While rummaging through the pantry, a 14 yr old boy found a can of Spam. He proc
ID: 58950 • Letter: W
Question
While rummaging through the pantry, a 14 yr old boy found a can of Spam. He proceeded to eat the canned meat without thorough heating. His mother returned home from grocery shopping and noticed that her son had dilated pupils, his right eye turned outward, he was limped, he was grasping for air, and his breathing was labored and difficult. She rushed her son to nearest ER where appropriate treatment is initiated. As the trauma nurse, what is your first step in the management of this patient? What is the most likely diagnosis? What is the most likely organism? What is the treatment of choice? What is the likely pathogenesis to this condition?
Explanation / Answer
As a trauma nurse, emptying the stomach or inducing the vomiting would be the first step in management of a patient with mild symptoms and provided food ingestion was recent. However, as in this patient the neurological symptoms started appearing, it is important to inject anti toxin and provide assistance in breathing.
Following the initial management, it is important to diagnose the disease. The most likely diagnosis of such patients includes physical examination of the patient at first instance followed brain scan/ spinal fluid examination and nerve conduction test.
Based on the symptoms, it may be inferred that the canned meat was infected with Clostridium botulinum that resulted in Botulism in the 14-year boy.
The treatment of choice would include inducing vomiting to facilitate removal of contaminated food, intradermal injection of anti- toxin that will bind to botulism toxin to prevent further neurological implications and in worse case, use of ventilators that will aid in breathing.
Pathogenesis of Botulism mediated by Clostridium botulinum- The toxin of Clostridium botulinum cleaves the proteins that aid in the fusion of membranes, an important step required for the release of acetyl choline from the synaptic vesicles into the synapse. Therefore, the toxin acts by blocking the release of acetyl choline into the synapse which accounts for the appearance of neurological symptoms.
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