Pediatric Botulism Follow-up

Updated: Feb 23, 2018
  • Author: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA; Chief Editor: Russell W Steele, MD  more...
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Follow-up

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. [38, 39]

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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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