tailieunhanh - Chapter 134. Botulism (Part 2)

Clinical Manifestations Food-Borne Botulism After ingestion of food containing toxin, illness varies from a mild condition for which no medical advice is sought to very severe disease that can result in death within 24 h. The incubation period is usually 18–36 h but, depending on toxin dose, can range from a few hours to several days. Symmetric descending paralysis is characteristic and can lead to respiratory failure and death. Cranial nerve involvement, which almost always marks the onset of symptoms, usually produces diplopia, dysarthria, dysphonia, and/or dysphagia. Weakness progresses, often rapidly, from the head to involve the neck, arms, thorax, and. | Chapter 134. Botulism Part 2 S0UK i F-buci as. K sper DU E. HiUíír SL Longe Du Jimtfpn JU Loic lso Ji H ffỉíữn f Prindpĩts ỮỈ JnitmtF teđỉCỉĩMì r 17Hhi Edition http_r www. cc Copyright Tht M Comp íHdtỉ Ịnc- fill ughtỉ J Clinical Manifestations Food-Borne Botulism After ingestion of food containing toxin illness varies from a mild condition for which no medical advice is sought to very severe disease that can result in death within 24 h. The incubation period is usually 18-36 h but depending on toxin dose can range from a few hours to several days. Symmetric descending paralysis is characteristic and can lead to respiratory failure and death. Cranial nerve involvement which almost always marks the onset of symptoms usually produces diplopia dysarthria dysphonia and or dysphagia. Weakness progresses often rapidly from the head to involve the neck arms thorax and legs occasionally weakness is asymmetric. Nausea vomiting and abdominal pain may precede or follow the onset of paralysis. Dizziness blurred vision dry mouth and very dry occasionally sore throat are common. Patients are generally alert and oriented but they may be drowsy agitated and anxious. Typically they have no fever. Ptosis is frequent the pupillary reflexes may be depressed and fixed or dilated pupils are noted in half of patients. The gag reflex may be suppressed and deep tendon reflexes may be normal or decreased. Sensory findings are usually absent. Paralytic ileus severe constipation and urinary retention are common. Wound Botulism Wound botulism occurs when the spores contaminating a wound germinate and form vegetative organisms that produce toxin. This rare condition resembles food-borne illness except that the incubation period is longer averaging about 10 days and gastrointestinal symptoms are lacking. Wound botulism has been documented after traumatic injury involving contamination with soil in injection drug users for whom black-tar heroin use has been identified as a risk .

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