— Kristina Lucare🥂i (@KristinaLuca) June 22, 2017
Filed under: human-condition, humanity Tagged: twitter
Today’s pearl is courtesy of North Korea. They claimed that Otto Warmbier, an imprisoned American who unfortunately died a few days after his return to the US, had suffered brain damage after contracting botulism. If you think that sounds wonky, you’re probably right. If you thinks that sounds probable, here is a refresher on botulism, a rare but deadly disease.
Anaerobic Clostridium botulinum produces an endotoxin that inhibits ACh release, resulting in neuromuscular paralysis; untreated can lead to respiratory failure. The spores can be found in soil, and are heat resistant.
(OK, I don’t want to agree with NK, but I suppose theoretically he could have had anoxic brain injury from botulism induced acute resp failure. I’m no federal agent [or am I?], but I think it is more probable that they accidentally overdosed him.)
There are multiple ways to acquire botulism:
Symptom onset: 6-48 hours s/p toxin poisoning
Diagnosis is made clinically; exclude other conditions (ie, LP to r/o GBS).
Assay not commonly available; can ID toxin in serum or stool.
Food source can also be tested for toxin.
Look who wrote this Tintinalli topic –
Andrus, Phillip, and J. Michael Guthrie. “Acute Peripheral Neurologic Disorders.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e Eds. Judith E. Tintinalli, et al. New York, NY: McGraw-Hill, 2016, http://accessemergencymedicine.mhmedical.com/content.aspx?bookid=1658§ionid=109437018.
Originally published at Pediatric EM Morsels on September 17, 2015. Reposted with permission.
Follow Dr. Sean M. Fox on twitter @PedEMMorsels
Fever is one of the most common chief complaints in the Peds ED. We are all very accustomed to the common considerations (ex, UTI, Croup, Bronchiolitis, Appendicitis, and Sinusitis). We also know there are “zebras” that may try to trample us (ex, Kawasaki’s, Myocarditis, Osteomyelitis, Acute Rheumatic Disease, Lemierre’s, and Cat Scratch Disease). Additionally, we are aware of how important it is to avoid the “It’s Just a Virus” statement. On occasion though, the cause of the fever will not be clear, but the prolonged fever warrants concern. Let us, now, look at Fever of Unknown Origin.
Tezer H1, Ceyhan M, Kara A, Cengiz AB, Devrim İ, Seçmeer G. Fever of unknown origin in children: the experience of one center in Turkey.Turk J Pediatr. 2012 Nov-Dec;54(6):583-9. PMID: 23692783. [PubMed] [Read by QxMD]
Chow A1, Robinson JL. Fever of unknown origin in children: a systematic review. World J Pediatr. 2011 Feb;7(1):5-10. PMID: 21191771. [PubMed] [Read by QxMD]
Tolan RW Jr1. Fever of unknown origin: a diagnostic approach to this vexing problem. Clin Pediatr (Phila). 2010 Mar;49(3):207-13. PMID: 20164070. [PubMed] [Read by QxMD]
Berezin EN1, Iazzetti MA. Evaluation of the incidence of occult bacteremia among children with fever of unknown origin. Braz J Infect Dis. 2006 Dec;10(6):396-9. PMID: 17420912. [PubMed] [Read by QxMD]