TAILIEUCHUNG - Chapter 134. Botulism

Botulism is a paralytic disease caused by potent protein neurotoxins elaborated by Clostridium botulinum. Illness begins with cranial nerve involvement and proceeds caudally to involve the extremities. Cases may be classified as (1) food-borne botulism, from ingestion of preformed toxin in food contaminated with C. botulinum; (2) wound botulism, from toxin produced in wounds contaminated with the organism; and (3) intestinal botulism, from ingestion of spores and production of toxin in the intestine of infants (infant botulism) or adults. Botulinum toxin, because of its extraordinary potency, has long been considered a threat as an agent of bioterrorism or biologic. | Chapter 134. Botulism Botulism is a paralytic disease caused by potent protein neurotoxins elaborated by Clostridium botulinum. Illness begins with cranial nerve involvement and proceeds caudally to involve the extremities. Cases may be classified as 1 food-borne botulism from ingestion of preformed toxin in food contaminated with C. botulinum 2 wound botulism from toxin produced in wounds contaminated with the organism and 3 intestinal botulism from ingestion of spores and production of toxin in the intestine of infants infant botulism or adults. Botulinum toxin because of its extraordinary potency has long been considered a threat as an agent of bioterrorism or biologic warfare that could be acquired by inhalation or ingestion Chap. 214 . Iatrogenic botulism can follow cosmetic or therapeutic use of toxin. tDeceased. A contributor to HPIM since the 12th edition Dr. Abrutyn passed away on February 22 2007. Etiologic Agent C. botulinum a species encompassing a heterogeneous group of anaerobic gram-positive organisms that form subterminal spores is found in soil and marine environments throughout the world and elaborates the most potent bacterial toxin known. Organisms of types A through G have been distinguished by the antigenic specificities of their toxins a classification system based on physiologic characteristics has also been described. Rare strains of other clostridial species C. butyricum and C. baratii have been found to produce toxin. C. botulinum strains with proteolytic activity can digest food and produce a spoiled appearance nonproteolytic types leave the appearance of food unchanged. Of the eight distinct toxin types described A B Cl C2 D E F and G all except C2 are neurotoxins C2 is a cytotoxin of unknown clinical significance. Botulinum neurotoxin whether ingested inhaled or produced in the intestine or a wound enters the vascular system and is transported to peripheral cholinergic nerve terminals including neuromuscular junctions postganglionic .

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