Download Botulism

Botulism
By Cicely Quade
Name and history:
Botulism; Scientific name: Clostridium botulinum, it is a bacterium that is part of the
Clostridium family and it is an endospore- it forms gram-positive bacilli8. There are
several common names for botulism including botulinum toxin as well as Botox8. There
are seven types of botulism bacteria that have been discovered and the have been
identified with the letters A-G but only the strains A, B, E and F can manifest themselves
in humans as an illness8. The taxonomy of the C. botulinum in the order of domain,
kingdom, phylum, class, order, family, genus and species is as follows: Bacteria,
Bacteria, Firmicutes, Clostridia, Clostridiales, Clostridiaceae, Clostridium and
Clostridium botulinum14 The bacterium is rod shaped and they grow best in environments
that are low in oxygen1. John Muller, who thought that the onset of symptoms was linked
to eating sausage, first discovered this disease in 1870. Thus, the name of botulism was
derived from the Latin word for sausage2.
Transmission:
Botulism is unique from other infectious diseases in that it is not transmitted directly
from human to human1. There are two main types of botulism: wound botulism and
foodborne botulism1. Wound botulism occurs when a person ingests food that has been
infected by the bacterium’s spores that can grow into bacteria in the intestines of both
adults and infants1. The bacteria release toxins in the intestines that affect the nerves of
the host1. Wound botulism occurs when a wound becomes infected with the Clostridium
botulinum bacterium and it produces toxins within the wound that travel through the body
to the nerves of the host1.
Reservoir:
Clostridium botulinum can be found within soil1. Most cases of foodborne botulism
transmission occur when home-processed foods are not processed correctly and they do
not have very much acid in their preservation solutions that allow the bacteria to become
active3. Botulism toxins in canned foods are more frequently present in the toxins that are
not very acidic3. When the human digests the food it can become infected with spores of
the bacteria. Wound botulism occurs most frequently from illegal drug use, especially
black tar heroin from Mexico that can contain the Clostridium botulinum spores7. When
the heroin is injected into the body the spores are absorbed into the blood stream and
circulated around the body7. The bacteria is extremely heat resistant8.
General Characteristics:
Laboratory: It is often difficult to confirm the presence of botulism when trying to
diagnose a patient, but routine tests are often helpful for ruling out other diseases for the
diagnosis5. Boutlism is positively identified by finding botulinum neurotoxin in the serum
of feces, vomit, or in a sample of the contents of the gastrointenstinal fluids or if a sample
of the food that was ingested if it is available5. They perform either mouse toxicity or a
neutralization bioassay.5 In the mouse toxicity test, a mouse is injected with the serum of
the patient and observed for signs of botulism5. If that is not conclusive then the serum
from the patient is added to six test tubes and then antibotulinum toxin (one for A, B, E
and F and a combination of all four) are added to each test tube and then injected into the
mouse and the mouse is observed for signs of botulism5.
Clinical: The physician obtains a log of all the food ingested by the patient for the
past five days1. The physician tests the individuals’ muscle and neurological responses
and looks for signs of muscle paralysis1.
Signs and Symptoms:
In foodborne botulism the onset of symptoms is usually eighteen- thirty-six hours after
ingesting the infected food1. But, signs have been known to occur as early as six hours
and as delayed as ten days1. There are several symptoms of botulism that include double
vision as well as blurry vision, droopy eyelids, muscle weakness, slurred speech, dry
mouth as well as difficulty swallowing1. In infants the symptoms include difficulty
eating, poor muscle tone as well as being constipated and having a weak cry1. All of these
symptoms indicate that the bacterial toxin is causing muscle paralysis1. If botulism is
diagnosed early on the patient can take a botulism antitoxin but if the symptoms are left
untreated the toxin could spread to the respiratory muscles and the abdominal muscles as
well as the muscles of the limbs1.
Virulence Mechanisms:
The Clostridium botulinum bacteria reproduce by spores that can remain dormant until it
is in anaerobic conditions that are ideal for the bacteria to reproduce3. For foodborne
botulism the food is ingested that has been contaminated with the toxin and it is absorbed
through the gastrointestinal tract into the blood stream3. The toxin circulates through the
body until it reaches a peripheral neuromuscular synapse and the toxin will bind to the
presynaptic terminals and that blocks the release of the acetylcholine3. The release of
acetylcholine is essential for the stimulation of muscle contractions3.
Prevention:
Botulism is most commonly transmitted through infected food and water13. To prevent
botulism in infants (under twelve months of age) it is recommended to not allow them to
eat honey12. In adults and children, a common source is home-canned foods that have a
low acid content but can also be found in commercially canned foods if it is improperly
done13. If canning foods at home it is important to follow proper canning methods13. If
you are wounded, proper treatment of the wound by seeking medical attention or cleaning
the wound can prevent wound botulism13.
Control/Treatment:
Botulism has a high mortality rate if it is not treated quickly after the onset of symptoms3.
