Botulism

1. What is the mechanism behind botulism?
2. When does botulism occur after ingestion?
3. What is the presentation of botulism?
4. What does EMG show?
5. What is the treatment for botulism?

Answers:
1. Toxin blocks exocystosis of ACh from nerve terminal.
2. Begins 2-7 days after ingestion.
3. Bulbar symptoms first (ptosis, dysphagia, dysarthria), diarrhea, N/V, widespread paralysis or flaccidity, abnormal MSR, respiratory and cardiac dysfunction.
4. SNAP normal, CMAP reduced amplitude, unstable MUAP.
5. Trivalent ABE antitoxin, wait for collateral sprouting.