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VIBE ✔️ CHECK
QUESTION :
An 18-year-old woman has eaten homemade preserves. Eighteen hours later, she develops diplopia, dysarthria, and dysphagia. She presents to the emergency room for assessment and on examination her blood pressure is 112/74 mmHg, heart rate 110/min, and respirations 20/min. The pertinent findings are abnormal extraocular movements due to cranial nerve palsies, difficulty swallowing and a change in her voice. The strength in her arms is 4/5 and 5/5 in her legs, and the reflexes are normal. Which of the following is the most likely causative organism?
reasoning : medium
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🤔 Analysis & Reasoning:
*Okay, the user is describing an 18-year-old woman who ate homemade preserves and now has diplopia, dysarthria, dysphagia, abnormal extraocular movements due to cranial nerve palsies, and difficulty swallowing with a voice change. She has 4/5 strength in her arms and 5/5 in her legs, with normal reflexes. I need to determine the most likely causative organism.
First, I should think about the symptoms. Diplopia, dysarthria, and dysphagia suggest cranial nerve involvement. The fact that she ate homemade preserves points to a foodborne illness. The time frame is 18 hours after ingestion, which is relatively rapid.
Cranial nerve palsies and dysphagia are characteristic of botulism, caused by Clostridium botulinum. The toxin affects the autonomic and motor nerves, leading to these symptoms. The normal strength in the legs and normal reflexes fit with botulism, as it primarily affects cranial nerves early on.
Other foodborne illnesses like Salmonella or E. coli don't typically cause cranial nerve palsies. Tetanus, caused by Clostridium tetani, causes muscle rigidity and spasms, not cranial nerve issues. So botulism is the most likely culprit here.
I should also consider the source of the homemade preserves. Improperly canned foods can harbor Clostridium botulinum spores, which produce the toxin. The symptoms align with botulism, and the time frame is consistent with the onset after ingestion.
Therefore, the most likely causative organism is Clostridium botulinum.*
💬 Final Response:
Clostridium botulinum is the most likely causative organism. This bacterium produces a potent neurotoxin that can contaminate improperly canned or preserved foods, such as homemade preserves. The toxin affects the autonomic and motor nerves, leading to cranial nerve palsies (diplopia, dysarthria, dysphagia, voice changes) and muscle weakness. The presentation of early cranial nerve involvement with normal limb strength and reflexes is characteristic of botulism.
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🤔 Analysis & Reasoning:
*We need to analyze the scenario. 18-year-old woman, homemade preserves, 18 hours later diplopia, dysarthria, dysphagia. Exam: abnormal extraocular movements due to cranial nerve palsies, difficulty swallowing and a change in her voice. Strength arms 4/5, legs 5/5, reflexes normal. So cranial nerve palsies, bulbar symptoms, mild weakness in arms. This suggests botulism? Botulism causes descending paralysis, but usually starts with cranial nerve palsies (diplopia, dysarthria, dysphagia), then descending flaccid paralysis. It can be caused by Clostridium botulinum in improperly preserved foods. The onset is about 12-48 hours. The weakness is descending, but early bulbar. The reflexes are normal. That fits botulism. So the causative organism is Clostridium botulinum.
But the question: "Which of the following is the most likely causative organism?" The answer: Clostridium botulinum. The scenario: homemade preserves (home canning). Botulism from improperly canned foods. So yes.
We need to consider other possibilities: Myasthenia gravis? No. Guillain-Barré? No. Listeria? No. C. botulinum. So answer: C. botulinum. Provide explanation.
We should consider the differential: Botulism: flaccid paralysis, cranial nerve involvement, descending. The key is normal reflexes. So yes.
Thus answer: Clostridium botulinum.
We might mention that it's a gram-positive, anaerobic, spore-forming rod. The toxin is a neurotoxin that blocks acetylcholine release at neuromuscular junction. So that is the likely cause.
Thus final.*
💬 Final Response:
Answer: Clostridium botulinum
Why this fits
| Feature | Botulism (C. botulinum) | Other causes |
| Onset after home‑canning | 12–48 h, often 18 h | GBS, myasthenia, etc.|
| Initial symptoms | Cranial nerve palsies → diplopia, dysarthria, dysphagia | Usually generalized weakness first |
| Pattern of weakness | Flaccid, descending paralysis | Ascending in GBS |
| Reflex status | Normal (no hyperreflexia or hyporeflexia) | GBS → areflexia; myasthenia → normal |
| Muscle strength | Mild arm weakness (4/5) → later legs | GBS → proximal > distal, often severe |
| Risk factor | Improperly canned/ preserved foods | – |
Botulism is caused by the neurotoxin produced by Clostridium botulinum, a gram‑positive, obligate anaerobe that forms heat‑stable spores. The toxin blocks acetylcholine release at the neuromuscular junction, producing the characteristic cranial‑nerve‑first, descending flaccid paralysis with preserved reflexes.