Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Constipation may occur. The doctor's examination may reveal that the gag reflex and the deep tendon reflexes like the knee-jerk reflex are decreased or absent.
Infants with botulism appear lethargic, weak, and floppy, feed poorly, become constipated,
and have a weak cry and poor muscle tone. In infants, constipation is often the first symptom to occur.
These are all symptoms of the muscle paralysis that is caused by
the bacterial neurotoxin. If untreated, these symptoms may progress to cause paralysis in various parts of the body, often seen as a descending paralysis of the arms, legs, trunk, and breathing muscles.
How soon do symptoms appear?
In food-borne botulism, symptoms generally begin 18-36 hours
after eating a contaminated food, but they can occur as early as six
hours or as late as 10 days afterward.
How is botulism diagnosed?
The patient's history and physical examination may suggest
botulism, but these clues are usually not enough to allow a diagnosis
of botulism. Symptoms of other diseases,
such as a stroke, Guillain-Barré syndrome (another disease of muscle
paralysis), and myasthenia gravis (which also causes weakness and
eyelid drooping) can appear similar to those of botulism. Special
tests may be needed to exclude these other conditions. These tests
may include a brain scan, spinal fluid examination, nerve conduction
test
(electromyography, or EMG), and a tensilon test for myasthenia
gravis. However, if botulism is strongly suspected (for example, several patients with botulism symptoms who ate from the same home-preserved food container), samples should be obtained for a mouse inoculation test (see below) and
then the patients should be treated immediately with botulism antiserum. These tests will help distinguish botulism from infections with
Salmonella, E. coli, and other Clostridium species (tetanus).
The most direct way to confirm the diagnosis is to identify the botulinum neurotoxin in the patient's blood, serum, or stool. This is done by injecting the patient's serum or stool into the peritoneal cavity of mice. An equal amount of serum or stool from the patient is treated with multivalent antitoxin and injected in other mice. If the antitoxin-treated serum- or stool-injected mice live while those injected with untreated serum or stool die, then this is a positive test for botulism and is called the mouse inoculation test. The bacteria can also be isolated from the stool of people with food-borne and infant botulism, but this is not a definitive test. However, stool cultures can help differentiate botulism from
E. coli, Salmonella, and other infectious agents.
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Drug addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Wrinkles, whether they be fine line or deep furrows, typically appear on areas of the body that receive a high amount of exposure to the sun. Smoking, light skin type, hairstyle, the way you dress, your occupational and recreational habits, and heredity are all factors that promote wrinkling. Medical treatments for wrinkles include antioxidants, moisturizers, alpha-hydroxy acids, and vitamin A acid. Cosmetic procedures that treat wrinkles include dermabrasion, microdermabrasion, glycolic acid peels, laser resurfacing, Botox, and fillers.
Bioterrorism is a form of terrorism where there is the intentional release of biological agents such as viruses, germs, or bacteria. Diseases caused by bioterrorism agents include anthrax, botulism, plague, smallpox, tularemia, brucellosis, food poisoning, Q fever, ricin toxin poisoning, cholera, epidemic typhus, viral encephalitis, XDR TB, and MDR TB.
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