RISK FACTORS: Foodborne - ingestion of home-canned or prepared foods, Infantile from ingestion of honey. Breast feeding (controversial), Wound - IV drug use (e.g., black tar heroin) or skin popping
APPROPRIATE HEALTH CARE:
Inpatient, with maximal monitoring capabilities, especially for respiratory failure
GENERAL MEASURES:
β’ Meticulous airway management
β’ Monitor pulmonary function
β’ Physical therapy with range of motion exercise and assisted ambulation as tolerated
β’ Prevention of decubiti
SURGICAL MEASURES: Wound excision debridement
DRUG(S) OF CHOICE:
* Antitoxin therapy with trivalent A-B-E antitoxin (available at CDC (404) 639-3670 or 639-2888), one vial IV
and one vial IM, repeat IV in 2-4 hours if symptoms persist
* Penicillin therapy of unclear value
* Infantile
. Antitoxin therapy not needed
. Penicillin therapy of unclear value
. Enemas may assist in removal of toxin
* Wound
. Antitoxin therapy with trivalent A-B-E antitoxin, one vial IV and one vial IM, repeat in 2-4 hours if persistent
symptoms
. Penicillin therapy of unclear value
. Contradictions: Aminoglycosides - may potentiate paralysis
. Precautions: Serum sickness or hypersensitivity reactions in 20% of antitoxin recipients. Test before
treating.
PATIENT MONITORING : Cardiorespiratory monitoring during illness
PREVENTION/AVOIDANCE:
. Avoid giving honey to infants
. Do not eat or taste food from bulging cans, or if food is off smelling
POSSIBLE COMPLICATIONS:
. Aspiration pneumonia
. Nosocomial infection
. Hypoxic tissue damage
. Death
EXPECTED COURSE/PROGNOSIS:
* Foodborne and wound
. Mortality 25% (<10% under 20 years of age), usually due to delayed diagnosis and respiratory failure
. Full recovery may require months
. Sequelae due to hypoxic insults
* Infantile
. Mortality < 10%
. Extended recovery period and sequelae as above