The antibotulinum toxin can be used to treat the patient but it will not be effective if the
botulinum toxin has already reached the neuromuscular synapses3. If the toxin reaches the
toxins then the individual still has a chance to recover but it is a very long and expensive
process3. The body never naturally becomes immune to the toxin and a vaccine has not
been developed due to the incredibly rare nature of the disease3. Infants can be protected
from the disease by not exposing them to solid food before twenty weeks of age3. Adults
can protect themselves from botulism by practicing safe canning practices and or eating
canned food that has been processed as well as by not injecting black tar heroin into their
blood stream5. A faster diagnosis test is currently being researched5.
Current Information:
United States:
In the United States there are an average of 145 cases reported each year1. Approximately
15% of these are foodborne, and the majority is represented by infant botulism and
approximately 20% of cases are wound botulism1. In 2015, there was an outbreak in Ohio
that was the largest outbreak in recent history11. The outbreak originated from a church
potluck where there were over 52 foods available11. The most likely source of the toxin
was from a potato salad that was prepared using potatoes that had been canned at home11.
The individual used a boiling water canner instead of a pressure canner, which kills the
Clostridium botulinum bacteria11. For most of the individuals at the potluck their
symptom onset was approximately 2 days after eating at the potluck11. There were
approximately 29 individuals affected during the outbreak but there were no casualties11.
Global information:
Outbreaks of botulism are rare but the WHO considers infection a public emergency
because it can be spread rapidly, especially if a large group of individuals are eating the
same food8. There was a massive outbreak of botulism in Northern Thailand in 200610.
The outbreak was due to contaminated home-canned bamboo shoots10. This outbreak
affected 209 individuals and 134 of them were hospitalized10. The response was
overwhelming to prevent the outbreak from spreading further out of the village and to
prevent any deaths10. Also, Italy tends to have more outbreaks of botulism in general
compared to other countries around the world9. Of the outbreaks recorded, 57% are the
result of vegetable canning and about 15% are the result of contaminated ham or
sausage9. The most recent outbreak was in 2011 in Finland but was the result of imported
jars of olives that were canned in Italy; there were three cases detected and one death9.
Work cited:
1. "Botulism."CentersforDiseaseControlandPrevention.CenterforDisease
ControlandPrevention,25Apr.2014.Web.26Feb.2016.
<http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/#diagno
se>.
2. “Botulism."OntarioMinestryofHealthAndLongTermCare.N.p.,2013.Web.
25Feb.2016.
<http://health.gov.on.ca/en/public/publications/disease/botulism.aspx>.
3. "Botulism."PathogenProfileDictionary.N.p.,n.d.Web.26Feb.2016.
<http://ppdictionary.com/bacteria/gpbac/botulinum.htm>.
4. ClostridiumBotulism.ByAlbertJ.Nantel.Erfurt:INTOX12,2000.Print.
5. "LaboratoryConfirmationofBotulism."N.p.,n.d.Web.26Feb.2016.
<https://saki.ohsu.edu/access/content/public/Botulism/Experts/Laborator
y%20Confirmation%20of%20Botulism.pdf>.
6. Payne,Ed,andAshleyFantz."1DeadinBotulismOutbreakLinkedtoOhio
ChurchPotluck."CNN.CableNewsNetwork,22Apr.2015.Web.26Feb.
2016.<http://www.cnn.com/2015/04/22/health/church-potluckbotulism/index.html>.
7. Schoenstadt,Arthur,MD."HowDoesBotulismTransmissionOccur?"
EMEDTV.Clinaero,Inc.,13July2013.Web.26Feb.2016.
<http://diseases.emedtv.com/botulism/botulism-transmission-p2.html>.
8. WorldHealthOrganization.ClostridiumBotulism.ByAlbertJ.Nantel.Erfurt:
INTOX12,2000.
http://www.who.int/csr/delibepidemics/clostridiumbotulism.pdf
9. BotulisminItaly.(2014,March30).RetrievedMay12,2016,from
http://www.gideononline.com/tag/botulism/
10. Ungchusak,K.,Chunsuttiwat,S.,Braden,C.,Aldis,W.,Ueno,K.,Olsen,S.,&
Wiboolpolprasert,S.(2007,March).Theneedforglobalplannedmobilization
ofessentialmedicine:LessonsfromamassiveThaibotulismoutbreak.
RetrievedMay12,2016,from
http://www.who.int/bulletin/volumes/85/3/06-039545/en/
11. McCarty,C.,PhD,Angelo,K.,DO,Beer,K.D.,Cibulskas-White,K.,Quinn,K.,De
Fijter,S.,...Walz,E.(2015,July31).NotesfromtheField:LargeOutbreakof
BotulismAssociatedwithaChurchPotluckMeal—Ohio,2015.Retrieved
May12,2016,from
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6429a6.htm
12. BotulismPrevention&Control.(2016,May3).RetrievedMay12,2016,from
http://www.cdc.gov/botulism/prevention.html
13. Botulism.(n.d.).RetrievedMay12,2016,from
http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/botulism/
14. Strandwitz,P.(2008,April17).Classification.RetrievedMay12,2016,from
http://bioweb.uwlax.edu/bio203/s2008/strandwi_phil/schedule.htm