What are the primary causes of botulism. How can botulism be prevented and treated. What are the most common symptoms of botulism in adults and infants. Why is botulism considered a medical emergency.

Understanding Botulism: A Rare but Serious Condition

Botulism is an uncommon yet potentially life-threatening illness caused by toxins produced by the bacteria Clostridium botulinum. This condition affects the nervous system, leading to muscle paralysis and, in severe cases, respiratory failure. Despite its rarity, botulism demands immediate medical attention due to its potentially fatal nature.

Types of Botulism

There are three primary forms of botulism:

• Foodborne botulism
• Wound botulism
• Infant botulism

Each type has distinct characteristics and transmission methods, but all share the common thread of the botulinum toxin’s devastating effects on the human body.

Foodborne Botulism: When Preservation Turns Deadly

Foodborne botulism occurs when a person consumes food contaminated with the botulinum toxin. This form of botulism is often associated with improperly canned or preserved foods, particularly those low in acid content.

Common Sources of Foodborne Botulism

While home-canned foods are the most frequent culprits, other sources have been identified:

• Fruits and vegetables
• Fish
• Spicy peppers (chiles)
• Foil-wrapped baked potatoes
• Oil infused with garlic

The bacteria thrive in environments with little oxygen, making improperly canned foods an ideal breeding ground. When consumed, the toxin disrupts nerve function, leading to paralysis.

Symptoms of Foodborne Botulism

Symptoms typically manifest between 12 and 36 hours after ingesting the toxin, although this timeframe can vary based on the amount consumed. Key indicators include:

• Difficulty swallowing or speaking
• Facial weakness
• Blurred or double vision
• Drooping eyelids
• Breathing difficulties
• Nausea, vomiting, and abdominal cramps
• Paralysis

Wound Botulism: When Injuries Become Infected

Wound botulism occurs when C. botulinum bacteria enter a wound and produce toxins. This form has seen an increase in recent years, particularly among individuals who inject drugs, especially black tar heroin.

Recognizing Wound Botulism

Symptoms of wound botulism typically appear about 10 days after exposure to the toxin. They closely resemble those of foodborne botulism, including:

• Difficulty swallowing or speaking
• Facial weakness
• Vision problems
• Drooping eyelids
• Breathing difficulties
• Paralysis

It’s important to note that the wound may not always appear red or swollen, making diagnosis challenging without proper medical evaluation.

Infant Botulism: A Unique Threat to Babies

Infant botulism is the most common form of botulism, typically affecting babies between 2 and 8 months of age. Unlike other forms, infant botulism occurs when babies ingest C. botulinum spores, which then grow and produce toxins in their intestinal tracts.

Sources of Infant Botulism

While honey is a known source of infant botulism, exposure to soil contaminated with the bacteria is more likely to be the culprit. This highlights the importance of maintaining a clean environment for infants.

Recognizing Infant Botulism

Symptoms of infant botulism can appear within 18 to 36 hours after toxin exposure. Parents and caregivers should be alert for the following signs:

• Constipation (often the first sign)
• Floppy movements and poor head control
• Weak cry
• Irritability
• Drooling
• Drooping eyelids
• Tiredness
• Difficulty sucking or feeding
• Paralysis

The Urgency of Botulism Treatment

Botulism is a medical emergency that requires immediate attention. Early diagnosis and treatment are crucial for improving survival rates and reducing the risk of complications.

Why is Botulism Considered a Medical Emergency?

Botulism is classified as a medical emergency due to its potential for rapid progression and life-threatening complications. The toxin’s ability to cause widespread muscle paralysis can lead to respiratory failure if left untreated. Moreover, prompt medical intervention can help prevent the toxin from binding to additional nerve endings, potentially limiting the extent of paralysis.

Treatment Approaches for Botulism

Treatment for botulism typically involves a multi-faceted approach:

1. Antitoxin administration: This helps neutralize toxins circulating in the bloodstream.
2. Supportive care: This may include mechanical ventilation for patients experiencing respiratory difficulties.
3. Wound care: For cases of wound botulism, proper cleaning and, if necessary, surgical intervention to remove infected tissue.
4. Monitoring: Close observation of vital signs and neurological function.

In cases of infant botulism, a specific treatment called Botulism Immune Globulin Intravenous (Human), or BIG-IV, may be administered.

Preventing Botulism: Safety Measures and Precautions

While botulism is rare, its severity makes prevention crucial. Understanding and implementing proper food handling and wound care can significantly reduce the risk of contracting this potentially fatal illness.

Food Safety to Prevent Foodborne Botulism

To minimize the risk of foodborne botulism, consider the following precautions:

• Follow proper canning techniques, especially for low-acid foods.
• Avoid consuming food from bulging or damaged cans.
• Refrigerate homemade oil infusions containing garlic or herbs.
• Heat home-canned foods to a rolling boil for 10 minutes before consuming.
• Never feed honey to infants under 12 months of age.

Wound Care to Prevent Wound Botulism

To reduce the risk of wound botulism:

• Clean all wounds thoroughly, even minor cuts.
• Seek medical attention for deep or dirty wounds.
• Avoid injecting drugs, particularly black tar heroin.

The Surprising Benefits of Botulinum Toxin

Despite its potent toxicity, botulinum toxin has found beneficial applications in both medical and cosmetic fields. Its ability to paralyze muscles has been harnessed for various therapeutic purposes.

Medical Applications of Botulinum Toxin

Botulinum toxin, particularly onabotulinumtoxinA (Botox), has been used to treat various medical conditions:

• Chronic migraines
• Eyelid spasms
• Cervical dystonia
• Excessive sweating (hyperhidrosis)
• Overactive bladder

Cosmetic Uses of Botulinum Toxin

In the cosmetic industry, botulinum toxin is widely used for:

• Reducing facial wrinkles
• Treating frown lines
• Minimizing crow’s feet

While these applications have proven effective, it’s crucial to note that they should only be administered by licensed medical professionals. Improper use can lead to serious side effects, including unintended muscle paralysis beyond the treated area.

Botulism Complications: Understanding the Risks

Botulism, if left untreated, can lead to severe complications due to its impact on muscle control throughout the body. The most immediate danger is respiratory failure, which can be fatal if not addressed promptly.

Potential Complications of Botulism

Some of the serious complications associated with botulism include:

• Respiratory failure
• Long-term difficulty swallowing
• Persistent fatigue
• Shortness of breath
• Extended periods of weakness

In severe cases, patients may require long-term care and rehabilitation to regain muscle strength and function.

Long-term Effects of Botulism

While many people recover fully from botulism, some may experience lingering effects:

• Fatigue
• Weakness
• Dizziness
• Dry mouth
• Difficulty concentrating

These symptoms can persist for weeks or even months after the initial infection, underscoring the importance of early detection and treatment.

Botulism, while rare, remains a significant public health concern due to its potentially devastating effects. Understanding its causes, recognizing its symptoms, and knowing how to prevent it are crucial steps in safeguarding against this serious condition. If you suspect botulism, seeking immediate medical attention is paramount. With proper care and treatment, many individuals can recover fully from this potentially life-threatening illness.

Botulism – Symptoms and causes

Overview

Botulism is a rare but serious condition caused by toxins from bacteria called Clostridium botulinum.

Three common forms of botulism are:

• Foodborne botulism. The harmful bacteria thrive and produce the toxin in environments with little oxygen, such as in home-canned food.
• Wound botulism. If these bacteria get into a cut, they can cause a dangerous infection that produces the toxin.
• Infant botulism. This most common form of botulism begins after Clostridium botulinum bacterial spores grow in a baby’s intestinal tract. It typically occurs in babies between the ages of 2 months and 8 months.

All types of botulism can be fatal and are considered medical emergencies.

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Symptoms

Foodborne botulism

Signs and symptoms of foodborne botulism typically begin between 12 and 36 hours after the toxin gets into your body. But, depending on how much toxin was consumed, the start of symptoms may range from a few hours to a few days. Signs and symptoms of foodborne botulism include:

• Difficulty swallowing or speaking
• Dry mouth
• Facial weakness on both sides of the face
• Blurred or double vision
• Drooping eyelids
• Trouble breathing
• Nausea, vomiting and abdominal cramps
• Paralysis

Wound botulism

Signs and symptoms of wound botulism appear about 10 days after the toxin has entered the body. Wound botulism signs and symptoms include:

• Difficulty swallowing or speaking
• Facial weakness on both sides of the face
• Blurred or double vision
• Drooping eyelids
• Trouble breathing
• Paralysis

The wound may or may not appear red and swollen.

Infant botulism

If infant botulism is related to food, such as honey, problems generally begin within 18 to 36 hours after the toxin enters the baby’s body. Signs and symptoms include:

• Constipation, which is often the first sign
• Floppy movements due to muscle weakness and trouble controlling the head
• Weak cry
• Irritability
• Drooling
• Drooping eyelids
• Tiredness
• Difficulty sucking or feeding
• Paralysis

Certain signs and symptoms usually don’t occur with botulism. For example, botulism doesn’t generally increase blood pressure or heart rate, or cause fever or confusion. Sometimes, however, wound botulism may cause fever.

When to see a doctor

Seek urgent medical care if you suspect that you have botulism. Early treatment increases your chances of survival and lessens your risk of complications.

Seeking medical care promptly may also alert public health authorities. They may then be able to keep other people from eating contaminated food. Botulism isn’t contagious from person to person.

Causes

Foodborne botulism

The source of foodborne botulism is often home-canned foods that are low in acid, such as fruits, vegetables and fish. However, the disease has also occurred from spicy peppers (chiles), foil-wrapped baked potatoes and oil infused with garlic.

When you eat food containing the toxin, it disrupts nerve function, causing paralysis.

Wound botulism

When C. botulinum bacteria get into a wound — possibly caused by an injury you might not notice — they can multiply and produce toxin. Wound botulism has increased in recent decades in people who inject heroin, which can contain spores of the bacteria. In fact, this type of botulism is more common in people who inject black tar heroin.

Infant botulism

Babies get infant botulism after consuming spores of the bacteria, which then grow and multiply in their intestinal tracts and make toxins. The source of infant botulism may be honey, but it’s more likely to be exposure to soil contaminated with the bacteria.

Are there benefits to botulinum toxin?

You might wonder how something so toxic could ever be beneficial, but scientists have found that the paralyzing effect of botulinum toxin makes it useful in certain circumstances.

Botulinum toxin has been used to reduce facial wrinkles by preventing contraction of muscles beneath the skin and for medical conditions, such as eyelid spasms and severe headaches. However, there have been rare occurrences of serious side effects, such as muscle paralysis extending beyond the treated area, with the use of botulinum toxin for medical reasons. Be sure to use a licensed doctor for any cosmetic or medical procedures using onabotulinumtoxinA (Botox).

Complications

Because it affects muscle control throughout your body, botulinum toxin can cause many complications. The most immediate danger is that you won’t be able to breathe, which is the most common cause of death in botulism. Other complications, which may require rehabilitation, may include:

• Difficulty speaking
• Trouble swallowing
• Long-lasting weakness
• Shortness of breath

Prevention

Use proper canning techniques

Be sure to use proper techniques when canning foods at home to ensure that any botulism germs in the food are destroyed:

• Pressure-cook these foods at 250 F (121 C) for 20 to 100 minutes, depending on the food.
• Consider boiling these foods for 10 minutes before serving them.

Prepare and store food safely

• Don’t eat preserved food if its container is bulging or if the food smells spoiled. However, taste and smell won’t always give away the presence of C. botulinum. Some strains don’t make food smell bad or taste unusual.
• If you wrap potatoes in foil before baking them, eat them hot or loosen the foil and store them in the refrigerator — not at room temperature.
• Store oils infused with garlic or herbs in the refrigerator.

