EGYPTIAN PROTOCOL FOR MANAGEMENT OF BOTULISM

Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum. Botulinum toxin binds irreversibly to presynaptic nerve endings at neuromuscular junctions. Through receptor-mediated endocytosis, toxin enters the cell and cleaves SNARE proteins, which are necessary for release of Acetylcholine into the synaptic cleft. Blockade of voluntary motor and autonomic cholinergic junctions leads to xerostomia (dry mouth), blurry vision, diplopia, dysphonia, dysarthria, dysphagia, and other muscle weakness. The most concerning clinical manifestation is when blockade affects respiratory muscles leading to respiratory failure. Stabilization of respiration is the most important in botulism, since the main cause of death is respiratory failure. Botulinum antitoxin is the specific antidote in case of botulism. Treatment of botulism is time sensitive; the antitoxin should be given as soon as possible once botulism is diagnosed. Having an interprofessional team of toxicologists, emergency medicine physicians, nurses, and pharmacists is important for decreasing time to diagnosis and ensuring patient safety during drug administration. Poison control should immediately be contacted if a patient has suspected botulism. Wound botulism requires incision and thorough debridement of the infected wound, antitoxin therapy, and high-dose intravenous penicillin therapy.