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Case STUDY Alana Saldana

Bacteriology case study

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Case study involving Clostridium botulinum

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Page 1: Bacteriology case study

Case STUDYAlana Saldana

Page 2: Bacteriology case study

Patient

A six month old male

3 day history of increasing hypotonia

1 day history of dehydration

4 week history of constipation

3 day history of decreased suck while breastfeeding with decreased intake of fluids

2 day history of generalized weakness with decreased movement and difficulty sitting up

Trouble with gurgling in the back of the throat, very poor head control, and increased floppiness

Page 3: Bacteriology case study

Physical examination

Generalized hypotonia

Head lag

Dehydration

Cerebrospinal fluid was normal

Page 4: Bacteriology case study

Treatment

Admitted to PICU

Intubated because of increasing respiratory difficulty

Extubated on day 7

Discharged on day 11

Page 5: Bacteriology case study

What is the clinical condition of this child?

This patient has infant botulism

Rare

Page 6: Bacteriology case study

Infant Botulism

Clinical manifestations are attributed to sepsis, CNS infections, or more esoteric diagnoses

Guillain-Barre syndrome

Inborn errors of amino acid metabolism

Characterized by descending paralysis

Initial signs:

Constipation

Poor suck

Increasing hypotonia

Page 7: Bacteriology case study

What is the organism causing this condition?

The patient is infected with Clostridium botulinum

Page 8: Bacteriology case study

Clostridium botulinum

Gram positive bacillus

Obligate anaerobe

Sporeformer

Produces a neurotoxin called botulinum toxin

The most potent biologic toxin known to mankind

One billionth of a gram can paralyze a person

There are seven different types of botulinum toxin designated A to G

Types A, B, and E are responsible for human disease

Page 9: Bacteriology case study

Clostridium botulinum

Most commonly seen form of botulism in the U.S.

Highest incidences of disease are seen in California and in the Delta Valley area of Pennsylvania and New Jersey

Toxin A producing strains are the predominant type found in soil in California

Toxin B producing strains are the predominant type found east of the Mississippi River

Page 10: Bacteriology case study

Clostridium botulinum

This disease occurs sporadically

No outbreaks of infant botulism have been reported

Spores are ingested either in foodstuffs or from dust

Honey and corn syrup

Produces toxin in the GI tract which is absorbed into the blood stream and binds to the presynaptic nerve endings

Page 11: Bacteriology case study

Laboratory Diagnosis

Routine lab tests are not helpful

Initial diagnosis is based on clinical symptoms

Treatment should not wait for laboratory confirmation

Two step process

Direct toxin analysis

Extraction of toxin directly

from the fecal specimen

Culture the specimen

Page 12: Bacteriology case study

Treatment

Antitoxin

Call state health department’s emergency number

State health department contacts CDC to report suspected botulism case

Clinical consultation by telephone between the treating physician and the CDC

Request release of botulinum antitoxin

Mechanical ventilatory support is essential

Death is due to respiratory arrest

Page 13: Bacteriology case study

Why is there increased concern about this organism among governmental agencies such as the Department of Defense, the Centers for Disease Control, and the Federal Bureau of Investigation

Page 14: Bacteriology case study

Concern continued

Potential weapon of bioterrorists

Botulinum toxin has been weaponized by several countries

During the Gulf War, missels with warheads containing botulinum toxin were reported to have been produced by Iraq

In crude form, this toxin is easily produced

Toxin enters the bloodstream following inhalation, it is possible to deliver this agent through aerosol

1 or 2 grams of botulinum put into a city’s water supply could kill 50% of the population

Page 15: Bacteriology case study

References

Gilligan, P. H., Smiley, L. M., & Shapiro, D. S. (2003). Cases in medical microbiology and infectious disease. (3rd ed.). Washington D.C.: ASM Press

Bhargava, Pushpa M. (2008). The Growing Planetary Threat from Biological Weapons and Terrorism. India: The Tribune