Botulism is a clinical condition caused by a nerve toxin produced by the bacterium Clostridium botulinum. Botulinum toxin poisons nerve cells, preventing them from relaying messages and causing weakness or paralysis. Botulism treatments aim to decrease the effects of the toxin and to support the body as it recovers from the nerve damage sustained. In-patient hospital treatment is a necessity. The Centers for Disease Control and Prevention (CDC) reports approximately 110 cases of botulism occur annually in the United States.
Induction of Vomiting or Gastric Lavage
According to the primer "Diagnosis and Management of Foodborne Illnesses: Botulism Poisoning," which is produced and published by the American Medical Association, induction of vomiting or gastric lavage may be used in the first hours of the illness to remove unabsorbed botulinum toxin from the stomach. Medications can be administered to induce vomiting. Alternatively, gastric lavage may be performed. This procedure involves inserting a tube down the throat into the stomach. Fluid is passed into the stomach through the tube and then vacuumed back out, cleansing the stomach. These treatments are helpful only if there is reason to believe food contaminated with botulinum toxin may still be in the stomach.
Laxatives and Enemas
Based on the same rationale as treatments to clear the stomach, laxatives or enemas may be used in the initial treatment phase of foodborne botulism to rid the intestines of any unabsorbed botulinum toxin.
Botulinum Antitoxin
The CDC recommends administration of botulinum antitoxin as soon as possible after diagnosis. The antitoxin is most effective if administered within 24 to 48 hours after the onset of symptoms. In the United States, the CDC is the sole source for the antitoxin, which binds to the botulinum toxin and renders it inactive. In March 2010, the CDC introduced a new version of the botulinum antitoxin with broader activity than the previous form.
Respiratory Support
Muscular paralysis caused by botulinum toxin often affects the respiratory muscles, which may necessitate use of artificial ventilatory support (being placed on a respirator). When botulinum toxin enters the communication junction between two nerve cells, it destroys the nerve ends that meet there. Recovery from botulism may take three months or more, because new nerve endings must grow to replace those that the toxin destroyed. Patients on a ventilator typically require intensive care.
Nutritional Support
People recovering from botulinum toxin poisoning require intensive nutritional support. Even for those not on a ventilator, eating may not be possible because of weakness of the musculature of the throat and esophagus. A feeding tube placed into the small intestine or stomach is commonly used. Although people with botulinum poisoning are critically ill, they have a good chance for full recovery if they can be adequately supported medically until new nerve junctions have an opportunity to grow.
References
- Centers for Disease Control and Prevention: Botulism, Epidemiological Overview for Clinicians
- Centers for Disease Control and Prevention: Botulism Treatment Overview for Clinicians
- Centers for Disease Control and Prevention, MMWR: Investigational Heptavalent Botulinum Antitoxin (HBAT) to Replace Licensed Botulinum Antitoxin AB and Investigational Botulinum Antitoxin E
- American Medical Association: Diagnosis and Management of Foodborne Illnesses--Botulism Poisoning
- "Principles and Practice of Infectious Diseases, Sixth Edition"; Gerald L. Mandell, M.D., et al, Editors; 2004
