Clostridium botulinum

• gram positive anaerobic bacillus
• 7 serotypes A-G
• produces botulinum toxin, a neurotoxin which irreversibly blocks the release of acetylcholine
• may result from eating contaminated food (e.g. tinned) or intravenous drug use
• neurotoxin often affects bulbar muscles and autonomic nervous system

Features

• patient usually fully conscious with no sensory disturbance
• flaccid paralysis
• diplopia
• ataxia
• bulbar palsy

Treatment

• botulism antitoxin and supportive care
  • antitoxin is only effective if given early - once toxin has bound its actions cannot be reversed