Adult Intestinal Botulism: A Rare Presentation in an Immunocompromised Patient With Short Bowel Syndrome

Guru, Pramod; Becker, Tara; Stephens, A. J. H.; Cannistraro, Rocco J.; Eidelman, Benjamin H.; Hata, D. Jane; Brumble, Lisa

doi:10.1016/j.mayocpiqo.2018.06.005

Cited by 12 publications

(21 citation statements)

References 19 publications

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“…Although adult intestinal toxemia botulism has been reported in previously healthy individuals with no history of gastrointestinal problems [34,[36][37][38], the majority of cases involve patients with previous bowel surgery, bowel anomalies, or recent use of antimicrobials that may disrupt the normal intestinal flora. Previous bowel and gastric surgery [33,34,37,[39][40][41][42][43][44] appear to be predisposing factors, as does Crohn's disease [37,44]. Previous administration of antibiotics, perhaps causing perturbation of the regular gut flora, has been reported for several cases [35,36,45,46].…”

Section: Predisposing Factorsmentioning

confidence: 99%

“…Severity of adult intestinal toxemia botulism may range from relatively mild cases with hospitalization for a month [38], to severe cases with prolonged hospitalization and rehabilitation [36,66], to fatality resulting from complications of botulism [39]. The clinical presentation of adult intestinal toxemia botulism is similar to other forms of botulism.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…The clinical presentation of adult intestinal toxemia botulism is similar to other forms of botulism. Initial symptoms may include one or more of nausea [46,47], vomiting [46][47][48], generalized muscle weakness [67], bloating [39] or distended abdomen [37,38,44,47,48,66], decreased bowel sounds [37,38], abdominal pain [39,[46][47][48], and constipation [38,39,41,46,48,67], in some cases lasting weeks to months [36]. Cranial nerve palsies may result in one or more cases of blurred vision, diplopia, ptosis, ophthalmoplegia, dysarthria, and dysphagia.…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…These symptoms occur in an otherwise alert and afebrile patient. The disease may progress to a descending, symmetrical flaccid paralysis, eventually causing respiratory failure requiring ventilation support [36,39,43,46]. Paralysis may progress to a point where the patient appears comatose [48,66].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

“…Paralysis may progress to a point where the patient appears comatose [48,66]. Alternative diagnoses may include Miller Fischer variant of Guillain-Barré syndrome [37,39,68,69], myasthenia gravis [37,39,44,68], viral encephalitis [37], meningitis [37], Eaton-Lambert syndrome [37], brain stem lesion [37], brain death [66], appendicitis [48], or Clostridium difficile associated diarrhea [47].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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Adult Intestinal Toxemia Botulism

Harris

Anniballi

Austin

2020

Toxins

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Intoxication with botulinum neurotoxin can occur through various routes. Foodborne botulism results after consumption of food in which botulinum neurotoxin-producing clostridia (i.e., Clostridium botulinum or strains of Clostridium butyricum type E or Clostridium baratii type F) have replicated and produced botulinum neurotoxin. Infection of a wound with C. botulinum and in situ production of botulinum neurotoxin leads to wound botulism. Colonization of the intestine by neurotoxigenic clostridia, with consequent production of botulinum toxin in the intestine, leads to intestinal toxemia botulism. When this occurs in an infant, it is referred to as infant botulism, whereas in adults or children over 1 year of age, it is intestinal colonization botulism. Predisposing factors for intestinal colonization in children or adults include previous bowel or gastric surgery, anatomical bowel abnormalities, Crohn's disease, inflammatory bowel disease, antimicrobial therapy, or foodborne botulism. Intestinal colonization botulism is confirmed by detection of botulinum toxin in serum and/or stool, or isolation of neurotoxigenic clostridia from the stool, without finding a toxic food. Shedding of neurotoxigenic clostridia in the stool may occur for a period of several weeks. Adult intestinal botulism occurs as isolated cases, and may go undiagnosed, contributing to the low reported incidence of this rare disease.

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Section: Predisposing Factorsmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Section: Diagnosis and Treatmentmentioning

confidence: 99%

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Adult Intestinal Toxemia Botulism

Harris

Anniballi

Austin

2020

Toxins

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Acute-Onset Oculobulbar and Proximal Weakness in a Patient With Crohn’s Disease

Gimarc

Barnett²,

Rad³

2021

Am J Phys Med Rehabil

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BRIEF HISTORY AND PHYSICAL EXAMINATIONThe patient is a 54-yr-old woman who was admitted to a community hospital with recurrent small bowel obstruction and 3 days of right eye ptosis, mild dysarthria, and mild dyspnea.A medical history included Crohn's disease on chronic immunosuppression, diverting colostomy, proctocolectomy, short bowel syndrome, chronic pain, and osteoporosis. Functionally, she was modified independent with ambulation, using single-point cane intermittently and independent with activities of daily living. She had a caregiver for assistance with instrumental activities of daily living because of chronic pain and fatigue. She had no family history of neurologic disease.At the community hospital, she was started on intravenous methylprednisolone for small bowel obstruction. Over the next several days, she developed progressive, proximal greater than distal weakness in the bilateral upper limbs and neck, bilateral ptosis with diplopia, facial weakness, hypophonia, worsening dysarthria, and dysphagia. Intravenous immunoglobulin was initiated for presumed myasthenia gravis crisis without significant improvement. She also received pyridostigmine on hospital day 4 without improvement in neurologic symptoms. She ultimately required intubation and tracheostomy for acute hypoxemic respiratory failure on hospital day 8 and was transferred to our tertiary care hospital on hospital day 12.Physical examination on hospital day 13 revealed the following: Cognition: oriented, able to write responses to questions Speech: aphonic secondary to tracheostomy and mechanical ventilation Cranial nerves: visual fields full. Extraocular eye movements intact. Severe bilateral ptosis, worsened with sustained upward gaze. Facial weakness with puffing cheeks.

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Clostridium botulinum

Johnson

2019

Food Microbiology

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Adult Intestinal Botulism: A Rare Presentation in an Immunocompromised Patient With Short Bowel Syndrome

Cited by 12 publications

References 19 publications

Adult Intestinal Toxemia Botulism

Adult Intestinal Toxemia Botulism

Acute-Onset Oculobulbar and Proximal Weakness in a Patient With Crohn’s Disease

Clostridium botulinum

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