Infant botulism

To reduce the risk of infant botulism, avoid giving honey — even a tiny taste — to children under the age of 1 year.

Wound botulism

To prevent wound botulism and other serious bloodborne diseases, never inject or inhale street drugs.

Aug. 12, 2020

Types, Causes, Symptoms & Treatments

Overview

What is botulism?

Botulism is a serious illness that affects the nervous system. It occurs when poisonous substances called botulinum toxins produce skeletal muscle paralysis. This paralysis can affect the muscles that help you move and breathe.

Botulism is rare. But because it can cause death, it is important for people with symptoms of botulism to see a doctor right away.

What are the types of botulism?

There are several different kinds of botulism. Three kinds of botulism are the most common:

Foodborne botulism

Foodborne botulism happens when people eat contaminated foods that already contain the toxin.

Incorrectly processed food may allow the bacteria to grow which then releases the toxin into the food. Home-canned or improperly canned store-bought foods are common sources of foodborne botulism. Other food sources associated with this illness include:

• Oils infused with herbs
• Potatoes baked in aluminum foil
• Cheese sauces
• Bottled garlic
• Foods kept warm or left unrefrigerated for too long

Infant botulism

Infant botulism typically occurs when babies ingest bacterial spores which are commonly found in soil or are fed foods which contain the spores, the most common being honey. The spores then become bacteria, which grow inside the baby’s intestines and release toxin.

Older children and adults have natural defenses against colonization, but infants younger than 12 months old don’t have those defenses. For this reason, experts advise that babies shouldn’t eat honey until they are at least 1 year old.

Wound botulism

Wound botulism develops when clostridium bacteria gets into a wound and grows. This type of botulism most often occurs in people who use a needle to inject drugs into their veins. In rare cases, it can also develop after surgery or a serious injury.

How common is botulism?

Few cases of botulism are reported in the United States each year. In 2016, 205 confirmed botulism cases were reported to the Centers for Disease Control.

Symptoms and Causes

What causes botulism?

Certain bacteria, including clostridium botulinum and clostridium butyricum, produce botulinum toxins. The spores of these bacteria are commonly found in soil but only rarely make people sick.

Specific conditions can cause bacterial spores to germinate and grow. These mature bacteria then secrete the toxin. When the toxin is released, it quickly spreads into the bloodstream and attaches to nerves. Botulism develops when those nerves no longer work. Conditions that allow spores to germinate include:

• Lack of oxygen
• Low acidity, sugar or salt
• Cooking temperatures that are too low (even boiling may not destroy the spores)
• Storage temperatures that are too warm

What are the symptoms of botulism?

Symptoms of botulism usually begin in the muscles of the face, eyes and throat. Without treatment, symptoms can spread to other parts of the body. Signs can appear from a few hours to several days after ingesting botulism spores. Symptoms include:

• Drooping eyelids
• Double or blurred vision
• Slurred speech
• Dry mouth
• Trouble swallowing
• Difficulty breathing
• Weakness of paralysis of arms or legs

Diagnosis and Tests

How is botulism diagnosed?

To diagnose botulism, doctors do a physical exam. They check for weak or paralyzed muscles. Similar symptoms occur in other conditions including stroke and Guillain-Barre syndrome. Doctors may need to do further testing to make sure it is botulism.

To confirm the diagnosis, your doctor can conduct a test that shows the toxin is present in your blood, stool or vomit. Suspected food samples can also be tested for the toxin. Other tests include nerve conduction studies (EMG). Because the results of these tests can take several days, doctors often begin treatment right away before the test results are back.

Management and Treatment

How is botulism treated?

Doctors use a variety of treatments to remove botulism toxins from the body. In the most common treatment, a doctor provides a medication called antitoxin. This medication contains antibodies which attach and neutralize the toxin which stops the toxin’s effects in the body.

People with wound botulism may need an operation where doctors surgically remove the contaminated part of the wound. After this operation, people take antibiotics to keep the infection from coming back.

Some people may need treatments to manage the symptoms of botulism. They sometimes need to use a ventilator (machine that helps breathing) until any paralysis affecting their breathing goes away.

What are the complications or side effects of botulism?

Botulism can paralyze the muscles that help you swallow and breathe. It can cause breathing problems that could lead to death. It can also leading to choking that leads to aspiration of food or your mouth’s secretions.

What can people expect after treatment for botulism?

Depending on the severity of the case, recovery from botulism can take weeks, months, or even years. Most people who receive prompt treatment recover completely in less than 2 weeks.

Some people feel tired and short of breath for years after surviving botulism. Breathing exercises and other therapies can help them manage these symptoms. People with ongoing breathing problems may have to continue using a ventilator for weeks or even months.

Prevention

Can botulism be prevented?

Yes, you can take steps to help prevent the most common types of botulism.

Foodborne botulism:

• Refrigerate foods within 2 hours after cooking. Proper refrigeration prevents the bacteria from producing spores.
• Cook food thoroughly.
• Avoid food containers that appear damaged or bulging. (These can be signs of gas produced by the bacteria.)

Infant botulism: Do not give honey to babies under 1 year old.

Wound botulism:

• Do not abuse injectable drugs.
• Seek medical treatment for a wound with signs of infection including redness, tenderness, swelling or pus
• Clean wounds contaminated by dirt and soil thoroughly.

Outlook / Prognosis

What is the outlook for people with botulism?

Botulism can be fatal if left untreated. But most people who receive a prompt diagnosis and treatment can make a full recovery from the illness. They return to normal function throughout their lives.

Botulism

Foodborne botulism is a serious, potentially fatal disease. However, it is relatively rare. It is an intoxication usually caused by ingestion of potent neurotoxins, the botulinum toxins, formed in contaminated foods. Person to person transmission of botulism does not occur.

Spores produced by the bacteria Clostridium botulinum are heat-resistant and exist widely in the environment, and in the absence of oxygen they germinate, grow and then excrete toxins. There are 7 distinct forms of botulinum toxin, types A–G. Four of these (types A, B, E and rarely F) cause human botulism. Types C, D and E cause illness in other mammals, birds and fish.

Botulinum toxins are ingested through improperly processed food in which the bacteria or the spores survive, then grow and produce the toxins. Though mainly a foodborne intoxication, human botulism can also be caused by intestinal infection with C. botulinum in infants, wound infections, and by inhalation.

Symptoms of foodborne botulism

Botulinum toxins are neurotoxic and therefore affect the nervous system. Foodborne botulism is characterized by descending, flaccid paralysis that can cause respiratory failure. Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhoea, constipation and abdominal swelling may also occur. The disease can progress to weakness in the neck and arms, after which the respiratory muscles and muscles of the lower body are affected. There is no fever and no loss of consciousness.

The symptoms are not caused by the bacterium itself, but by the toxin produced by the bacterium. Symptoms usually appear within 12 to 36 hours (within a minimum and maximum range of 4 hours to 8 days) after exposure. Incidence of botulism is low, but the mortality rate is high if prompt diagnosis and appropriate, immediate treatment (early administration of antitoxin and intensive respiratory care) are not given. The disease can be fatal in 5 to 10% of cases.

Exposure and transmission

Foodborne botulism

C. botulinum is an anaerobic bacterium, meaning it can only grow in the absence of oxygen. Foodborne botulism occurs when C. botulinum grows and produces toxins in food prior to consumption. C. botulinum produces spores and they exist widely in the environment including soil, river and sea water.

The growth of the bacteria and the formation of toxin occur in products with low oxygen content and certain combinations of storage temperature and preservative parameters. This happens most often in lightly preserved foods and in inadequately processed, home-canned or home-bottled foods.

C. botulinum will not grow in acidic conditions (pH less than 4.6), and therefore the toxin will not be formed in acidic foods (however, a low pH will not degrade any pre-formed toxin). Combinations of low storage temperature and salt contents and/or pH are also used to prevent the growth of the bacteria or the formation of the toxin.

The botulinum toxin has been found in a variety of foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products, such as ham and sausage. The food implicated differs between countries and reflects local eating habits and food preservation procedures. Occasionally, commercially prepared foods are involved.

Though spores of C. botulinum are heat-resistant, the toxin produced by bacteria growing out of the spores under anaerobic conditions is destroyed by boiling (for example, at internal temperature greater than 85 °C for 5 minutes or longer). Therefore, ready-to-eat foods in low oxygen-packaging are more frequently involved in cases of foodborne botulism.

Food samples associated with suspect cases must be obtained immediately, stored in properly sealed containers, and sent to laboratories in order to identify the cause and to prevent further cases.

Infant botulism

Infant botulism occurs mostly in infants under 6 months of age. Different from foodborne botulism caused by ingestion of pre-formed toxins in food, it occurs when infants ingest C. botulinum spores, which germinate into bacteria that colonize in the gut and release toxins. In most adults and children older than about 6 months, this would not happen because natural defences in intestines that develop over time prevent germination and growth of the bacterium.

C. botulinum in infants include constipation, loss of appetite, weakness, an altered cry and a striking loss of head control. Although there are several possible sources of infection for infant botulism, spore-contaminated honey has been associated with a number of cases. Parents and caregivers are therefore warned not to feed honey to the infants before the age of 1 year.

Wound botulism

Wound botulism is rare and occurs when the spores get into an open wound and are able to reproduce in an anaerobic environment. The symptoms are similar to the foodborne botulism, but may take up to 2 weeks to appear. This form of the disease has been associated with substance abuse, particularly when injecting black tar heroin.

Inhalation botulism

Inhalation botulism is rare and does not occur naturally, for example it is associated with accidental or intentional events (such as bioterrorism) which result in release of the toxins in aerosols. Inhalation botulism exhibits a similar clinical footprint to foodborne botulism. The median lethal dose for humans has been estimated at 2 nanograms of botulinum toxin per kilogram of bodyweight, which is approximately 3 times greater than in foodborne cases.

Following inhalation of the toxin, symptoms become visible between 1–3 days, with longer onset times for lower levels of intoxication. Symptoms proceed in a similar manner to ingestion of botulinum toxin and culminate in muscular paralysis and respiratory failure.

If exposure to the toxin via aerosol inhalation is suspected, additional exposure to the patient and others must be prevented. The patient’s clothing must be removed and stored in plastic bags until it can be washed thoroughly with soap and water. The patient should shower and be decontaminated immediately.

Other types of intoxication

Waterborne botulism could theoretically result from the ingestion of the pre-formed toxin. However, as common water treatment processes (such as boiling, disinfection with 0.1% hypochlorite bleach solution) destroy the toxin, the risk is considered low.

Botulism of undetermined origin usually involves adult cases where no food or wound source can be identified. These cases are comparable to infant botulism and may occur when the normal gut flora has been altered as a result of surgical procedures or antibiotic therapy.

Adverse effects of the pure toxin have been reported as a result of its medical and/or cosmetic use in patients, see more on ‘Botox’ below.

‘Botox’

The bacterium C. botulinum is the same bacterium that is used to produce Botox, a pharmaceutical product predominantly injected for clinical and cosmetic use. Botox treatments employ the purified and heavily diluted botulinum neurotoxin type A. Treatment is administered in the medical setting, tailored according to the needs of the patient and is usually well tolerated although occasional side effects are observed.

Diagnosis and treatment

Diagnosis is usually based on clinical history and clinical examination followed by laboratory confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or a culture of C. botulinum from stool, wound or food. Misdiagnosis of botulism sometimes occurs as it is often confused with stroke, Guillain-Barré syndrome, or myasthenia gravis.

Antitoxin should be administered as soon as possible after a clinical diagnosis. Early administration is effective in reducing mortality rates. Severe botulism cases require supportive treatment, especially mechanical ventilation, which may be required for weeks or even months. Antibiotics are not required (except in the case of wound botulism). A vaccine against botulism exists but it is rarely used as its effectiveness has not been fully evaluated and it has demonstrated negative side effects.

