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Pediatric Botulism Follow-up

  • Author: Muhammad Waseem, MD, MS; Chief Editor: Russell W Steele, MD  more...
 
Updated: Feb 23, 2015
 

Further Inpatient Care

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  • Avoid administration of sedatives or CNS depressants in patients with botulism.
  • Stool softeners and adequate hydration are useful in patients with constipation.
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Transfer

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  • Transfer the patient to an institution able to provide antitoxin and adequate supportive care, if necessary.
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Deterrence/Prevention

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  • Instruct patients to adhere to safe methods of food handling and preparation.
  • Thoroughly cleanse and debride potentially contaminated wounds.
  • Instruct parents to avoid feeding honey to infants in the first year of life.[9, 11]
  • Early studies of a vaccine against botulinum toxin are underway.[37, 38]
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Complications

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  • Aspiration pneumonia
  • Respiratory failure
  • Secondary urinary and respiratory tract infections and sepsis
  • Subglottic stenosis (following intubation)
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Prognosis

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  • Timing of antitoxin administration greatly influences the prognosis. Studies with the new Heptavalent botulinum antitoxin show that if it is administered longer than 12 hours after hospitalization longer periods of assisted ventilation were required and there was greater mortality. Retrospective analysis has shown that use of antitoxin within 24 hours is associated with a 10% mortality rate, antitoxin administered more than 24 hours later is associated with a 15% mortality rate, and failure to administer antitoxin carries a 46% mortality rate. Timing of administration also affects length of hospital stay, with a median stay of 10 days when antitoxin is administered within 24 hours, 41 days if administered after 24 hours, and 56 days if not used at all. In infants with botulism, treatment with BabyBig within 7 days markedly improves the prognosis (papers 1,3,4,7).
  • Prompt and vigorous supportive care, especially respiratory care, greatly improves the prognosis (paper 3).
  • After recovery from acute illness, late symptoms may remain, primarily muscle weakness including diplopia and fatigue with exertion. Although some patients have reported feeling breathless, pulmonary function test results demonstrate that results in lung volumes, forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), maximum inspiratory and expiratory pressures, and ventilatory response to exercise fall within reference ranges.
  • There have been reported episodes of relapse within 13 days in infants with botulism, therefore close observation for recurrence of symptoms is necessary.[25]
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Contributor Information and Disclosures
Author

Muhammad Waseem, MD, MS Associate Professor of Emergency Medicine in Clinical Pediatrics, Associate Professor of Clinical Healthcare Policy and Research, Weill Medical College of Cornell University; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Muhammad Waseem, MD, MS is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, Society of Critical Care Medicine, Society for Simulation in Healthcare, American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Joel R Gernsheimer, MD, FACEP Visiting Associate Professor, Department of Emergency Medicine, Attending Physician and Director of Geriatric Emergency Medicine, State University of New York Downstate Medical Center

Joel R Gernsheimer, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Geriatrics Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Itzhak Brook, MD, MSc Professor, Department of Pediatrics, Georgetown University School of Medicine

Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, Society for Ear, Nose and Throat Advances in Children, American Federation for Clinical Research, Surgical Infection Society, Armed Forces Infectious Diseases Society

Disclosure: Nothing to disclose.

Acknowledgements

Nahed M Abdel-Haq, MD Assistant Professor, Department of Pediatrics, Wayne State University School of Medicine

Nahed M Abdel-Haq, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Daniel AC Frattarelli, MD, FAAP Senior Staff, Departments of Pediatrics and Emergency Medicine, Henry Ford Hospital

Daniel AC Frattarelli, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Clinical Pharmacology, and American Society for Clinical Pharmacology and Therapeutics

Disclosure: Nothing to disclose.

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This is a photomicrograph of Clostridium botulinum stained with Gentian violet. The bacterium, C botulinum, produces a neurotoxin which causes the rare, but serious, paralytic illness, botulism.
 
 
 
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