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
 NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 15: BOTULISM | 1ST SEMESTER A.Y. 2023-2024
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
swallowing, hypotonia, poor feeding, pooled
oral secretions, generalized
weakness, and poor head control, which
gives the infant a characteristic floppy
appearance.
 Neurologic findings include
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
and toxin circulating in the blood.
3. Physicians may try to remove
muscle 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.
ptosis,
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
NCM 112: MEDICAL-SURGICAL NURSING
LECTURE 15: BOTULISM | 1ST SEMESTER A.Y. 2023-2024

Pediatric nutritional support: Intravenous

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