Prevention

Prevention of foodborne botulism is based on good practice in food preparation particularly during heating/sterilization and hygiene. Foodborne botulism may be prevented by the inactivation of the bacterium and its spores in heat-sterilized (for example, retorted) or canned products or by inhibiting bacterial growth and toxin production in other products. The vegetative forms of bacteria can be destroyed by boiling but the spores can remain viable after boiling even for several hours. However, the spores can be killed by very high temperature treatments such as commercial canning.

Commercial heat pasteurization (including vacuum packed pasteurized products and hot smoked products) may not be sufficient to kill all spores and therefore the safety of these products must be based on preventing bacterial growth and toxin production. Refrigeration temperatures combined with salt content and/or acidic conditions will prevent the growth of the bacteria and formation of toxin.

The WHO Five Keys to Safer Food serve as the basis for educational programmes to train food handlers and educate the consumers. They are especially important in preventing food poisoning.

The Five Keys are:

• keep clean
• separate raw and cooked
• cook thoroughly
• keep food at safe temperatures
• use safe water and raw materials.

WHO’s response

Botulism outbreaks are rare but are public health emergencies that require rapid recognition to identify the disease source, distinguish outbreak types (between natural, accidental or potentially deliberate), prevent additional cases and effectively administer treatment to affected patients.

Successful treatment depends significantly on early diagnosis and the rapid administration of the botulinum antitoxin.

WHO’s role in responding to outbreaks of botulism that may be of international concern is as follows.

Surveillance and detection: WHO supports the strengthening of national surveillance and international alert systems to ensure rapid local outbreak detection and an efficient international response. WHO’s main tool for these activities of surveillance, coordination and response is the use of the International Network of Food Safety Authorities (INFOSAN) which links national authorities in Member States in charge of managing food safety events. This network is managed jointly by FAO and WHO.

Risk assessment: WHO response is based on a risk assessment methodology that includes consideration of whether the outbreak is natural, accidental, or, possibly, intentional. WHO also provides scientific assessments as basis for international food safety standards, guidelines and recommendations developed by the Codex Alimentarius Commission.

Containment at the disease source: WHO coordinates with national and local authorities in order to contain outbreaks at their source.

Delivery of assistance: WHO coordinates between international agencies, experts, national laboratories, airlines and commercial organizations to mobilize response equipment, materials and supplies, including the provision and administration of botulinum antitoxin.

Infant Botulism (for Parents) – Nemours Kidshealth

What Is Infant Botulism?

Infant botulism is an illness that can happen when a baby ingests (takes in) toxins from a type of bacteria. Babies with infant botulism (BAH-chuh-liz-im) can have muscle weakness, a weak cry, and trouble breathing. They need to be treated in a hospital. With early diagnosis and proper medical care, a baby should fully recover from the illness.

What Causes Infant Botulism?

Infant botulism is caused by a toxin (a poison) from Clostridium botulinum bacteria, which live in soil and dust. The bacteria can get on surfaces like carpets and floors and also can contaminate honey. That’s why babies younger than 1 year old should never be given honey.

These bacteria are harmless to older kids and adults. That’s because their mature digestive systems can move the toxins through the body before they cause harm.

Infant botulism usually affects babies who are 3 weeks to 6 months old. But all babies are at risk for it until their first birthday.

What Are the Signs & Symptoms of Infant Botulism?

Babies with infant botulism might have:

• constipation (often the first sign that parents notice)
• weak facial muscles that makes their face look “flat”
• a weak cry
• weak muscles in the arms, legs, and neck
• breathing problems
• trouble swallowing with a lot of drooling

They also might not feed well or move as much as usual.

How Is Infant Botulism Diagnosed?

Doctors diagnose infant botulism by asking about the baby’s symptoms. They’ll do an exam, and might order tests to see how the baby’s muscles are working.

How Is Infant Botulism Treated?

Babies with infant botulism need care in a hospital, usually in the intensive care unit (ICU). The health care team will try to limit the problems the toxin causes in the baby’s body.

Doctors treat infant botulism with an antitoxin called botulism immune globulin intravenous (BIGIV). They give this to babies as soon as possible. Babies with botulism who get BIGIV recover sooner and spend less time in the hospital than babies who don’t.

If the toxin affects the breathing muscles, a baby might need to use a breathing machine (ventilator) for a few weeks until they get stronger. It also can affect the swallowing muscles, so babies usually need intravenous (IV) fluids or feedings through a tube to get nourishment.

Can Infant Botulism Be Prevented?

Experts don’t know why some infants get botulism while others don’t.

One way to reduce the risk of botulism is to not give infants honey or any processed foods with honey before their first birthday. Honey is a proven source of the bacteria. If you have questions about other products to avoid, ask your doctor.

Botulism – NHS

Botulism is a very rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria.

These toxins are some of the most powerful known to science. They attack the nervous system (nerves, brain and spinal cord) and cause paralysis (muscle weakness).

Most people will make a full recovery with treatment, but the paralysis can spread to the muscles that control breathing if it isn’t treated quickly. This is fatal in around 5 to 10% of cases.

Symptoms of botulism

The time it takes to develop symptoms can vary from a few hours to several days after exposure to the Clostridium botulinum bacteria or their toxins.

Depending on the exact type of botulism, some people initially have symptoms such as feeling sick, being sick (vomiting), stomach cramps, diarrhoea or constipation.

Without treatment, botulism eventually causes paralysis that spreads down the body from the head to the legs.

Symptoms can include:

Affected babies may also have a weak cry, find it difficult to feed, and have a floppy head, neck and limbs.

When to get medical advice

Botulism is a very serious condition that requires immediate medical attention.

Go to your nearest A&E department or immediately dial 999 if you or someone you know has symptoms of botulism.

Treatment is more effective the earlier it’s started.

Causes and types of botulism

Clostridium botulinum bacteria are found in soil, dust and river or sea sediments.

The bacteria themselves aren’t harmful, but they can produce highly poisonous toxins when deprived of oxygen, such as in closed cans or bottles, stagnant soil or mud, or occasionally, the human body.

There are 3 main types of botulism:

• food-borne botulism – when someone eats food containing the toxins because it hasn’t been properly canned, preserved or cooked
• wound botulism – when a wound becomes infected with the bacteria, usually as a result of injecting illegal drugs like heroin contaminated with the bacteria into muscle rather than a vein
• infant botulism – when a baby swallows a resistant form of the bacteria, called a spore, in contaminated soil or food, such as honey (these spores are harmless to older children and adults because the body develops defences against them from about the age of 1)

All these types of botulism are very rare in the UK, but occasional cases do occur.

Treatment for botulism

Botulism needs to be treated in hospital.

The way it’s treated depends on the type of botulism, but usually involves:

• neutralising the toxins with injections of special antitoxins or antibodies
• supporting the functions of the body, such as breathing, until you recover

Treatment won’t reverse any paralysis that’s already been caused by the toxin, but will stop it getting any worse.

In most people, paralysis that occurred before treatment will gradually improve over the following weeks or months.

Preventing botulism

As a result of high standards of food hygiene in the UK, the chances of getting food-borne botulism from food bought in this country are tiny.

There’s a slightly higher risk if you produce your own food, particularly if this involves canning.

But following food hygiene procedures and canning recommendations will reduce any risk.

Don’t eat food from bulging or damaged cans, and avoid eating foul-smelling preserved foods, foods stored at the incorrect temperature, and out-of-date foods.

Heroin users should avoid injecting heroin into their muscles. Injecting heroin into a vein or smoking it can reduce the risk of botulism, although not using heroin at all is by far the best course of action.

Find out how to get help to stop using heroin

In many cases of infant botulism, the specific cause isn’t identified so it may not always be possible to prevent it.

But you should avoid giving babies under the age of 1 honey as it’s been known to contain Clostridium botulinum spores.

Page last reviewed: 26 November 2018
Next review due: 26 November 2021

Botulism – Causes, Symptoms, Treatment, Diagnosis

The Facts

Most people know that botulism is dangerous, but many are confused about whether it’s an infection or a case of poisoning. In fact, it can be both. Clostridium botulinum is a worldwide bacterium that inhabits rivers, soil, and the guts of mammals, fish, and shellfish. It’s not an organism that normally makes its living by attacking humans. We most often encounter C. botulinum by accident.

C. botulinum secretes a neurotoxin (nerve poison) that can weaken or paralyze muscles and can even cause death. This is botulin toxin, one of the most dangerous substances known. Botulism is the condition of having been poisoned with C. botulinum toxin.

Causes

Botulism is rare, but there are still cases every year.

There are 6 ways to get botulism:

• Foodborne botulism occurs when food contaminated with the toxin is eaten. The bacteria are dead or gone by the time you eat the food, but the toxin remains. Most foodborne botulism is attributed to home-canned foods, but outbreaks occasionally occur in commercially-prepared foods.
• Infant botulism occurs when infants under 12 months of age eat bacterial spores rather than the toxins. Spores of C. botulinum then grow in the infant’s intestines, where they produce toxins. Honey can contain spores of C. botulinum and is associated with infant botulism and should not be given to children under 12 months old. Infant botulism is rare.
• Adult intestinal colonization botulism occurs when C. botulinum spores are ingested. The spores grow and eventually produce toxins in the digestive system. People with altered gastrointestinal systems and local microbes (due to surgery, presence of inflammatory bowel disease, or exposure to antibiotics) are most often affected.
• Wound botulism occurs when live bacteria infect an open cut and the toxin is carried through the body by the blood.
• Bioterrorism-associated botulism is a possible terrorist threat. It would be delivered by aerosol or foodborne means.
• Iatrogenic botulism caused by cosmetic use of botulin toxin occurs when people receive botulinum toxin injections (e.g., Botox®) for a variety of health reasons or cosmetic purposes. If injected improperly or at the wrong dose, this could cause botulism.

Rarely, toxins can be inhaled or absorbed through the eyes.

Botulism can cause death due to paralysis of muscles used in breathing. However, advancements in supportive care have greatly reduced the death rate, and now less than 10% of people who get botulism die from the condition.

Symptoms and Complications

C. botulinum toxin attacks nerve endings, damaging them and then stopping muscle function. It can’t cross the barrier that protects the brain. The heart has its own wiring system and also isn’t affected. However, botulin can affect all the other nerves of the body, including the nerves of the muscles that operate the lungs. Botulin toxin kills by shutting down breathing.

Symptoms usually appear quickly in foodborne botulism, within 12 to 36 hours, but a few people feel no symptoms for as many as 8 days after eating the poison. Dry mouth, vomiting, nausea, diarrhea, and abdominal cramps are the first signals.

Then the neurological symptoms begin to appear – the muscles slowly shut down, starting with the temple and forehead and proceeding slowly down both sides of the body. The face goes slack and expressionless, the eyelids droop, and the victim may drool. Vertigo and double vision are common. The arms slowly get weaker, then the legs. Diarrhea is replaced by constipation. By this time there’s also difficulty in talking, swallowing, and breathing. Temperature and pulse remain normal.

The first sign of infant botulism is constipation. The neurological symptoms are the same as in foodborne botulism but develop less rapidly. This is because the spores produce toxin slowly and the child absorbs it bit by bit instead of all at once as in foodborne botulism. The baby may also suck milk weakly, have difficulty crying loudly, lose head control, and lack facial expression.

Making the Diagnosis

Your doctor will ask you questions about your symptoms and perform a physical exam.

The Botulism Reference Service for Canada conducts the laboratory investigation for diagnosing botulism. The diagnosis of foodborne botulism is made by verifying whether the botulin toxin is in the food. Alternatively, C. botulinum can be isolated from the stool or stomach fluids. The diagnosis of intestinal botulism is made by identifying C.botulinum organisms and toxin in the feces. The diagnosis of wound botulism is made by detecting the toxin in the wound or by isolating C.botulinum from a positive wound culture.

