Wound Botulism  

Oleh:

Sam, Amir H. ; Beynon, Huw L.C.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The New England Journal of Medicine (keterangan: ada di Proquest) vol. 363 no. 25 (Dec. 2010), page 2444.
Topik: Antimicrobial Therapy; Clostridium Botulinum; Botulinum Toxin
Fulltext: Wound Botulism.pdf (59.69KB)

Ketersediaan

Perpustakaan FK Nomor Panggil: N08.K.2010.01 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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A 42-year-old man with a history of subcutaneous heroin use presented to the hospital with slurred speech, diplopia, and dysphagia. The physical examination showed bilateral ptosis (Panel A), a sluggish pupillary response to light, bilateral sixth-cranial-nerve palsies, and multiple skin abscesses on his arms and legs. Shortly after admission, the dysphagia progressed, necessitating intubation for airway protection. Single-fiber electromyography suggested a disorder of neuromuscular transmission, and a clinical diagnosis of wound botulism was made. He received empirical treatment with equine serum trivalent botulism antitoxin and antimicrobial therapy, and the abscesses were surgically débrided (Panel B). Subsequently, botulinum toxin was detected in his serum, and Clostridium botulinum was cultured from abscess specimens. The patient was extubated after 2 weeks, but complete neurologic recovery took several months. Botulinum toxin irreversibly disrupts stimulation-induced acetylcholine release at peripheral cholinergic synapses. The resulting clinical syndrome is typically characterized by bilateral cranial neuropathies and descending symmetric muscle weakness. Subcutaneous or intramuscular injection of heroin that is contaminated with spores of C. botulinum is a major risk factor for the development of wound botulism.

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