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Bacteriology case study
This case study describes a 6-month-old male infant presenting with hypotonia, dehydration, constipation, decreased suck and fluid intake, weakness, and difficulty sitting up. The infant was diagnosed with infant botulism caused by Clostridium botulinum. C. botulinum is a gram-positive, anaerobic, spore-forming bacillus that produces a potent neurotoxin. The infant was treated with antitoxin and supportive care and recovered. There is increased bioterrorism concern regarding C. botulinum because its toxin is easily produced and lethal even in small amounts if inhaled or introduced into water supplies.
Bacteriology case study
- 1.
- 2. Patient A sixmonth 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
- 3. Physical examination Generalizedhypotonia Head lag Dehydration Cerebrospinal fluid was normal
- 4. Treatment Admitted toPICU Intubated because of increasing respiratory difficulty Extubated on day 7 Discharged on day 11
- 5. What is theclinical condition of this child? This patient has infant botulism Rare
- 6. Infant Botulism Clinicalmanifestations 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
- 7. What is theorganism causing this condition? The patient is infected with Clostridium botulinum
- 8. Clostridium botulinum Grampositive 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
- 9. Clostridium botulinum Mostcommonly 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
- 10. Clostridium botulinum Thisdisease 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
- 11. Laboratory Diagnosis Routinelab 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
- 12. Treatment Antitoxin Callstate 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
- 13. Why is thereincreased concern about this organism among governmental agencies such as the Department of Defense, the Centers for Disease Control, and the Federal Bureau of Investigation
- 14. Concern continued Potentialweapon 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
- 15. 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