Treatment and Prevention

Supportive care is provided to anyone with botulism. This may include hospitalization, use of a ventilator to help with breathing, and nursing care. Recovery can take many weeks as paralysis slowly improves.
While there is a botulism antitoxin and immune globin therapy, they are not approved for sale in Canada and are currently only available through Health Canada’s Special Access Program.

The antitoxin works by neutralizing botulin. However, the antitoxin needs to be administered as soon as possible after diagnosis. The medication can’t repair nerve endings already damaged. This means that while you may survive, you will be temporarily left in the state you were in at the time the medication was administered. That may mean paralysis, sometimes to the point of being unable to talk or even swallow.

The good news is that you’ll recover, because new nerves can grow to replace those that were killed. However, this is a slow recovery process and it may take weeks or months, even up to a year, for this to occur.

The antitoxin is generally not given for infant botulism.

For wound botulism, antibiotics are given in addition to supportive care.

Preventing botulism is usually possible. However, if you prepare and store a lot of your own food, you may be creating unnecessary risk. The C. botulinum bacterium is anaerobic, meaning it likes airless environments. This is why you can get foodborne botulism out of a can. Very few cases of botulism arise from commercially canned food. Most occur when individuals can their own products.

Botulin toxin has been found in North America in these foods:

• asparagus
• baked potatoes
• beets
• canned corn
• chicken, chicken livers, and liver paté
• garlic-in-oil dressing
• green beans
• ham
• lobster
• luncheon meats
• mushrooms
• peppers
• ripe olives
• sausage
• smoked and salted fish
• soups
• spinach
• stuffed eggplant
• tuna fish

Only highly acidic foods are safe from C. botulinum. Freezing will shut down toxin production, but a fridge isn’t cold enough. The following food handling procedures can help you to prevent foodborne botulism:

• Preserved food should be heated to a temperature above 100°C (212°F) for at least 10 minutes during the canning process.
• Cook food at 79.9°C (176°F) for at least 30 minutes. This usually destroys toxins.
• Do not eat or store cooked foods that have been at room temperature for 4 hours or more.
• Do not eat foil-wrapped baked potatoes that have been left at room temperature, and do not store chopped garlic or onions in oil at room temperature.
• If eating home-canned food, boil it first with frequent stirring for 10 minutes.
• Do not feed honey to infants less than 12 months old.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/condition/getcondition/Botulism

Botulism – StatPearls – NCBI Bookshelf

Continuing Education Activity

Botulism is a rare, potentially fatal syndrome of diffuse, flaccid paralysis caused by botulinum neurotoxin (BoNT) which is elaborated by the bacterium Clostridium botulinum. It begins with cranial nerve paralysis which progresses down to the symmetrical weakness of the trunk and extremities with eventual flaccid paralysis. This activity describes the evaluation and management of botulism and explains the role of the interprofessional team in improving care for patients with this condition.

Objectives:

• Identify the Clostridium species in the etiology of botulism.

• Describe the pathophysiology of botulism.

• Explain the use of antitoxin in the management of botulism.

• Summarize the importance of collaboration and communication among the interprofessional team to improve outcomes for patients affected by botulism.

Access free multiple choice questions on this topic.

Introduction

Botulism is a rare but potentially fatal syndrome of diffuse, flaccid paralysis caused by botulinum neurotoxin (BoNT), an exo neurotoxin elaborated by the bacterium Clostridium botulinum. Since its recognition as a foodborne entity in Germany and Belgium in the 1800s, several other etiologies of botulism have been described, including wound botulism, iatrogenic botulism, and inhalational botulism. While the administration of polyvalent antitoxin to botulinum neurotoxin mitigates the clinical course of botulism, no true antidote exists, and management continues to rely on weeks of mechanical ventilation and other resource-heavy therapies while the body’s neuromuscular signaling mechanisms recover. The most potent poison known to man, botulinum neurotoxin is relatively simple to produce, store, and disperse, and is thus a subject of intense interest for defense organizations around the world.[1]

Etiology

 Botulism is a neuroparalytic syndrome that results from the systemic effects of an exo neurotoxin produced by the gram-positive, rod-shaped, spore-forming, obligate anaerobic bacterium Clostridium botulinum. Other Clostridium species (Clostridium butyricum, Clostridium baratii) occasionally produce the toxin as well. C. botulinum is a heterogeneous and ubiquitous group of bacteria, usually divided into four groups (groups I, II, III, and IV) based on physiologic characteristics. C. botulinum is easily isolated from soil, marine sediment, seafood, fruits, and vegetables. It forms heat-resistant spores that germinate in anaerobic, substrate-rich conditions to grow into toxin-producing bacilli.[2][3]

Botulinum neurotoxin is considered the deadliest toxin known due to its high potency and lethality, with a lethal dose (LD50 – the amount required to kill 50% of a test sample) of 1 ng to 3 ng (nanograms) of toxin per kilogram (kg) of body mass. The flaccid paralysis of botulism is the result of irreversible inhibition of acetylcholine (ACh) release at the presynaptic nerve terminal of the body’s neuromuscular junctions (NMJs). Botulism can be acquired through exposure to the pre-formed toxin via improperly-stored food, iatrogenic injection, or bioterrorism, or it can result from the systemic release of the toxin in vivo, as in the cases of infant and wound botulism.

Epidemiology

Since 1973, the Centers for Disease Control and Prevention (CDC) has maintained the National Botulism Surveillance System to monitor cases of botulism in the United States. In the 5 years from 2011 through 2015, an average of 162 annual cases of botulism was reported. The respective proportions of each botulism type ranged from 71% to 88% for infant botulism, 1% to 20% for foodborne botulism, 5%-10% for wound botulism, and 1% to 4% for botulism of other or unknown origin. With the exception of rare, large outbreaks (i.e., an outbreak of foodborne botulism in Ohio in April 2015 accounted for 27 cases alone), the total number of botulism cases and relative proportions of each subtype have remained relatively stable over the past 10 years. There have been no reported cases of botulism due to bioterrorism in the United States, and only one reported case of iatrogenic botulism, which resulted from the use of an unlicensed, highly concentrated form of BoNT.[4][5]

Mortality from botulism is low. Before the 1950s, mortality rates for foodborne botulism were 60-70%. For the period 1975-2009, overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases. There were 18 [less than 1%] deaths from 2352 cases of infant botulism, 61 [7.1%] deaths from 854 cases of foodborne botulism, 18 [5.0%] deaths from 359 cases of wound botulism, and 12 [22.6%] deaths from 53 cases of botulism from other or unknown origin.

Pathophysiology

Botulinum neurotoxin is a 150kDa protein that comprises a 100kDa heavy chain and 50kDa light chain linked by a single disulfide bridge. There are eight distinct serotypes of BoNT, A (BoNT/A) through H (BoNT/H), based on recognition by polyclonal serum. Toxin subtypes A, B, E, and rarely F, G, and H cause human disease. The vast majority of cases reported in the US are caused by BoNT/A and BoNT/B. While most strains of C. botulinum produce only one toxin serotype, dual toxin-producing strains have been identified. Toxin type A is the most potent, followed by BoNT/B.

The mode of entry of the toxin into the bloodstream depends on the type of exposure. In infant botulism, the lack of a robust immune system allows the proliferation of toxin-elaborating C. botulinum colonies in the digestive tract or bronchioles following ingestion or inhalation of spores. Once released, BoNT migrates via transcytosis across the mucosal barrier (either intestinal or pulmonary epithelium) into the circulation. The ingestion of preformed toxin in improperly stored food results in food-borne botulism, which is then absorbed in the intestinal tract similarly to infant botulism. Wound botulism is the result of C. botulinum spore germination in devitalized tissue, most commonly as a result of subcutaneous injection of spore-contaminated illicit drugs, with the release of BoNT into the local circulation.

Once in the bloodstream, BoNT travels to and binds presynaptic nerve terminals of the voluntary motor and autonomic NMJs. The heavy chain moiety of the toxin promotes endocytosis, after which the light chain is cleaved and released into the cytosol. The light chain targets and cleaves serotype-specific targets of the SNARE (SNAP-25, VAMP, or syntaxin) polypeptide complex, proteins required for fusion of ACh-containing vesicles with the presynaptic membrane. Fusion allows exocytosis of ACh into the NMJ and depolarization of the postsynaptic membrane. By cleaving these fusion complexes, BoNT blocks presynaptic ACh release and inhibits muscle contraction, causing flaccid paralysis. Despite serotype-specific differences in target sites, all BoNT serotypes share the downstream syndrome of flaccid paralysis secondary to failure of ACh release at the NMJ.

Toxicokinetics

After exposure to BoNT, the time to symptom onset depends upon the dose of the toxin and the relevant kinetics of absorption. For food-borne botulism, symptoms typically appear within 12 to 72 hours of ingesting contaminated food, although onset times from as little as 2 hours to as long as 8 days have been recorded. For infectious (i.e., wound and infant) botulism, the onset depends on spore exposure time, time to germination, and how quickly the resulting colonies elaborate sufficient BoNT to cause symptoms, which varies widely with bacterial species, toxin serotype, and the patient’s age and immunological status.

Following symptom onset, the duration of symptoms is a function of toxin dose, toxin elimination, and regeneration of cleaved polypeptide components of the SNARE complex. The LD50 of BoNT is 1 ng/kg to 3ng/kg of body mass. Smaller doses affect fewer SNARE components and are cleared more quickly than larger doses. The elimination half-life (t1/2) of each toxin serotype is not known, however, a murine model of BoNT/A administered parenterally demonstrated a serum t1/2 of approximately 230 minutes.

Elimination of BoNT from the blood is enhanced by administration of serotype-specific neutralizing antibody (antitoxin), which limits the total number of SNARE complexes affected by the toxin. Once bound by antitoxin, BoNT is sequestered in the liver and spleen. Time to antitoxin administration significantly affects the clinical course. In one study of infant botulism, untreated infants had a significantly longer duration of mechanical ventilation (2.4 weeks versus 0.7 weeks), hospital admission (5.7 weeks versus 2.6 weeks), and tube feeding (10 weeks versus. 3.6 weeks) compared to treated infants. Similarly, earlier antitoxin administration (less than 12 hours) has been shown to reduce intensive care unit length of stay in both foodborne and wound botulism.

Regeneration of SNARE polypeptides is required for resumption of normal ACh release and muscle function and is related in part to the specific polypeptide targets of BoNT serotypes. A recent study comparing the activity of BoNT/A to BoNT/B revealed a significantly longer time to the regeneration of the BoNT/A target protein SNAP-25. Case reports of infant botulism by different Clostridium species that elaborate the BoNT/E and BoNT/F serotypes describe a much faster onset and resolution of symptoms compared to cases caused by the typical BoNT/A, which further supports the importance of SNARE component regeneration for the duration of the syndrome.

History and Physical

Botulism classically begins with cranial nerve palsies (“bulbar symptoms”) that progress to the symmetrical descending weakness of the trunk, extremities, and smooth muscle, with eventual flaccid paralysis. Patients usually have no sensory deficits except for blurred vision, although paresthesias are occasionally seen. Typical early symptoms include diplopia (visual disturbances), dysphagia (difficulty swallowing), dysphonia (voice change), and dysarthria (slurred speech), reflecting the high susceptibility of cranial nerve efferent presynaptic terminals to the activity of BoNT. Involvement of the diaphragm precipitates respiratory failure, often requiring intubation and mechanical ventilation. Palsies of autonomic smooth muscle cause constipation and urinary retention. Food-borne botulism will often present with a prodrome of abdominal pain, nausea, and vomiting beginning 12 to 72 hours after ingestion of the preformed toxin.

