Describe the causative microbial agent of botulism?
First topic questions
Why was the doctor interested in Grandma’s canned veggies?
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What is the mechanism of action of botulinum toxin?
What is the treatment for botulism?
Can botulinum toxin be a used as a drug? How and Why?
second topic questions
Describe the likely causative microbial agent and how it causes the disease presentation.
What is the route of infection? Is it contagious? If so, how can it be spread?
What is the treatment regimen for this disease?
Sarah, a twenty-one-year-old student at the University of Maryland – College Park had spent Thanksgiving day with relatives at her grandparent’s farm. During her drive back to campus on Friday morning her vision became blurry, and she was forced to pull over to the side of the road. As she sat in her car, her vision worsened. She opened the car hood in hope of attracting aid and tried to relax. In a short time, a Maryland State Trooper pulled over and approached Sarah. By this time, Sarah was having trouble swallowing and speaking clearly. The officer helped Sarah to his car and rushed her to the emergency room at a nearby hospital.
In the ER, Sarah was able to describe her symptoms to a physician. The physician made note of what Sarah had eaten during the last 24 hours and was especially interested in the fact that Sarah’s grandmother canned all of her own vegetables. The physician observed that Sarah’s breathing was becoming labored. She ordered Sarah’s blood sampled, her stomach pumped, and a mechanical respirator prepared for use. Fearing that Sarah suffered from a case of botulism, she asked that Sarah’s grandparents be contacted and samples of the Thanksgiving meal retained, if possible, and sent to a local clinic for analysis.
A 50-year-old college professor consulted his primary health-care provider because of tiredness, lethargy, and an abdominal pain centered around the lower end of his sternum, which woke him in the early hours of the morning. The pain was relieved by food and antacids. His uncle had died of stomach cancer and he was worried that he had the same illness.
Abdominal pain has an extremely broad differential diagnosis list. Certain features often help in determining which is the most likely etiology. Lower-right quadrant pain suggests appendicitis, whereas upper-right quadrant pain is suggestive of cholecystitis or cholelithiasis. The absence of diarrhea or emesis makes gastroenteritis and Crohn disease unlikely. Esophagitis or reflux disease would likely have chest pain as a prominent symptom. Pain associated with signs of acid hypersecretion suggests peptic ulcer disease. However, these are generalizations. and other factors, such as lab results and endoscopy should be considered.
On examination his doctor noted that he seemed a bit pale and that he had a tachycardia. His blood pressure was low. He was slightly tender in his upper abdomen but there was no guarding or rebound tenderness. The doctor took blood and fecal samples. The complete blood count (CBC) showed a hypochromic normocytic anemia with a hematocrit of 38% and a hemoglobin of 8.9 gram/100 mL consistent with iron deficiency anemia. The fecal antigen test for the suspected microorganism was positive as was the 13C urea-breath test.
An upper gastrointestinal endoscopy was conducted and the gastroscopic exam showed a 3cm ulcer in the prepyloric region of the stomach. PCR (polymerase chain reaction) analysis of the gastric biopsy confirmed the identity of the microorganism. The patient was started on routine treatment for a duodenal ulcer.