Document Detail

Progression of clinical signs in severe infant botulism. Therapeutic implications.
MedLine Citation:
PMID:  6257443     Owner:  NLM     Status:  MEDLINE    
The clinical evaluation of nine patients with severe infant botulism revealed an identifiable progression of signs due to blockade of the cholinergic synapse similar to that described for competitive blocking agents. This predictable sequence reflects different "margins of safety" for muscles involved in repetitive activities, diaphragmatic function and movement of the extremities. It is important for the clinician to realize that return of peripheral motor activity does not signify a completely recovered cholinergic synapse. Instead of having a four- to five-fold margin of safety, the infant remains close to the point of neuromuscular blockade. Added insults or stress to neuromuscular transmission may precipitate respiratory failure. An understanding of the signs associated with progressive impairment of cholinergic synapses both during onset and during resolution of disease will allow safe care of the infant and will diminish the risk of iatrogenic complications. Evaluation of head control is the most sensitive physical finding indicative of return of adequate neuromuscular function and signifies that oral feedings can be reinstituted.
C L'Hommedieu; R A Polin
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical pediatrics     Volume:  20     ISSN:  0009-9228     ISO Abbreviation:  Clin Pediatr (Phila)     Publication Date:  1981 Feb 
Date Detail:
Created Date:  1981-04-21     Completed Date:  1981-04-21     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0372606     Medline TA:  Clin Pediatr (Phila)     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  90-5     Citation Subset:  AIM; IM    
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MeSH Terms
Autonomic Nervous System / physiopathology
Autonomic Nervous System Diseases / etiology
Botulism / complications,  physiopathology*
Motor Activity / physiology
Muscles / physiopathology
Neuromuscular Junction / physiopathology
Respiratory Insufficiency / etiology
Stress, Physiological / complications
Synaptic Transmission

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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