NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 15: BOTULISM | 1ST SEMESTER A.Y. 2023-2024
DEFINITION
Came from the greek word Botulos (sausage),a rare
but serious paralytic illness by a potent neurotoxin
produced by the bacterium Clostridium Botulinoum
possessing the folowing characteristics:
a. Gram (+),spore-forming,anaerobic organism
whose natural habitat is the soil;
b. The spore can withstand boiling for several
hours; and
c. Botulinal toxin is the most potent toxin
known to man.
HUMAN FORMS OF BOTULISM
d. Foodborne (classical)botulism results from
ingestion of inadequately cooked
contaminated food,especially those with low
acid content.
e. Wound botulism (cutaneous botulism) is
characterized by the formation of ulcers with
sharply demarcatededges and a mebranous
base as a result of deposition of toxin in the
area.
f. Infant botulism usually afflicts infants aged
three to 20 weeks.The disease can produce
hypotonic(floppy) infant
syndrome,mainfested by constant
constipation,feeble cry,depressed
gagreflex,and inability to suck.Toxins
released by the organism ca cause death to
the infant b y weakening or paralyzing the
moscle sof the tongue and pharynx,which are
innervated by cranial nerves IX to XII.
INCUBATION PERIOD
 Classic symptoms of food-borne botulism occur
between 12–36 hours after consuming the
botulinum toxin (they can occur as early as 6
hours or as late as 10 days)
 Wound botulism has a longer incubation period,
usually between 4–14 days.
 The incubation period associated with infant
botulism varies from 3-30 days.
DIAGNOSTIC EXAM
1. Electrodiagnostic
Repetitive nerve stimulation
Increment: With (40 Hz) or paired stimuli
Occurs in 50% to 60% of patients
Testing of multiple muscles may be needed to see
increment
More common with type B botulism
Decrement on slow RNS: Occasional patients
CMAPs: Small
Motor unit potentials: Short
Recruitment: Normal, or Mildly reduced
SNAPS: Normal
EMG: Muscle enervation; Fibrillations & Positive
sharp waves
Muscle biopsy: Scattered angular, small muscle fibers
Analysis of serum, feces & implicated food
Passive transfer of serum or other body fluid to mice
Toxicity to mice
Selectively prevented by anti-toxin
Stool or wound culture: Not useful in Iatrogenic or
Inhalation syndromes
CLINICAL MANIFESTATION
The degree of involvement in this form of the disease
can vary from asymptomatic to paralysis to
sudden death.
 Other clinical features include listlessness, lethargy,
difficulty in sucking and swallowing, hypotonia, poor
feeding, pooled oral secretions, generalized muscle
weakness, and poor head control, which gives the
infant a characteristic floppy appearance.
 Neurologic findings include ptosis, ophthalmoplegia,
sluggish pupillary reaction to light, flaccid expression,
dysphagia, weak gag reflex, and poor anal sphincter
tone.
 Respiratory failure occurs in approximately 50% of
diagnosed patients.
NURSING DIAGNOSIS
• Impaired physical mobility
• Potential impairmentr of skin
integrity
• Alteration in bowel elimination
• Pain nad discomfort
• Altered nutrition:less than body
requirement
• Anxiety
MEDICAL MANAGEMENT
1. The respiratory failure and paralysis that occur
with severe botulism may require a patient to be
on a breathing machine for weeks.
2. If diagnosed early, foodborne and wound
botulism can be treated by inducing passive
immunity with a horse-derived antitoxin, which
blocks the action of toxin circulating in the
blood.
NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 15: BOTULISM | 1ST SEMESTER A.Y. 2023-2024

3. Physicians may try to remove contaminated food

still in the gut by inducing vomiting or by using
enemas.
4. Wounds should be treated, usually surgically, to
remove the source of the toxin-producing
bacteria.
5. Good supportive care in a hospital is the
mainstay of therapy for all forms of botulism

NURSING CARE/MANAGEMENT
Supportive care is needed with particular attention to
respiratory and nutritional needs.

In food-borne botulism, emetics and gastric lavage are

recommended.

In wound botulism, exploration and debridement of

the site need to undertaken. Ventilatory support

Surgical debridement of wounds

Pediatric nutritional support: Intravenous feeding

(hyperalimentation) is discouraged because of its
potential for secondary infection and because of the
success with nasogastra