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BOTULISM 4

Clinical features
Clostridium botulinum
Diagnosis
Mechanisms of action
Pathology
Prevention
Prognosis
Structure
Types
Clinical Syndromes
  Food-borne
  Iatrogenic: Generalized
  GI colonization
  Infantile
  Inhalation
  Wound

Justinus Kerner

Emile Van Ermengem

Clostridium
botulinum

Causative organisms
Botulinum Toxin: Proteins & Transport
Botulinum toxin: Mechanism of action at presynaptic nerve terminals 2
Botulinum toxin: Subtypes & Features
Botulism: Clinical features
Botulism: Diagnosis
Botulism: Clinical syndromes

Food-borne
GI colonization
Iatrogenic
Inhalation
Wound


Botulism: Prevention
Botulism: Pathology of terminal axons


Botulinum toxin treatment: Terminal axons at Neuromuscular junctions (Rat)
Botulinum toxin induces: Enlargement of NMJs (middle) & Sprouting of nerve terminals (middle & top)

Normal NMJ
Terminal axon branches at NMJ (Surrounded by esterase stain (blue)


Also see: Terminal axon sprouting

Botulinum toxin: Muscle pathology

H&E stain
Muscle Fiber Sizes
  Varied
  All fibers are small
  Aggregates in some muscle fibers are targets

H&E stain


NADH stain
Botulinum toxin: Targets, NADH stain
  Rounded pale regions in muscle fibers
  Usually surrounded by dark rim

NADH stain

VvG stain
Botulinum toxin: Targets, VvG stain
  Rounded dark regions in muscle fibers
  Usually surrounded by irregular cytoplasm

VvG stain

ATPase pH 9.4 stain
Botulinum toxin: Fiber types
  Atrophy: All muscle fibers
  Type 2 fibers (Dark): Smaller than type 1

ATPase pH 9.4 stain


ATPase pH 4.3 stain
Botulinum toxin: Fiber types
  Few small type 2 C fibers


Esterase stain
Botulinum toxin: Neuromuscular Junctions
  Varied morphology
    Dark-stained
    Several patches on one fiber
    Small & Pale

Esterase stain

Botulinum Toxin, Type B

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References
1. Muscle Nerve 2000;23:1137-1144
2. Nature Structural Biology 2000;7:617-619
3. JAMA 2001;285:1059-1070
4. Annu Rev Pharmacol Toxicol 2004;44:167193
5. Neurology 2005;64:20292032
6. Emerg Infect Dis 2009;15:69-71
7. J Zoo Wildl Med 2012;43:388-390
8. Case Rep Neurol 2012;4:113-115, Neuromuscul Disord 2012 Jun 22
9. Neurology 2005;65:1694-700, Emerg Infect Dis 2012;18:102-104
10. Clin Microbiol Infect 2015; Oct 20
11. Toxicology 201;335:79-84
12. MMWR Morb Mortal Wkly Rep 2019 ;67(5152):1415-1418

5/29/2019