The presentation and severity of infant botulism are variable, due to different inoculum sizes, host susceptibilities, and time to presentation. Early symptoms frequently involve constipation, weakness, feeding difficulties, weak cry, and drooling. A ‘floppy baby’ exhibiting global hypotonia implies the need for immediate intubation and mechanical ventilation.

Wound botulism should be suspected in patients who present with bulbar symptoms and cellulitis secondary to subcutaneous administration of illicit drugs. The incubation time for wound botulism is 5 to 15 days from the time of spore introduction. Wound botulism is the only variant presenting with fever and signs of infection.

Evaluation

Many presentations of botulism are subtle and easily missed. Because therapy should be administered as early as possible, and laboratory confirmation of botulism takes several days, treatment will often proceed based on clinical suspicion alone. A careful history and physical exam are therefore essential. Electrophysiologic studies (electromyogram/EMG) can support a presumptive diagnosis based on history and physical while laboratory results are pending.[6]

Laboratory confirmation of botulism can be obtained with serum and stool assays for BoNT, stool microscopy for spores, stool cultures, and wound cultures in the case of wound botulism. Laboratory testing to detect BoNT has traditionally relied on the mouse lethality assay, wherein a live mouse is injected with a sample of stool or serum from a subject and observed for signs of botulism and death. Attempts at developing immunologic assays for BoNT detection (ELISA, electrochemiluminescence) suffer from low-quality antibodies and confounding by factors in complex matrices like stool and serum, with consequently low sensitivity. Endopeptidase assays have demonstrated high sensitivity and specificity and are still currently in development.

Treatment / Management

Treatment of botulism consists of antitoxin administration, hospital admission, close monitoring, respiratory support as required, and debridement plus antibiotics in the case of wound botulism. Any patient with a clinical presentation concerning for botulism should be hospitalized immediately for close observation. Antitoxin therapy available to healthcare providers currently exists in two forms: heptavalent equine serum antitoxin, indicated for patients older than 1 year, and human-derived immunoglobulin, indicated for infants under the age of 1. Heptavalent equine serum antitoxin contains antibodies to BoNT/A-BoNT/G and is available through State Health Departments and the CDC.[7][8]

When botulism is suspected, the clinician should seek immediate assistance from their regional Poison Control Center, State’s Health Department, or the CDC Director’s Emergency Operations Center. If suspicion is high and symptoms are progressing, immediate antitoxin acquisition and administration is indicated. The dose for adults is one vial. The dose for infants, children, and adolescents should be established in conjunction with Poison Control.

Close monitoring should include frequent clinical evaluation of ventilation, perfusion, and upper airway integrity, continuous pulse oximetry, spirometry, and arterial blood gas measurement. Intubation should be considered for patients with upper airway compromise or vital capacity of less than 30% of predicted.

For wound botulism, debridement and antibiotic therapy are indicated following antitoxin administration. Appropriate regimens include three million units of Penicillin G intravenously (IV) every 4 hours, or metronidazole 500 mg every 8 hours for penicillin-allergic patients. Aminoglycosides are relatively contraindicated as they have been shown to potentiate neuromuscular blockade caused by botulism. Antibiotics should not be used in infant botulism because of possible BoNT release following cell lysis. Additional therapies include total parenteral nutrition in cases of severe ileus and whole bowel irrigation in cases of foodborne botulism without severe ileus.

Other measures

• Aggressive supportive care in an ICU setting

• Monitor airway as respiratory failure is common

• Monitor vitals, oxygenation, and arterial blood gases

• Intubation if there is the slightest hint of respiratory distress

• Some patients require tracheostomy to manage secretions

• Do not administer magnesium salts as they can potentiate the neuromuscular block

• Insert Foley and provide stress ulcer prophylaxis

Complications

• Nosocomial infections

• UTI

• Thrombophlebitis

• Deep vein thrombosis

• Pressure sores

• Contractures

• Failure to thrive

Pearls and Other Issues

Vaccines

An investigational pentavalent botulinum toxoid is available for persons at elevated risk for BoNT exposure, such as laboratory workers and military personnel. No FDA-approved vaccine exists for the general public. The pentavalent toxoid is not being considered for public use due to cost, the number of required vaccinations, and the recent decline in immunogenicity.

Security

Botulinum neurotoxin has been considered for use as a weapon of mass destruction by terrorist organizations and nations for over 60 years, and several examples of the militarized development of BoNT exist. The Aum Shinrikyo cult in Japan attempted to disperse BoNT at United States bases in Japan in the 1990s. Operation Desert Storm revealed several thousand liters of concentrated BoNT in Iraq, half of which had been loaded onto military weapons systems. Models of terrorist attacks employing BoNT release into consumer goods have indicated several deficiencies in the country’s capacity to thwart such an attack. Due to its potency, its lethality, and the facility with which it can be isolated, acquired, stored, and disseminated, BoNT continues to be an area of intense interest for national security organizations around the world.

Enhancing Healthcare Team Outcomes

Botulism is a serious neurological disorder that can be life-threatening. Because of the systemic effects, the disorder is best managed by an interprofessional team that consists of a neurologist, infectious disease expert, intensivist, pulmonologist, pharmacist and ICU nurses.

These patients are usually managed in an ICU setting and nurses have to be aware that respiratory distress can occur at any time. Hence, the set up for intubation should be at the bedside and the anesthesiologist should be informed. These patients develop viscous secretions and thus suctioning to keep the airway patent is necessary. Nurses also have to provide pressure sore, DVT and stress ulcer prophylaxis.

The dietitian should be consulted for nutrition. If ileus is present, the patient may require TPN.

Physical therapy should exercise the muscles to prevent wasting.

The pharmacist should check every medication order to ensure that magnesium or aminoglycosides are not administered. These medications can worsen the neuromuscular blockade.

Close observation by clinicians is necessary to prevent aspiration pneumonia and aggressive pulmonary toilet is recommended.

The interprofessional team must hold daily conferences to determine the goals of treatment. Any change in treatment must be communicated to the team to ensure patient safety and recovery.

Outcomes

Unlike the past, the mortality from botulism has significantly declined in the last 3 decades. Today, the risk of death for an infant is less than 1%. However, the recovery is often prolonged and may take months or even years to fully become functional. For those who suffer from hypoxia, some type of neurological deficit will be present for life.[9][10][11]

Prevention

The most important concern for the prevention of botulism is proper food handling techniques. In particular, appropriate processing of home-canned and home-preserved food, including minimum temperature, pressure, and cooking times per manufacturer’s recommendations, kills Clostridium spores and effectively prevents toxin exposure. Boiling home-canned food for 10 minutes will inactivate preformed toxin and kill bacteria, but will not destroy spores. Infant botulism is best prevented by avoiding honey for infants less than 12 months of age. 

References

1.

Dong M, Masuyer G, Stenmark P. Botulinum and Tetanus Neurotoxins. Annu Rev Biochem. 2019 Jun 20;88:811-837. [PMC free article: PMC7539302] [PubMed: 30388027]

2.

Silva ROS, Martins RA, Assis RA, Oliveira Junior CA, Lobato FCF. Type C botulism in domestic chickens, dogs and black-pencilled marmoset (Callithrix penicillata) in Minas Gerais, Brazil. Anaerobe. 2018 Jun;51:47-49. [PubMed: 29621603]

3.

Hellmich D, Wartenberg KE, Zierz S, Mueller TJ. Foodborne botulism due to ingestion of home-canned green beans: two case reports. J Med Case Rep. 2018 Jan 04;12(1):1. [PMC free article: PMC5755244] [PubMed: 29301587]

4.

Czerwiński M, Czarkowski MP, Kondej B. Foodborne botulism in Poland in 2016. Przegl Epidemiol. 2018;72(2):149-155. [PubMed: 30111083]

5.

Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clinical Characteristics and Ancillary Test Results Among Patients With Botulism-United States, 2002-2015. Clin Infect Dis. 2017 Dec 27;66(suppl_1):S4-S10. [PubMed: 29293936]

6.

Zariquiey-Esteva G, Galeote-Cózar D, Santa-Candela P, Castanera-Duro A. Botulism in the ICU: Nursing care plan. Enferm Intensiva (Engl Ed). 2018 Apr – Jun;29(2):86-93. [PubMed: 29277396]

7.

Long SS. BabyBIG has BIG advantages for treatment of infant botulism. J Pediatr. 2018 Feb;193:1. [PubMed: 29389443]

8.

Sobel J, Rao AK. Making the Best of the Evidence: Toward National Clinical Guidelines for Botulism. Clin Infect Dis. 2017 Dec 27;66(suppl_1):S1-S3. [PubMed: 29293933]

9.

Griese SE, Kisselburgh HM, Bartenfeld MT, Thomas E, Rao AK, Sobel J, Dziuban EJ. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. Clin Infect Dis. 2017 Dec 27;66(suppl_1):S17-S29. [PubMed: 29293924]

10.

Martin SJ, Penrice G, Amar C, Grant K, Gorrie GH. Wound botulism, its neurological manifestations, treatment and outcomes: A case series from the Glasgow outbreak, 2015. Scott Med J. 2017 Nov;62(4):136-141. [PubMed: 28480790]

11.

Opila T, George A, El-Ghanem M, Souayah N. Trends in Outcomes and Hospitalization Charges of Infant Botulism in the United States: A Comparative Analysis Between Kids’ Inpatient Database and National Inpatient Sample. Pediatr Neurol. 2017 Feb;67:53-58. [PubMed: 28041655]

90,000 Botulism: causative agent, symptoms, treatment

Despite the active development of medicine, some infectious diseases threaten people today. One of these dangerous diseases that can be fatal is botulism. What is this infection? What is it caused by? In what forms does it take place? How to treat this pathology? Let’s try to figure it out.

Historical background

The term “botulism” comes from the Latin word “botulus” (translated as sausage).The reason for choosing this name, according to experts, was the mass poisoning of blood sausage at the end of the 18th century in Germany. In Russia, up to the beginning of the 20th century, a disease with characteristic symptoms was called “ichthyism”, associating with it all the poisoning of salted and smoked fish.

He was the first to describe in detail the symptoms and ways of spreading the disease in 1820 by the sanitary doctor J. Kerner, who was nicknamed the “godfather” of botulinum toxin research. It was he who suggested the biological origin of this toxin based on the similarity of its action with the action of atropine and snake venom.And at the end of the 19th century, the Belgian microbiologist E. Van-Ermengem isolated the causative agent of the infection from the remains of ham and cadaveric material of a deceased patient.

Who is he, this formidable microbe?

The causative agent of botulism is the Gram-positive bacillus Clostridium botulinum, which secretes a toxin that determines the clinical picture of the disease.

Distinguish between vegetative forms of bacteria and spores (“dormant” forms). Vegetative forms are poorly stable in the environment, which cannot be said about disputes – they do not die even after many hours of boiling, disinfection, drying, and ultraviolet irradiation.

Clostridia of botulism inhabit the intestines of many animals and the soil into which they enter with feces and live in it for a long time. Spores of the pathogen can be found on vegetables and fruits contaminated with soil or faeces.

A feature of these bacteria is active reproduction in the absence of oxygen with the production of a specific toxin that affects the nervous system.

How can you get botulism?

One of the ways of infection is the ingestion of food containing the causative agent of the infection.What foods cause botulism? Botulinum toxin can be found in almost any preservation, that is, the potential danger lies in all kinds of it (canned fish and meat, preparations from vegetables, fruits, mushrooms), if the ingredients were poorly washed or not sterilized enough. Cases of botulism infection have been reported with the use of honey.

A serious problem is that botulinum toxin cannot be determined by the taste, color and smell of canned food.Infection with botulism from such industrial products occurs much less frequently, but it is also possible.

Another way of getting botulinum bacillus into the human body is through damaged skin and mucous membranes. The toxin produced by microorganisms is absorbed into the bloodstream and causes intoxication. That is why it is necessary to prevent the entry of the pathogen into the wounds and subject them to special medical treatment.

