Tuesday, March 9, 2010

Botulism

Botulism - Acute


 

Definition  

A life-threatening neuro-paralytic disease produced by neurotoxins elaborated by Clostridium botulinum


 

Medical History  

* Food poisoning due to Clostridia

* Wound of skin

* Illicit drug use

* Victim of bio-terrorism


 

Findings  

* Apnea

* Shallow breathing

* Abdominal cramps

* Abdominal distension

* Abducens nerve weakness

* Abnormal vision

* Dysarthria

* Dysphagia

* Dyspnea - Acute

* Hypoactive gag reflex

* Muscle weakness

* Mydriasis

* Paralysis

* Tachypnea

* Abnormal deep tendon reflex

* Bladder distention

* Mentally alert

* Ptosis of eyelid

* Urinary retention

* Constipation

* Light intolerance

* Nausea and vomiting - Acute

* Pain in throat

* Xerostomia


 

Tests  


 

Suspected botulism  

* Clostridium botulinum toxin assay: Identification of Clostridium botulinum neurotoxin in specimens confirms the diagnosis of botulism .


 

Suspected wound botulism  

* Clostridium botulinum culture: Clinical diagnosis of wound botulism can be confirmed by isolation of Clostridium botulinum; however, treatment should not be delayed for microbiologic results .


 

Suspected botulism  

* Electromyography: Electromyography may document electrophysiologic abnormalities consistent with botulism before the results of specialized microbiologic tests are available .


 

Differential Diagnosis  

* Guillain-Barré syndrome - Acute

* Cerebrovascular accident

* Meningitis

* Infant botulism - Acute

* Myasthenia gravis - Acute

* Foodborne botulism

* Food poisoning

* Wound botulism

* Tick paralysis

* Botulism - unclassified

* ARSENIC

* LEAD

* MERCURY, ORGANIC

* Inhalational botulism


 

Treatment  


 

Drug Therapy  


 

Botulism  


 

BOTULISM ANTITOXIN  

Ingestion of food or a pharmaceutical preparation known to contain botulinum toxin  


 

ACTIVATED CHARCOAL  

Adults: 50 to 100 g or 1 to 2 g/kg orally

Pediatrics (<1 year): 1 g/kg as slurry in water orally

Pediatrics (1-12 years): 25 to 50 g or 1 to 2 g/kg as slurry in water orally

Pediatrics (?13 years): 50 to 100 g or 1 to 2 g/kg orally


 

Procedural Therapy  


 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .


 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .


 

Wound botulism  

* Wound care: Wound botulism requires early, thorough wound irrigation and aggressive debridement .


 

Paralytic ileus  

* Insertion of nasogastric tube


 

Reportable infectious diseases  

* Infectious disease notification: In the United States, specific infectious diseases must be reported to the state or local public health department .

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SYSTEM BASED CLASSIFICATION OF DISEASES

SYSTEM BASED CLASSIFICATION OF DISEASES

Bone and Joint Diseases

  1. Gout and Hyperurecemia
  2. Osteoarthritis
  3. Rheumatoid Arthritis
  4. Acute coronary Syndroms

Cardiovascular Diseases

  1. Arrhymias
  2. Cardiopulmanary Resuscitation
  3. Heart Failure
  4. Hypertension
  5. Hyperlipidemia
  6. Ischemic Heart Diseases
  7. Shock
  8. Stroke
  9. Venous Thromboembolism

Dermatrologic Diseases

  1. Acne
  2. Psoriasis
  3. Skin Disorders and Cutaneous Drug Eruptions

Endocrine Diseases

  1. Cirrhosis
  2. Portal Hypertension

Gastrointestinal Diseases

  1. Irritable Bowel Syndrome
  2. Constipation
  3. Diarrhea
  4. Gastroesophagal Reflux Disease
  5. Hepatitis, Viral
    1. Hepatitis A
    2. Hepatitis B
    3. Hepatitis C
  6. Nausea and Vomiting
  7. Pancreatitis
  8. Peptic Ulcer disease

Gynecologic and Obstetric Diseases

  1. Contraception
  2. Hormone therapy

Hematologic Diseases

  1. Anemia
    1. Megaloblastic Anemia

i. Megaloblastic Anemia due to Folate Deficiency

ii. Megaloblastic Anemia due to Vitamine B12 Deficiency

    1. Sickle Cell anemia
    2. Hemolytic Anemia
    3. Iron Deficiency Anemia
    4. Aplastic Anemia
    5. Iron Deficiency Anemia

Infectious Diseases

  1. Central Nervous System infections
  2. Endocarditis
  3. Fungal infections, Invasive
  4. Gastrointestinal Infection
  5. HIV / AIDS
  6. Intra-Abdominal Infection
  7. Respiratory Tract infections, Lower
  8. Respiratory Tract infections, Upper
  9. Sepsis and Septic Shock
  10. Sexually transmited Diseases (STD)
  11. Skin and soft tissue infection
  12. Tuberculosis
  13. Urinary tract infection and prostatitis

Neurologic Diseases

  1. Epilepsy
  2. Headache
    1. Migraine
    2. Cluster Headache
  3. Pain management
  4. Parkinson’s Diseases
  5. Status epilepticus

Nutritional Diseases

  1. Enteral Nutrition
  2. Obesity
  3. Parentaral Nutrition

Onchologic Diseases

  1. Breast cancer
  2. Colorectal Cancer
  3. Lung cancer
  4. Lymphomas
  5. Prostate cancer
  6. Cervical Cancer
  7. Esophageal Cancer
  8. Gastric Cancer
  9. Head and Neck Cancer
  10. Lung Cancer
  11. Ovarian Cancer
  12. Pancreatic Cancer
  13. Primary bone Cancer
  14. Primary Brain cancer
  15. Testicular Cancer
  16. Thyroid Gland Cancer
  17. Urinar Bladder cancer
  18. Uterine Cancer

Ophtalmic Diseases

  1. Glaucoma

Psychiatric Diseases

  1. Alzhimer’s Diseases
  2. Anxiety Disease
  3. Bipolar Diseases
  4. Depressive diseases
  5. Schizophrenia
  6. Sleep Diseases
  7. Substance-Related Diseases

Renal Diseases

  1. Acid base Diseases
  2. Acute renal Failure
  3. Chronic Renal Failure
  4. Drug Dosing in renal insufficiency
  5. Electrolyte Homeostasis

Respiratory Diseases

  1. Allergic Rhinitis
  2. Asthma
  3. Chronic Obstructive Pulmonary Diseases

Urologic Diseases

  1. Benign Prostatic, Hyperplasia
  2. Erectile Dysfunction
  3. Urinary Incontinence