USMLE WORld Clostridium Botulinism QUestion ??

[medInUSA]

---

Members do not see this ad.

The following USMLE world question is weird:

A woman brings her 10 week old child to a Emergency department, because he hadn't had a bowel movement in 3 days. IN addition his suckling and crying have been feebler than normal. He has been breast fed since birth and his grrandmother feeds him HONEY. Immunizations are up to date.
He appears weak and listless. What is the most appropriate treatment option for this baby

A. blah
B. bla
C. Administration of equine derived botulinum antitoxin
D. Supportive care
E. Tetanus Vaccine and Toxoid

 

[medInUSA]

Answer is D supportive therapy. !!!!!!!!

explanation:

"This is infant botulinism which occurs in kids younger than one caused by ingestion of C botulinum. Supportive care is the mainstay of therapy for infant botulinism. they should be admitted to the hospital because they frequently require airway management. nasogastric tube feeding, administration of purgatives and physical and occupational therapy.

those infants diagnosed with infant botulinism should be given human derived botulinum antitoxin as early as possible in the course of the illness to reduce the severity and duration of symptoms."

what the hell!! they are contradicting themselves within the same explanation. ANd I think I remember another question where human derived antitoxin was the right choice.

SO which one is it supportive care or human derived antitoxin?????

 

[medInUSA]

by the way this question was only answered correctly by 28% of people

 

[SOUNDMAN]

look at the answer you posted and you'll see why supportive care is correct.

The answer in the question says "EQUINE" derived. It should be human derived according to the explanation. Sneaky, sneaky they are!!

 

[RussianJoo]

yep.. exactly.. they'll never have human derived antitoxin and supportive care together as answer choices. you just have to be more careful and pay more attention to the details.

 

[Scaredshizzles]

look at the answer you posted and you'll see why supportive care is correct.

The answer in the question says "EQUINE" derived. It should be human derived according to the explanation. Sneaky, sneaky they are!!

Per wiki



The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing passive immunity with a horse-derived antitoxin, which blocks the action of toxin circulating in the blood.[9] This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.


Besides supportive care, infant botulism can be treated with botulism immunoglobulin intravenously (BIG-IV),(source Microbiology 2nd edition baumen 2009) when available. Supply is extremely limited, but is available through the California Department of Health Services. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period.





Which makes me wonder, is horse serum a no-no in infants? Is this a general principle? Any pedi immunologists out there?

 

[RussianJoo]

Per wiki



The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing passive immunity with a horse-derived antitoxin, which blocks the action of toxin circulating in the blood.[9] This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.


Besides supportive care, infant botulism can be treated with botulism immunoglobulin intravenously (BIG-IV),(source Microbiology 2nd edition baumen 2009) when available. Supply is extremely limited, but is available through the California Department of Health Services. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period.





Which makes me wonder, is horse serum a no-no in infants? Is this a general principle? Any pedi immunologists out there?

I wouldn't call Wiki a primary source.. If you ever quote wiki at my hospital it's an automatic extra 2 calls. So my advice don't quote wiki to your attendings, unless you like to look like a fool.

 

[Scaredshizzles]

I wouldn't call Wiki a primary source.. If you ever quote wiki at my hospital it's an automatic extra 2 calls. So my advice don't quote wiki to your attendings, unless you like to look like a fool.

While you are correct, I couldn't care less. I'm smart enough to determine whether the material is accurate or not...Wikipedia is almost always accurate, though not always precise enough.

A new age has dawned in America with the election of President Obama; I truly believe this. And it was the younger generations who dared to look past the age old conventions and biases---if you dare to change the world, this is how you do it. The real tool is the person who follows along with every conventional wisdom and is too cowardly to ever challenge them and too cowardly to endure the ridicule of a know-nothing attending. Picking on wikipedia as a source is like picking on someone for not having the perfect grammar because he didn't have the perfect British boarding school education, as if that actually determines his intelligence. Now granted, I rarely quote wikipedia (if ever) to an attending because what is in wikipedia is generally common knowledge and doesn't require a source. The detailed stuff attendings usually ask you to look up requires a literature search.

And where are you that attendings determine your call schedule out of curiosity? Or was that tongue in cheek..I can never figure that out with you russianjoo.

 

[rup47]

i think there is a high incidence of serum sickness to the equine derived toxin so it is not recommended for infant botulism anymore. If it is deemed necessary that more than supportive care is neede then the human derived anti toxin should be used. At least that is what i think is what they were trying to say without being clear in their explanation

 

[wonderboy00]

While you are correct, I couldn't care less. I'm smart enough to determine whether the material is accurate or not...Wikipedia is almost always accurate, though not always precise enough.

A new age has dawned in America with the election of President Obama; I truly believe this. And it was the younger generations who dared to look past the age old conventions and biases---if you dare to change the world, this is how you do it. The real tool is the person who follows along with every conventional wisdom and is too cowardly to ever challenge them and too cowardly to endure the ridicule of a know-nothing attending. Picking on wikipedia as a source is like picking on someone for not having the perfect grammar because he didn't have the perfect British boarding school education, as if that actually determines his intelligence. Now granted, I rarely quote wikipedia (if ever) to an attending because what is in wikipedia is generally common knowledge and doesn't require a source. The detailed stuff attendings usually ask you to look up requires a literature search.

And where are you that attendings determine your call schedule out of curiosity? Or was that tongue in cheek..I can never figure that out with you russianjoo.

great response!!! although russianjoo often has insightful and helpful comments, we'd be better off without his wanna-be smart-alec comments.

 

[RussianJoo]

While you are correct, I couldn't care less. I'm smart enough to determine whether the material is accurate or not...Wikipedia is almost always accurate, though not always precise enough.

A new age has dawned in America with the election of President Obama; I truly believe this. And it was the younger generations who dared to look past the age old conventions and biases---if you dare to change the world, this is how you do it. The real tool is the person who follows along with every conventional wisdom and is too cowardly to ever challenge them and too cowardly to endure the ridicule of a know-nothing attending. Picking on wikipedia as a source is like picking on someone for not having the perfect grammar because he didn't have the perfect British boarding school education, as if that actually determines his intelligence. Now granted, I rarely quote wikipedia (if ever) to an attending because what is in wikipedia is generally common knowledge and doesn't require a source. The detailed stuff attendings usually ask you to look up requires a literature search.

And where are you that attendings determine your call schedule out of curiosity? Or was that tongue in cheek..I can never figure that out with you russianjoo.

i am at hospital in NJ and the co-program director makes our call schedules, and he is the one who usually rounds with us. so yeah he can change our call schedule to be whatever he wants it be. not sure who makes the call schedule at your hospital but that's how it is for all our rotations.

can never figure out with me? how many of my posts have you read.. i hardly post on here and when i do it's usually a question.

 

[RussianJoo]

great response!!! although russianjoo often has insightful and helpful comments, we'd be better off without his wanna-be smart-alec comments.

wanna be? I resent that.. I am definitely not a wanna be...