How is botulism manifested?

When eating foods contaminated with bacteria, the first signs of the disease appear after 18-24 hours.In children, the disease develops more rapidly: the symptoms of botulism can emerge as early as 4-6 hours after eating.

Botulism in humans occurs with damage to the nervous system as pseudoparalysis. Unlike true paralysis, there is no anatomical damage to the nerve structures.

Digestive dysfunction (dry mouth, abdominal pain, vomiting, diarrhea) along with visual impairment are early typical signs of botulism infection. Patients note a weakening of visual acuity, double vision, “fog” before the eyes.Along with eye symptoms, there are disorders of swallowing and speech – hoarseness, slurred voice, blurry speech, choking.

If the disease progresses, patients develop severe general weakness, paralysis of the limbs, respiratory muscles.

How to treat botulism?

Treatment consists in providing medical care in the first hours of detecting an infection – this is the key to a full and quick recovery of the patient. Therefore, patients with suspected botulism are immediately admitted to the infectious diseases hospital.

To neutralize botulinum toxin, therapeutic anti-botulinum serums are used. In addition, special therapy is carried out to combat intoxication. With the development of complications in the form of respiratory distress, they resort to hyperbaric oxygenation (treatment with oxygen under high pressure) and artificial ventilation of the lungs. If swallowing is impaired, patients are provided with tube feeding.

Be careful! Follow the rules for processing, storing and preserving food at home.

The article was prepared with the advisory support of “Clinic Expert” Voronezh

The editors recommend:

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Botulism

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\ nThe spores produced by Clostridium botulinum are resistant to high temperatures and are widespread in the environment. In the absence of oxygen, these spores germinate, develop and begin to release toxins.There are 7 different forms of botulinum toxin – types A – G. Four of them (types A, B, E and in rare cases F) cause human botulism. Types C, D, and E cause disease in mammals, birds, and fish.

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\ nBotulinum toxins enter the body through the consumption of foods that have not been properly processed, in which bacteria or spores survive and produce toxins. The main cause of human botulism is food intoxication, but it can be caused by intestinal infections in infants, wound infections, and inhalation.

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Symptoms of foodborne botulism

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\ nBotulinum toxins are neurotoxic and therefore affect the nervous system. Foodborne botulism is characterized by descending flaccid paralysis, which can lead to respiratory failure.

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\ nEarly symptoms are severe fatigue, weakness and dizziness, usually followed by blurred vision, dry mouth, and difficulty swallowing and speaking. Vomiting, diarrhea, constipation, and bloating may also occur.As the disease progresses, weakness in the neck and arms may develop, followed by damage to the respiratory and lower body muscles. The temperature does not rise and no loss of consciousness occurs.

\ n

\ nThe cause of these symptoms is not the bacteria itself, but the toxin it produces. Symptoms usually appear 12 to 36 hours (minimum 4 hours and maximum 8 days) after exposure. Botulism incidence rates are low, but mortality rates are high if the correct diagnosis is not promptly made and immediate treatment (administration of antitoxin in the early stages and intensive mechanical ventilation) is provided.The disease can be fatal in 5-10% of cases.

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Exposition and transmission

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Foodborne botulism

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\ nC. botulinum is an anaerobic bacterium, which means that it can only grow in the absence of oxygen. Foodborne botulism occurs when C. botulinum bacteria grow and produce toxins in food prior to consumption. C. botulinum produces spores that are widespread in the environment, including soil and river and sea water.

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\ nBacterial growth and toxin production occur in foods with a low oxygen content and at a certain combination of storage temperature and preservation parameters. This occurs most often in lightly preserved foods, as well as in foods that have not been properly processed, canned or bottled at home. In an acidic environment (pH less than 4.6) C. botulinum does not develop, and therefore no toxin is produced in acidic foods (however, a low pH does not destroy toxins previously produced).Low storage temperatures combined with specific levels of salt and / or acidity are also used to prevent bacterial growth and toxin production.

\ n

\ nBotulinum toxin is found in a wide variety of foods, including low acid canned vegetables such as green beans, spinach, mushrooms and beets; fish such as canned tuna, fermented, salted and smoked fish; and meats such as ham and sausages. Food products vary from country to country and reflect local dietary habits and food preservation practices.Sometimes botulinum toxins are found in industrially prepared foods.

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\ nAlthough C. botulinum spores are resistant to high temperatures, the toxin produced by bacteria that develop from spores under anaerobic conditions is destroyed by boiling (for example, at an internal temperature> 85C for five minutes or more) … Therefore, the most common cause of human botulism is ready-to-eat foods in packages with a low oxygen content.

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\ nTo determine the cause and prevent further cases of illness, samples of the food implicated in the suspected cases must be obtained immediately, placed in suitable hermetically sealed containers and sent to laboratories.

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Infant botulism

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\ nChildren botulism develops mainly in children under 6 months of age. Unlike foodborne botulism, which is caused by the consumption of already produced toxins in food (see “a” above), infant botulism develops when children ingest C. botulinum spores, which develop bacteria that colonize the intestines and release toxins. This does not happen in most adults and children over 6 months of age, because the natural defense mechanisms of the intestines, which develop later, prevent spore germination and bacterial growth.

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\ n Clinical symptoms in infants include constipation, loss of appetite, weakness, altered crying, and a pronounced loss of ability to hold the head. There are several possible sources of infant botulism infection, but a number of cases are associated with honey contaminated with spores. Therefore, parents and caregivers should not give honey to children under 1 year of age.

\ n

Wound botulism

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\ n Wound botulism rarely develops when spores get into an open wound and are able to multiply under anaerobic conditions.Symptoms are similar to foodborne botulism, but may appear after two weeks. This form of the disease is associated with substance abuse, in particular with heroin injections.

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Botulism as a result of inhalation

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\ nBotulism rarely develops as a result of inhalation. Such incidents do not occur naturally, they are associated, for example, with accidental or deliberate events (such as bioterrorism) that lead to the release of toxins in aerosols. The clinical presentation of botulism resulting from inhalation is similar to that of foodborne botulism.The average lethal dose for humans is estimated at 2 nanograms of botulinum toxin per kilogram of body weight, which is about 3 times higher than in cases of foodborne botulism.

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\ nSymptoms appear 1-3 days after inhalation of toxins, or longer in the case of lower levels of toxicity. Symptoms develop in the same way as with foodborne botulism, and in the final stage, muscle paralysis and respiratory failure occur.

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\ nIf exposure to a toxin by inhalation of an aerosol is suspected, additional exposure to the patient and others must be prevented.Clothing should be removed from the patient and stored in plastic bags until thoroughly washed with soap and water. The patient must shower and disinfect immediately.

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Other types of intoxication

\ n

\ nIn theory, botulism can be transmitted through water as a result of ingestion of a previously produced toxin. However, given the fact that water treatment (such as boiling or disinfecting with 0.1% hypochlorite solution) degrades the toxin, this risk is considered low.

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\ nBotulism of undetermined origin is usually recorded among adults in cases where the source of foodborne or wound botulism has not been identified. These cases are comparable to infantile botulism and can occur when the normal gut flora changes as a result of surgery or antibiotic therapy.

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\ nAdverse reactions have been reported to the pure toxin used among patients for medical and / or cosmetic purposes, for more information see(see Botox section below).

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Botox

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\ nThe bacterium C. botulinum is used for the production of Botox, a pharmaceutical used primarily for injections for clinical and cosmetic purposes. For Botox, a purified and highly diluted botulinum neurotoxin type A is used. Procedures are performed in hospitals according to the patient’s needs and are generally well tolerated, although adverse reactions are rare.

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Diagnosis and Treatment

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\ n The diagnosis is usually made on the basis of medical history and clinical examination with subsequent laboratory confirmation, including demonstration of the presence of botulinum toxin in serum, stool or food, or cultivation of C.botulinum in stool, wound fluid, or food samples. Botulism is sometimes misdiagnosed as it is often mistaken for stroke, Guillain-Barré syndrome, or myasthenia gravis.

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\ nAfter a clinical diagnosis, antitoxin should be administered as soon as possible. Early administration of antitoxin effectively reduces mortality rates. In the case of severe botulism, supportive therapy is required, in particular mechanical ventilation, which may be required for several weeks or even months.Antibiotics are not required (except in cases of wound botulism). There is a vaccine against botulism, but it is rarely used because its effectiveness has not been fully evaluated and adverse reactions have been reported.

\ n

Prevention

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\ nPrevention of foodborne botulism is based on good food preparation practices, particularly during cooking / sterilization, and hygiene.

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\ n Foodborne botulism can be prevented by inactivating bacteria and their spores in heat-sterilized (eg autoclaved) or canned foods, or by inhibiting bacterial growth and the production of toxins in other foods.Vegetative forms of bacteria can be killed by boiling, but spores can remain viable even when boiled for several hours. However, spores can be destroyed by heat treatment at very high temperatures, such as industrial canning

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\ nIndustrial heat pasteurization (including vacuum-packed pasteurized food and hot smoked food) may not be enough to kill all spores and therefore, the safety of these products must be based on the prevention of bacterial growth and toxin production.Low temperatures combined with salt and / or acidic environments inhibit bacterial growth and toxin production.

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\ nWHO’s Five Essential Principles for Safe Nutrition serves as the foundation for educational programs to prepare food handlers and educate their consumers. They are especially important for preventing foodborne illness.

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\ nThese are the following five principles:

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• keep clean;

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• separate raw from finished;

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• heat thoroughly;

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• keep food at a safe temperature;

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• Use clean water and clean food raw materials.

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WHO activities

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\ nBotulism outbreaks are rare, but they are public health emergencies that require rapid identification in order to identify the source of infection, to determine the type of disease outbreak (among natural, accidental or potentially deliberate ), preventing other cases of illness and effectively treating affected patients. Treatment success is highly dependent on early diagnosis and rapid administration of botulinum antitoxin.

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\ n The role of WHO in responding to outbreaks of botulism that may be of international concern is as follows:

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• Surveillance and detection: WHO supports strengthening national surveillance and international alert systems to ensure rapid detection of outbreaks disease in the field and an effective international response. WHO’s primary tool for surveillance, coordination and response is the International Food Safety Authorities Network (INFOSAN), which links the national authorities of Member States responsible for managing food safety events.This network is jointly managed by FAO and WHO.

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• Risk Assessment: The heart of the WHO response is a risk assessment methodology that includes determining the type of outbreak – whether it is natural, accidental, or possibly intentional. WHO also provides scientific assessments as the basis for international food safety standards, guidelines and recommendations developed by the Codex Alimentarius Commission.

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• Isolation of source of infection: WHO is coordinating with national and local authorities to contain the further spread of disease outbreaks.

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• Assistance: WHO is coordinating with international agencies, experts, national laboratories, airlines and commercial organizations to mobilize equipment, funds and supplies for a response, including the supply and administration of botulinum antitoxin.

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Botulism – Causes, Symptoms and Treatment – Medcompass

Botulism is a pathological condition provoked by botulism sticks and toxins secreted by them. The pathogen can get from the soil and food products – meat, cereals, fruits, vegetables, canned food, mushrooms and others.

Symptoms of the disease

The initial symptoms of the disease are minor pain syndrome, intoxication and general weakness. They are complemented by dyspeptic disorders (in particular, diarrhea or diarrhea), which are not amenable to the action of laxatives and microclysters.

Other signs of a pathological condition:

• Impaired vision – strabismus, diplopia or double vision, ptosis of the upper eyelid
• Voice change
• Slurred speech, weak voice, dry mouth
• Slightly fever.

When spores germinate, ocular symptoms increase, swallowing disorders, low blood pressure, changes in heart and pulse sounds, cyanosis, respiratory paralysis, which is the cause of possible death.

