Botulism
Janina Sanchez
N415 Pediatric Health Care
Pathophysiology
Agenda
Etiology
Transmission & Communicability
Risk Factors
Incidence
Characteristics
Diagnosis
Assessment
Treatment
Management
Nursing Diagnoses
Conclusion
Pathophysiology

Botulism:

Rare, but life-threatening disease caused
by bacteria known as Clostridium
botulinum.

Attacks the nervous system causing
muscle PARALYSIS, difficulty breathing,
and even death.

Requires immediate medical attention!
Etiology

Clostridium botulinum:

gram-positive bacillus bacterium

Releases botulinum neuro-toxin that inhibits
ACh at NMJ causing weakness and paralysis
of the skeletal muscles.

Incubation period is 2hrs – 8 days

Anaerobic

Moist

Heat

High/Low Temp

Oxygen rich

Wet/Dry

Almost anywhere
Transmission &
Communicability

NOT transmitted from human-to-human

Implement Standard precautions
1. Ingestion

Infant botulism is the most common in the United
States and results from the ingestion of spores C.
botulinum, most often from environmental dust.

DO NOT give raw honey to infants under 12 mos
2. Direct Inoculation 3. Inhalation
Risk Factors

Infants less than 12 months old–
due to immature immune and
digestive systems (Infant Botulism)

People who eat home-canned or
home fermented foods (traditional
Alaska Native fermented foods)
(Food-borne Botulism)

People who use drugs via injection
(i.e., heroin, botox) (Wound
botulism)
Confirmed Botulism Cases by
State – USA, 2017
Incidence

Occurs worldwide.

In 2018, health
departments reported 242
cases of botulism to CDC.

7% food-borne

25% wound

67% infant botulism

S&S in INFANTS:

Characteristics of
Infant Botulism








1st:

Constipation
Poor feeding
Hypotonia
Ptosis
Malaise
Weak/altered cry
Diminished suck and
gag reflex
Respiratory distress or failure
S&S in OLDER
CHILDREN:

Diplopia

Blurred vision

Ptosis

Dysphagia

Slurred speech

Muscle weakness
Prognosis is good-- many children an adults
recover. Recovery time may vary.
If left untreated-- paralysis of skeletal muscles.
Possible Complications: aspiration pna,
respiratory failure, paralytic ileus, death
Diagnosis

Toxin may be detected in
the patient’s serum, stool,
or gastric contents

Nerve conduction studies
– electromyography

CT of brain

Spinal tap

Rule out GBS, stroke, MG
Nursing
Considerations:
Assessment

Healthy History interview and physical

Focused: Respiratory system


ABG’s

Need for suction

Need for mechanical ventilation
Focused: GI/GI system

Intake and output

Need for IV bolus or parenteral nutrition
Treatment
Depends on severity


Mild: Supportive Care
Moderate-Severe:

administration of botulinum immune
globulin or botulism antitoxin.



Prevents progression but does not reverse
effects
Supplemental O2 or Mechanical
ventilation
Antibiotics (Wound Botulism)
Contact Infectious Disease Nurse/Unit
Medication administration
Nursing
Considerations:
Management
Airway management
ABG’s
Suction
Supportive care
Ventilator
TCDB/IS
Nursing Considerations:
Nursing Diagnoses
Ineffective breathing pattern
Ineffective airway clearance
Impaired swallowing
Imbalanced nutrition: Less than body requirements
Risk for Injury
Impaired physical mobility
Acute pain
Conclusion

Botulism Facts:
 Rare.
 Life-threatening paralytic illness.
 Transmitted via ingestion, direct inoculation, or inhalation.
 Spores can be found in many places such as soil, dust, honey,
improperly canned food, street drugs.
 Infant botulism (Most Common type)
 Treatable: Antitoxin, Immune globulin, antibiotics.
 Disease monitored by public health agencies.
Questions?