Botulism

 Q: Botulism causes? (select one)

A) symmetric ascending weakness 

 B) symmetric descending weakness

Answer: B

The knowledge of the nature of paralysis in botulism is of clinical significance as patients exposed to botulism may be alert, have no fever but may have an acute onset of bilateral cranial neuropathies with symmetric descending weakness. Administration of antitoxin early in the course is of paramount importance. Human-derived botulism immune globulin (called BIG-IV or BabyBIG) is available but is off-label for adults. 

Moreover, intubation may be needed if vital capacity drops below 30 percent of the predicted.

#toxicology

References:

1. Chaudhry R. Botulism: a diagnostic challenge. Indian J Med Res. 2011;134(1):10-12. 

2. Cherington M. Clinical spectrum of botulism. Muscle Nerve. 1998 Jun;21(6):701-10. doi: 10.1002/(sici)1097-4598(199806)21:6<701::aid-mus1 style="color: #0c343d;">3.0.co;2-b. PMID: 9585323.

<701::aid-mus1 style="color: #0c343d;">3. Sobel J. Botulism. Clin Infect Dis. 2005 Oct 15;41(8):1167-73. doi: 10.1086/444507. Epub 2005 Aug 29. PMID: 16163636. 

<701::aid-mus1 style="color: #0c343d;">4. Chalk CH, Benstead TJ, Pound JD, Keezer MR. Medical treatment for botulism. Cochrane Database Syst Rev. 2019 Apr 17;4(4):CD008123. doi: 10.1002/14651858.CD008123.pub4. PMID: 30993666; PMCID: PMC6468196.