Invaginación intestinal en un lactante con diagnóstico de botulismo: Reporte de un caso / Intussusception in infant with diagnostic botulism: A case report

El botulismo es un importante problema de salud pública en Argentina. Es una enfermedad potencialmente letal y de difícil diagnóstico. Existen casos de presentación infrecuente de dicha enfermedad, como el abdomen agudo. Exponemos el caso de un niño de 4 meses, que consultó por constipación de 3 días de evolución, asociada a decaimiento y regular actitud alimentaria de 12 horas de evolución. Presentaba tono muscular conservado, sin alteraciones en la succión ni deglución, según la referencia materna. Se constató sensorio alternante y abdomen agudo, por lo que ingresó a quirófano con sospecha de invaginación intestinal, la cual fue confirmada mediante desinvaginación neumática. Durante la internación, el paciente evolucionó desfavorablemente y presentó llanto débil, hipotonía progresiva e insuficiencia respiratoria, por lo que requirió cuidados intensivos. Se aisló Clostridium botulinum en la muestra de materia fecal y toxina botulínica tipo A en el suero. Recibió toxina antibotulínica equina como tratamiento, con recuperación total a los 25 días de haber ingresado.

Botulism is an important public health problem in Argentina. It is a potentially fatal disease, and its diagnosis may be difficult. There are rare presentation forms of the disease, such as acute abdomen. We present a 4-monthbaby with a 3-day constipation condition, associated with weakness and abnormal eating attitude in the last 12 hours. The baby presented preserved muscle tone, with no changes in sucking or deglutition according to the mother's observations. Altered sensorium and acute abdomen were found; the patient was entered into the operating room with presumptive diagnosis ofintussusception, which was confirmed by pneumatic desinvagination. During hospitalization, the patient did not make good progress and presented weak cry, progressive hypotonia and respiratory failure requiring intensive care. Clostridium botulinum was isolated from the stool sample and botulinum toxin type A was isolated from serum. The patient was treated with equine botulinum toxin. Twenty five days after admission, he was totally recovered.

Botulism as a food poisoning: what is it?

Botulism is a rare but potentially life-threatening neuroparalytic syndrome resulting from the action of a neurotoxin elaborated by the microorganism Clostridium botulinum. This disease has a lengthy history; the first investigation of botulism occurred in the 1820s with a case report on hundreds of patients with [sausage poisoning] in a southern German town. Several decades later in Belgium, the association was demonstrated between a neu-romuscular paralysis and ham infected by a spore forming bacillus that was isolated from the ham. The organism was named Bacillus botulinus after the Latin word for sausage, botulus

Botulismo: estudo clínico / Botulism: clinical studies

O botulismo é uma doença infecciosa, neuroparalítica, envolvendo a placa motora, causada pela toxina produzida pelo Clostridium botulinum. Apresenta impacto significativo quando de sua ocorrência, com relação à gravidade dos quadros produzidos. Os autores revisam os aspectos mais relevantes da doença.

The bolulism is a neuroparalitic disease caused by toxin produced by Clostridium botulinum with important impact in public health. In this article is presented a review with the most relevant aspects of the botulism.

Botulismo e disfagia / Botulism and dysphagia

TEMA: o botulismo é uma doença neuroparalítica grave, de caráter agudo, afebril e causada pela ação de uma toxina produzida pelo Clostridium botulinum. Essa toxina se liga aos receptores da membrana do axônio dos neurônios motores, impedindo a liberação de acetilcolina na junção neuromuscular, o que causa paralisia flácida dos nervos cranianos e da musculatura esquelética, estruturas responsáveis pela adequada funcionalidade da deglutição nos indivíduos. OBJETIVO: apresentar o trabalho fonoaudiológico realizado junto a um paciente com quadro clínico de botulismo com queixa de disfagia. MÉTODO: paciente adulto, gênero masculino, com quadro clínico de botulismo, encaminhado para avaliação fonoaudiológica por apresentar dificuldades em deglutir saliva. Durante avaliação observou-se: alteração na mobilidade, tonicidade e sensibilidade dos órgãos do Sistema Miofuncional Orofacial (OMSs); redução dos movimentos laríngeos; estase de saliva em cavidade oral; ausência do reflexo de deglutição; ausência da função de deglutição. Foram realizadas nove sessões de fonoterapia, nas quais se abordou: estimulação dos OMSs - mobilidade, tonicidade e sensibilidade; estimulação dos reflexos orais e faríngeos; testes e treinos de deglutição com diferentes consistências alimentares e com auxilio de manobras de proteção e de limpeza de vias aéreas. RESULTADOS: melhora da mobilidade, tonicidade e sensibilidade dos OMSs; presença do reflexo de deglutição; melhora da elevação laríngea; restabelecimento da função de deglutição sem necessidade de assistência de qualquer profissional ou de manobras clínicas; qualidade vocal próxima aos parâmetros de normalidade (hipernasalidade e incoordenação pneumofonoarticulatória leves). Paciente recebeu alta fonoaudiológica e hospitalar, sendo indicado atendimento clínico para adequação e aperfeiçoamento dos OMSs. CONCLUSÃO: o trabalho fonoaudiológico mostrou-se eficiente no restabelecimento dos OMSs e da função da deglutição,...