Causes of the disease

The causative agent of the pathological condition is the anaerobic Clostridium, which forms the strongest exotoxin. Sources of pathogens are various animals, fish, humans, crustaceans and molluscs, as well as soil, water, silt.

Pathology develops when smoked products, sausages, salted fish and various canned foods, especially homemade, are included in the diet. The greatest danger is posed by food in contact with contaminated soil.

The toxin is also spread through blood transfusion or inhalation of dust. Isolated cases of the wound form of the disease are not excluded, when the toxin penetrates through a burn, wound or other injured tissue. Infant botulism is known.

There is no danger to others from a patient with this disease.

Diagnostics

Diagnosis of the disease is carried out by analyzing the symptoms and clinical signs, the patient’s history (whether the patient has consumed homemade or industrial canned food or fish, whether there are injured areas) and a variety of laboratory tests.

The pathogen can be identified using bacteriological analysis, the material for which is gastric lavage, waste products, residual food or vomit. The toxin can be identified using studies of vomit, waste products, gastric lavage and blood before serum administration.

Wound type of pathology is confirmed by examining blood from the wound, rejected tissue and tampons used to treat the wound.

It is very important to preserve suspected food items and residues until a doctor is examined.

Complications

With botulism, the following hazards and complications often develop:

• Aspiration pneumonia
• Respiratory paralysis
• Serum sickness
• Myositis
• Myocarditis

Fever and cystitis

Possible neurological symptoms.

Treatment of the disease

If this pathological condition is suspected, urgent hospitalization is required. Regardless of the severity of the disease and the timing, first aid is carried out, in particular, gastric lavage through a probe, the introduction of therapeutic solutions and highly purifying enemas.

Anti-botulinum polyvalent serum is used intramuscularly or intravenously until the type of toxins that caused the disease is established.Usually it is administered once. Monovalent serum is used after the pathogen has been identified, along with detoxification solutions and antibiotics.

The most important principles of therapy are careful care, constant supervision and the strictest bed rest. If swallowing is impaired, then feeding is performed by means of a probe and drip nutritional enemas. With oxygen deficiency, artificial lung ventilation and hyperbaric oxygenation are used.

The fight against bedsores, swallowing disorder and other complications is also important.For example, keratoconjunctivitis, tracheobronchitis, or pneumonia.

Botulism

is an acute toxic and infectious disease associated with the consumption of foods containing the Clostridium botulinum toxin and the pathogens themselves. Characterized by the development of paresis and paralysis of the muscles in connection with the blockade of the toxin release of acetylcholine in the nerve synapses.

Reservoir and sources of infection – soil, wild animals, waterfowl, fish and humans. The causative agent of botulism lives in the intestines of cows, horses, pigs, rabbits, rats, minks, chickens, wild waterfowl and many other representatives of the animal world.In this case, the carriage of pathogens usually does not cause visible harm to animals. A sick person does not pose an epidemiological danger to those around him. Bacteria are excreted from the body of infected animals (or humans) with feces and enter the soil, water, livestock feed, etc. Contamination of various elements of the external environment can also be caused by the decomposition of the corpses of rodents and birds that died from botulism.

Transmission mechanism – fecal-oral. The main cause of the disease is the consumption of home-canned food, most often vegetables and mushrooms, as well as sausages, ham, smoked and salted fish contaminated with pathogens.Almost all food products contaminated with soil or intestinal contents of animals, birds, fish may contain spores of botulism pathogens. However, the disease can occur only when eating foods that have been stored in anaerobic (without oxygen) conditions (homemade canned food). Wound botulism and botulism of newborns occurring in the latter when Clostridia enter the intestine and release toxin by them is much less common. With injuries in crushed, necrotic tissues, deprived of oxygen access, conditions close to anaerobic conditions are created, under which spores germinate and botulinum toxin accumulates.The toxin is well absorbed not only from the mucous membrane of the gastrointestinal tract, but also from the mucous membranes of the eyes and upper respiratory tract, which poses a great danger if the toxin aerosol is used as a biological weapon.

The incubation period of botulism in most cases is short and is 4-6 hours. However, in rare cases, it can be extended to 7-10 days. This makes it necessary for 10 days to monitor the health of all persons who ate the product that caused the first case of the disease.
Initial period. Symptoms of the disease can be vague, similar to a number of other diseases, making it difficult to diagnose early. By the nature of the main clinical manifestations of botulism in the initial period, the following options can be conditionally distinguished:
– severe dryness of the mucous membranes of the oral cavity, which cannot be explained by a slight loss of fluid. There are “eye” symptoms – visual impairment. “Flies, veil” before the eyes, blurred vision of objects., Constriction of the pupil, double vision.There may be abdominal pain, vomiting. In severe cases, acute respiratory failure develops – shortness of breath, cyanosis, palpitations. A common symptom during this period is the difficulty in passing food through the esophagus (“lump in the throat”) of solid and then liquid food. Due to the paralysis of the swallowing muscles, when swallowing, water is poured out through the nose, speech is disturbed, and a nasal voice appears. The disease is accompanied by severe weakness and unsteadiness of gait.

Prevention of botulism is based on strict adherence to sanitary and technological rules for food preservation.Meat and fish are allowed to be preserved only fresh. Vegetables and fruits must be thoroughly washed before canning to remove soil particles. Canning of overripe fruits is also unacceptable. The regime of guaranteed sterilization must be strictly observed. Sterilization should be carried out in autoclaves, since high pressure and high temperature (120 ° C) destroy not only bacterial cells and toxin, but also spores. At home, products of plant origin can be harvested for future use only by pickling or salting with the addition of a sufficient amount of acid and salt and always in a container open for air access.Prevention of botulism in the trade network is of great importance. The most important point is compliance with the storage conditions for perishable food. Canned food spoiled (with bombing) and expired sale should not be allowed into the distribution network. An important role is played by explanatory work among the population about the dangers of botulism and the rules of canning food at home.

Doctor of infectious diseases

Healthcare Institution “22nd City Polyclinic” E. KrinitsynaG.

Bolshekrepinskoe :: BOTULISM IS DANGEROUS!

The most dangerous of the microbes that cause food poisoning is the botulism bacillus, which is widespread in nature.

Botulism is a severe toxic-infectious food poisoning, often leading to death. The disease has been known for a long time and is recorded annually to this day.

Spores of the causative agent of botulism are found in the soil, in the water of the seas and freshwater bodies, in the intestines of animals and fish, which inevitably leads to their contamination of various types of raw materials for the preparation of canned food, as well as fish, meat, etc.d.

The causative agents of botulism are severe anaerobes, that is, they develop without air access. Therefore, they usually multiply and produce poison (toxin) in the depths of large pieces of fish, ham, sausage, or in hermetically sealed canned food. At the same time, the products seem to be quite benign in appearance and smell. In addition, there is often a nested accumulation of toxin in foods with a dense consistency, such as fish. This explains that the disease sometimes occurs only in one or two people from the group of companions who used the same product.

The accumulation of botulinum toxin in fish can occur both before salting during storage without freezing, and in the first days after salting, while the concentration of salt in the muscle tissue is still insufficient to delay the formation of toxin. At low storage temperatures and high salt concentration, botulism toxin cannot be formed after salting fish.

Home-made canned vegetables can also cause botulism. Homemade canned food made from mushrooms is especially dangerous, since it is almost impossible to completely wash mushrooms from the remains of soil and sand.

Boiling and sterilization at home are not capable of destroying the spores of the causative agent of botulism. The temperature required for this (+ 120 ° C) can only be achieved in industrial production.

Canning vegetables at home is carried out in almost every family, therefore, the harvested canned vegetables and meat should be carefully examined before opening in order to identify swollen cans (bombing or crackers). The contents of the jar in appearance, smell, color must be characteristic of each type of product and satisfy the traditionally established tastes and habits of the population.

In the human gastrointestinal tract, the poison secreted by the causative agent of botulism is not destroyed, and in some cases is even activated. The first symptoms of the disease can appear several hours after eating poor-quality products, but sometimes their appearance can be delayed up to 3-7 days.

Patients report muscle weakness, nausea, and abdominal pain. With the further development of the disease, visual disturbances appear (“mesh” in front of the eyes, dilated pupils, drooping of the upper eyelid), difficulty in swallowing, breathing, speaking, voice changes, unsteadiness of gait.Death occurs as a result of respiratory arrest.

If you develop symptoms of botulism, you must immediately wash your stomach and urgently seek medical help to avoid unfortunate consequences.

So, over the past period of 2016, 7 people applied for medical help with the above complaints and they were diagnosed with botulism. They ate dried fish, made independently with violations of technology or acquired from random people, and canned mushrooms made at home.

Analysis of the available materials shows that the cause of the high mortality rate was the peculiarities of the course of the disease, untimely seeking medical help, which in many cases did not allow timely diagnosis of botulism, appropriate treatment and preventive measures.

To avoid getting botulism, the following rules should be followed:

Before canning, fruits, berries, vegetables, herbs and especially mushrooms must be sorted from damaged and rotten ones and rinsed thoroughly with plenty of water until all soil residues are removed.

Meat, fish, as well as mushrooms and greens spreading on the ground, for example, purslane, young dill, cannot be harvested for future use by canning with a hermetic sealing. Greens and mushrooms should be pickled, since the acid, which is supposed to be added to the marinade according to the recipe, prevents spore germination and the formation of toxins.

For the same reason, add citric acid to all hermetically preserved foods with low acidity (apricots, pears, figs, peaches, green peas, cucumbers).

If you decide to salt or dry the fish, do not forget: only freshly caught and undamaged fish are suitable. Be sure to chill it in the refrigerator, only then start processing.

Gut the fish with particular care to prevent intestinal germs from entering the muscles. Tuzluk (that is, salt brine) should contain about 10-11% table salt in order for the fish to be well salted, it should completely cover the surface, for which oppression is put on top.

All homemade canned food, salted and dried fish should be kept in the cold.

It is recommended to boil the contents of a hermetically sealed can immediately before use.

In no case should you purchase canned products, smoked and dried fish of homemade origin from random persons, as well as in places of unauthorized trade. Often, it is these products that cause fatal poisoning.

Take care of your health and the health of children!

FBUZ “Center for Hygiene and Epidemiology in the Rostov Region”

CAUTION! MUSHROOMS!

Dear residents!

On the territory of the Rostov region, cases of acute mushroom poisoning are annually recorded, the peak of which falls on the beginning and middle of autumn.Recently, there has been a high number of poisonings with conditionally edible and poisonous mushrooms, including those with a lethal outcome.

The main reason for these poisonings is the low awareness of the population about edible and inedible mushrooms. Mushroom poisoning can be caused by poisonous mushrooms themselves (pale toadstool, fly agarics, false mushrooms), conventionally edible mushrooms (raincoats, morels, lines), and even edible mushrooms (as a result of violation of the technology of mushroom preparation, when proteins are decomposed in old mushrooms).

To avoid poisoning, you need to know well the main signs of poisonous and inedible mushrooms and adhere to the rule – never eat unknown mushrooms.

In addition, you need to have an idea about the signs of poisoning, about the properties of mushroom poisons.

Know!

As a rule, poisoning occurs with poisonous mushrooms, which contain toxins and alkaloids. The proportion of these substances in mushrooms depends on the place of growth and weather conditions.

The first signs are noticeable within a few hours (1.5-3 hours). Against the background of rapidly growing weakness, drooling, nausea, excruciating repeated vomiting, headache, and dizziness appear.

Soon there is diarrhea (often bloody) and signs of damage to the nervous system: visual disturbances, delirium, hallucinations, motor agitation, convulsions. Cardiac activity weakens, blood pressure and body temperature decrease.

If the patient is not helped, then a collapse develops, quickly leading to death.

