odor; however, contaminated food may also look and taste normal. Hence, terminal heating of toxin-containing food can prevent illness and is an important preventive measure.
  • Wound botulism due to intravenous drug abuse can be prevented by cessation of drug use.
  • Wound botulism is best prevented by prompt thorough debridement of contaminated wounds. Prophylactic use of antibiotics after trauma cannot be relied on to prevent wound botulism.
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Complications

  • Nosocomial infections
    • Hospital-acquired pneumonia, especially aspiration pneumonia, can occur. Atelectasis and poor secretion clearance also increase the risk of hospital-acquired pneumonia.
    • Urinary tract infection can occur from in-dwelling Foley catheters.
    • Skin breakdown and decubitus formation can occur.
    • Thrombophlebitis, cellulitis, and line infections can occur. These patients often have peripheral and central intravenous catheters for prolonged periods.
    • Fungal infections can occur; the predisposing factors include prolonged hospitalization, parenteral nutrition, and central venous catheters. DVT prophylaxis is essential to reduce the risk of these potential complications. DVT and pulmonary embolism (PE) are potential complications because patients can be bedridden for weeks to months.
    • Stress ulcers can occur and are common in the intensive care unit setting. Stress ulcer prophylaxis is essential to reduce the risk of this potential complication.
  • Hypoxic tissue damage can lead to permanent neurologic deficits.
  • Death
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Prognosis

  • Botulism due to type A toxin is generally more severe than that caused by type B or E.
  • Mortality rates vary based on the age of the patient and the type of botulism. Foodborne botulism carries an overall mortality rate of 5-10%. Botulism carries a higher mortality rate in patients older than 60 years than in younger patients. Wound botulism carries a mortality rate that ranges from 15-17%. The risk of death due to infant botulism is usually less than 1%.
  • The recovery period ranges from 30-100 days. Artificial respiratory support may be required for months in severe cases. Full neurologic recovery usually occurs. Hypoxic insults, although infrequent, can result in permanent deficits. Some patients experience residual weakness and autonomic dysfunction for as long as a year after disease onset.
  • Mortality is due to the following:
    • Delayed diagnosis and respiratory failure
    • Hospital complications such as nosocomial infections (usually pneumonia)
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Patient Education

  • When preserving food at home, kill C botulinum spores by pressure cooking at 250°F (120°C) for 30 minutes.
    • The toxin can be destroyed by boiling for 10 minutes or cooking at 175°F (80°C) for 30 minutes.
    • Do not eat or taste food from bulging cans. Discard food that smells bad.
  • Cessation of intravenous drug use prevents wound botulism due to this vehicle.
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Contributor Information and Disclosures
Author

Kirk M Chan-Tack, MD  Medical Officer, Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration

Disclosure: Nothing to disclose.

Coauthor(s)

John Bartlett, MD  Chief of Division of Infectious Diseases, Chief of HIV Care Service, Professor, Department of Internal Medicine, Johns Hopkins University School of Medicine

John Bartlett, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Pharmacology, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, American Thoracic Society, American Venereal Disease Association, Association of American Physicians, Infectious Diseases Society of America, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David Hall Shepp, MD  Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Gilead Sciences Salary Management position

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Bioterrorist Agents. Signs and symptoms. Chart courtesy of North Carolina Statewide Program for Infection Control and Epidemiology (SPICE), copyright University of North Carolina at Chapel Hill, www.unc.edu/depts/spice/bioterrorism.html.
 
 
 
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