BACKGROND: botulism is a severe neuroparalytic, of an acute characteristic, afebrile and is caused by the action of a toxin produced by Clostridium botulinum. This toxin links itself to the receptors of the axon membrane of the motor neurons, preventing the release of acetylcholine in the neuromuscular junction, causing flaccid paralysis of the cranial nerves and skeleton musculature. AIM: to present the speech therapy procedures adopted with a patient with botulism and who was presenting dysphagia. METHOD: a male adult, with botulism, sent for a speech-language evaluation due to the presence of difficulties when swallowing saliva. During the evaluation the following was observed: alteration in mobility, tonicity and sensibility of the organs of the Orofacial Myofunctional System (OMSs); reduction of the laryngeal movements; stasis of saliva in the oral cavity; absence of the swallowing reflex; absence of the swallowing function. Nine speech therapy sessions were carried out with the following procedures: stimulation of the OMSs - mobility, tonicity and sensibility; stimulation of the oral and pharyngeal reflexes; tests and trainings for swallowing with different food consistencies and with the help of maneuvers aiming at the protection and clearing of the airways. RESULTS: improvement in mobility, tonicity and sensibility of the OMSs; improvement in the elevation of the larynx; re-establishment of the swallowing function without the assistance of other professionals or clinical maneuvers; vocal quality close to the normal parameters (light hypernasality and pneumophonoarticulatory incoordination). The patient was discharged from hospital and speech therapy; clinical assistance for adjustment and improvement of the OMSs was suggested. CONCLUSION: speech therapy demonstrated to be efficient in the re-establishment of OMSs and of the swallowing function, enabling the patient to restore the adequate functionality of his orofacial myofunctional system.

Medical referral of patients with acute respiratory failure: lessons learned from a large outbreak of botulism in northern Thailand.

BACKGROUND: There was an outbreak of botulism in a district in Nan Province in upper northern Thailand. The outbreak occurred after the villagers took bamboo shoots preserved in a sealed bucket under anaerobic conditions (home-canned bamboo shoots). There were 209 people at risk, of whom 119 (56.9%) were hospitalized. Among the 119 cases, 42 (35.3%) needed ventilators. Of the 42 cases, 25 (59.5%) were transferred to another hospital. OBJECTIVE: Describe and review transferal processes of the 25 cases and document lessons learned for medical services response from a public health aspect. MATERIAL AND METHOD: Review of records and reports. RESULTS: All 25 cases were successfully transferred with no mishaps. The duration of transferal was less than 3 hours. CONCLUSION: Preparedness of local capacity to cope with botulism outbreak of this scale is important. However, it is also necessary to develop a good system for medical referral of severe cases, to be started early in the course of medical care.

Botulismo: relato de caso / Food borne botulism: case report

É relatado o caso de um paciente de 39 anos, com quadro agudo de sintomas gastrointestinais e neuroparalíticos, após ingestão de alimentos contaminados. O quadro evoluiu com parada cardiorrespiratória e necessidade de ventilação mecânica. O diagnóstico de botulismo foi confirmado pelo achado da toxina tipo A em amostras de sangue do paciente, que recebeu suporte clínico e tratamento especifico com antitoxina botulinica, recuperando-se sem apresentar seqüelas.

This is a report of a 39 year-old man who presented an acute onset of gastrointestinal and neuroparalytic symptoms after the ingestion of contaminated food. He had a cardiac arrest and needed ventilatory support. The diagnosis was confirmed by the presence of type A botutinal toxin in the patient's serum. He received supportive care and botulin antitoxin, recovering without sequelae.