Remember

1. Collect only those mushrooms that you know for sure are edible.

2. Never taste raw mushrooms.

Remember that the absence of an unpleasant smell, sharp, bitter taste does not mean that you have an edible mushroom in front of you. In pale toadstool and fly agarics, the flesh is very pleasant to the taste.

3. Never pick or eat mushrooms that are overripe, mucky, wormy and spoiled.

4. Do not pick mushrooms, even those known to be edible, in city parks, courtyards, as well as along roads and railways. Mushrooms are capable of accumulating toxic substances and becoming unsuitable for human consumption.

5. Buy mushrooms only in specially designated places (markets, shops). Don’t buy homemade canned mushrooms.

6. If you feel unwell after eating mushrooms, consult a doctor immediately.

FBUZ? Center for Hygiene and Epidemiology in the Rostov Region?

Botulism – causes, symptoms, prevention – VESTI / Tambov

Preparing more homemade canned food, making the shelves in the cellar tighter – this is the dream of every true housewife. Some do home canning out of necessity, others out of habit, and still others for aesthetic reasons, but everyone is in the zone of mortal risk. Everyone who loves homemade pickled crispy cucumbers, canned juicy tomatoes, spicy forest mushrooms.Any canned food is a time bomb. After all, any jars with homemade preparations, with the slightest mistake in the cooking technology, may well become fatal – if the bacterium Clostridium botulinum appears in the jar. The neurotoxin it secretes is the most potent poison known in the world.

Today we will talk about the rules of food preservation and our food safety in general. In particular, this should be remembered by lovers of fish and meat delicacies in the form of various kinds of smoked meats.We will thoroughly question the head of the department of food hygiene and sanitary and epidemiological examinations of the Center for Hygiene and Epidemiology in the Tambov Region, Galina Zelenova, about everything in order.

Botulism is a serious disease that affects the central nervous system, and if not addressed in time for help, it ends in death. On average, about 200 people suffer from botulism in Russia every year. When preparing home preservation, it must be remembered that it is homemade preparations that are most often the cause of the deadly disease – botulism.The causative agents of botulism live only in the absence of oxygen. That is why botulism often falls ill after consuming hermetically sealed canned food, pickles and smoked products of home production, where air does not penetrate into the thickness of the product, and favorable conditions are created for the preservation of the pathogen of the disease. At the same time, the appearance, taste and smell of products does not change, sometimes, and not at all, there may be swelling of cans,

– Galina Zelenova, head of the department of food hygiene and sanitary-epidemiological examinations, head of the department of food hygiene and sanitary-epidemiological examinations ” Center for Hygiene and Epidemiology in the Tambov Region “.

Botulism

Newsletter
October 2017

Key facts:

• Clostridium botulinum is a bacterium that produces dangerous toxins (botulinum toxins) in low oxygen conditions.
• Botulinum toxins are among the most powerful lethal substances known to date.
• Botulinum toxins block nerve functions and can lead to respiratory and muscle paralysis.
• Human botulism can refer to foodborne botulism, infant botulism, wound botulism and botulism by inhalation or other types of intoxication.
• Foodborne botulism caused by the consumption of unprocessed food is a rare but potentially fatal disease if not diagnosed early and treated with antitoxin.
• Canned or home-fermented foods are a major source of foodborne botulism and special precautions must be taken when preparing them.

Overview.

Foodborne botulism is a severe, potentially fatal, but relatively rare disease. This is an intoxication, usually caused by the consumption of highly active neurotoxins, botulinum toxins, formed in contaminated food. Botulism is not spread from person to person.

The spores produced by Clostridium botulinum are resistant to high temperatures and widespread in the environment. In the absence of oxygen, these spores germinate, develop and begin to release toxins.There are 7 different forms of botulinum toxin – types A – G. Four of them (types A, B, E and in rare cases F) cause human botulism. Types C, D, and E cause disease in mammals, birds, and fish.

Botulinum toxins enter the body through the consumption of unprocessed foods, in which bacteria or spores survive and produce toxins. The main cause of human botulism is food intoxication, but it can be caused by intestinal infections in infants, wound infections, and inhalation.

Symptoms of foodborne botulism.

Botulinum toxins are neurotoxic and therefore affect the nervous system. Foodborne botulism is characterized by descending flaccid paralysis, which can lead to respiratory failure.

Early symptoms are severe fatigue, weakness and dizziness, usually followed by blurred vision, dry mouth, and difficulty swallowing and speaking. Vomiting, diarrhea, constipation, and bloating may also occur.As the disease progresses, weakness in the neck and arms may develop, followed by damage to the respiratory and lower body muscles. The temperature does not rise and no loss of consciousness occurs.

The cause of these symptoms is not the bacterium itself, but the toxin it produces. Symptoms usually appear 12 to 36 hours (minimum 4 hours and maximum 8 days) after exposure. Botulism incidence rates are low, but mortality rates are high if the correct diagnosis is not promptly made and immediate treatment (administration of antitoxin in the early stages and intensive mechanical ventilation) is provided.The disease can be fatal in 5-10% of cases.

Exposure and transmission.

Foodborne botulism.

C. botulinum is an anaerobic bacterium, which means that it can only grow in the absence of oxygen. Foodborne botulism occurs when C. botulinum bacteria grow and produce toxins in food prior to consumption. C. botulinum produces spores that are widespread in the environment, including soil and river and sea water.

Bacterial growth and toxin production occur in foods with a low oxygen content and at a certain combination of storage temperature and preservation parameters. This occurs most often in lightly preserved foods, as well as in foods that have not been properly processed, canned or bottled at home. In an acidic environment (pH less than 4.6) C. botulinum does not develop, and therefore no toxin is produced in acidic foods (however, a low pH does not destroy toxins previously produced).Low storage temperatures combined with specific levels of salt and / or acidity are also used to prevent bacterial growth and toxin production.

Botulinum toxin is found in a wide variety of foods, including low acid canned vegetables such as green beans, spinach, mushrooms and beets; fish such as canned tuna, fermented, salted and smoked fish; and meats such as ham and sausages. Food products vary from country to country and reflect local dietary habits and food preservation practices.Sometimes botulinum toxins are found in industrially prepared foods.

Although C. botulinum spores are resistant to high temperatures, the toxin produced by bacteria that develop from spores under anaerobic conditions is destroyed by boiling (for example, at an internal temperature> 85C for five minutes or more). Therefore, the most common cause of human botulism is ready-to-eat foods in packages with a low oxygen content.

In order to determine the cause and prevent further cases of illness, samples of the food implicated in the suspected illness should be obtained immediately, placed in suitable hermetically sealed containers and sent to laboratories.

Children’s botulism.

Infant botulism develops mainly in children under 6 months of age. Unlike foodborne botulism, which is caused by the consumption of already produced toxins in food (see “a” above), infant botulism develops when children ingest C. botulinum spores, which develop bacteria that colonize the intestines and release toxins. This does not happen in most adults and children over 6 months of age, because the natural defense mechanisms of the intestines, which develop later, prevent spore germination and bacterial growth.

Clinical symptoms in infants include constipation, loss of appetite, weakness, altered crying, and a pronounced loss of ability to hold the head. There are several possible sources of infant botulism infection, but a number of cases are associated with honey contaminated with spores. Therefore, parents and caregivers should not give honey to children under 1 year of age.

Wound botulism.

Wound botulism rarely develops when spores enter an open wound and are able to multiply under anaerobic conditions.Symptoms are similar to foodborne botulism, but may appear after two weeks. This form of the disease is associated with substance abuse, in particular with heroin injections.

Botulism due to inhalation.

Botulism rarely develops as a result of inhalation. Such incidents do not occur naturally, they are associated, for example, with accidental or deliberate events (such as bioterrorism) that lead to the release of toxins in aerosols. The clinical presentation of botulism resulting from inhalation is similar to that of foodborne botulism.The average lethal dose for humans is estimated at 2 nanograms of botulinum toxin per kilogram of body weight, which is about 3 times higher than in cases of foodborne botulism.

Symptoms appear 1–3 days after inhalation of toxins, or longer for lower levels of toxicity. Symptoms develop in the same way as with foodborne botulism, and in the final stage, muscle paralysis and respiratory failure occur.

If exposure to a toxin by inhalation of an aerosol is suspected, additional exposure to the patient and others must be prevented.Clothing should be removed from the patient and stored in plastic bags until thoroughly washed with soap and water. The patient must shower and disinfect immediately.

Other types of intoxication.

In theory, botulism can be spread through water by ingesting a previously produced toxin. However, given the fact that water treatment (such as boiling or disinfecting with 0.1% hypochlorite solution) degrades the toxin, this risk is considered low.

Botulism of undetermined origin is commonly reported in adults when the source of foodborne or wound botulism has not been identified. These cases are comparable to infantile botulism and can occur when the normal gut flora changes as a result of surgery or antibiotic therapy.

Adverse reactions to a pure toxin used in patients for medical and / or cosmetic purposes have been reported, for more information see(see Botox section below).

Botox.

The bacterium C. botulinum is used to produce Botox, a pharmaceutical used primarily for clinical and cosmetic injection purposes. For Botox, a purified and highly diluted botulinum neurotoxin type A is used. Procedures are performed in hospitals according to the patient’s needs and are generally well tolerated, although adverse reactions are rare.

Diagnostics and treatment.

Diagnosis is usually made on the basis of medical history and clinical examination with subsequent laboratory confirmation, including demonstration of the presence of botulinum toxin in serum, stool, or food, or culture of C. botulinum in stool, wound fluid, or food samples. Botulism is sometimes misdiagnosed as it is often mistaken for stroke, Guillain-Barré syndrome, or myasthenia gravis.

Following a clinical diagnosis, antitoxin should be administered as soon as possible.Early administration of antitoxin effectively reduces mortality rates. In the case of severe botulism, supportive therapy is required, in particular mechanical ventilation, which may be required for several weeks or even months. Antibiotics are not required (except in cases of wound botulism). There is a vaccine against botulism, but it is rarely used because its effectiveness has not been fully evaluated and adverse reactions have been reported.

Prevention.

Prevention of foodborne botulism is based on good food preparation practices, particularly during cooking / sterilization, and hygiene.

Foodborne botulism can be prevented by inactivating bacteria and their spores in heat-sterilized (eg autoclavable) or canned foods, or by inhibiting bacterial growth and the production of toxins in other foods. Vegetative forms of bacteria can be killed by boiling, but spores can remain viable even when boiled for several hours.However, spores can be destroyed by heat treatment at very high temperatures, such as industrial canning

Industrial heat pasteurization (including vacuum-packed pasteurized and hot-smoked foods) may not be sufficient to kill all spores and therefore the safety of these products should be based on preventing bacterial growth and toxin production. Low temperatures combined with salt and / or acidic environments inhibit bacterial growth and toxin production.

The WHO brochure The Five Essential Principles for Safe Nutrition serves as the foundation for educational programs to prepare food handlers and consumers. They are especially important for preventing foodborne illness.

These are the following five principles:

1. Maintain cleanliness;
2. Separate raw from cooked;
3. Conduct a thorough heat treatment;
4. Store food at a safe temperature;
5. Use clean water and clean food raw materials.

WHO activities.

Outbreaks of botulism are rare, but they are public health emergencies that require rapid recognition to identify the source of infection, determine the type of outbreak (whether natural, accidental, or potentially deliberate), prevent other cases, and effectively treat affected patients. Treatment success is highly dependent on early diagnosis and rapid administration of botulinum antitoxin.

WHO’s role in responding to outbreaks of botulism that may be of international concern is as follows:

• Surveillance and detection: WHO supports the strengthening of national surveillance and international alert systems to ensure rapid local outbreak detection and effective international response measures. WHO’s primary tool for surveillance, coordination and response is the International Food Safety Authorities Network (INFOSAN), which links the national authorities of Member States responsible for managing food safety events.This network is jointly managed by FAO and WHO.