Medical After Action Report

File: doc04_22.txt
Page: 22
Total Pages: 23
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        b.  ~ BOTULISM

     Botulism is a life threatening,   paralytic illness produced by
   neurotoxin  elaborated  by  Clostridium botulinum~   The  natural
   disease is primarily from food poisoning although wound botulism
   and infant botulism do occur.   The TOXIN released by the bacteria
   during growth has eight immunologically distinct toxin types and
   a given bacterial strain produces only a single toxin type.    The
   toxins interfere with neurotransmission at peripheral cholinergic
   synapses  by   binding tightly  to the  presynaptic  membrane  and
   preventing the release of the neurotransmitter acetylcholine.  The
   SYMPTOMS are therefore those of atropine poisoning and exactly the
   opposite of    chemical nerve  agent poisoning.   Paralysis  is a
   symmetrical, descending, flaccid paralysis and occurs quickly after
   inhalation (3 - 48 hours post-exposure).
   The interruption of cholinergic autonomic transmission results in
   diminished salivation and extreme dryness of the mouth,   tongue,
   and pharynx, which is unrelieved by drinking fluids. The dryness
   may be quite painful and cause the patient to complain of 11sore
   throat1'. Ileus,   constipation, and urinary retention can result.
   A constellation of   SIGNS  suggest the diagnosis: 1) unexplained
   postural hypotention; 2) dilated, unreactive pupils; 3) dry mucous
   membranes;  4) descending paralysis with progressive respiratory
   weakness; and 5) the absence of fever.
     DIAGNOSIS can be confirmed by demonstration of botulinum toxin
   in the blood~stream of the patient and can be accomplished by the

     TRE~:NTof precipitous respiratory failure with early elective
   tracheostomy and the use of ventilatory assistance can be life-
   saving.  If ileus is profound, nasogastric suction and parenteral
   nutrition   may  be  necessary.   Urinary  retention will require
   indwelling bladder catheterization.  Fever signifies a complicating
   nosocomial bacterial infection.   ANTITOXIN therapy is recommended
C,_                                       and should be administered
   as soon  as   possIble a~t~r  specimens for  laboratory  study are
   obtained.     Antitoxin may be  beneficial even if  delayed.   All
   antitoxins    are of equine origin  and up  to 20  percent of  the
   patients have,untoward reactions.
     An active VACCINE is available and will be administered as a
   three shot series - the first two at a two week interval and the
   third at 10 weeks.    The vaccine does not cover all serotypes of
   toxin.

        c.  STAPHYLOCOCCAL ENTEROTOXIN B (SEB)

     About  half  of  all isolated  strains of  Sta~hylococcus aureus
   produce  enterotoxins,  of  which  ther are  presently five  (A-E)
   serologically distinct types.     They are a major cause  of   food
   poisoning and some (e.g. - enterotoxin F) have been implicated in
   the Toxic Shock Syndrome.  These remarkably heat-stable TOXINS have
   an unknown    mode of action,  but definitely  increase  intestinal