Botulism

Faculty Of Pharmacy ASUToxicology Course

A little Introduction…Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum.There are five main kinds of botulism:

1 )Food borne. 2) Wound botulism.3  )Infant botulism. 4) Adult intestinal toxemia (adult intestinal colonization)

5) iatrogenic botulism. • In the United States, an average of 145 cases are reported each year. Of these, approximately 15% are foodborne, 65% are infant botulism, and 20% are wound. Adult intestinal colonization and iatrogenic botulism also occur, but rarely. • Outbreaks of foodborne botulism involving two or more persons occur most years and are usually caused by home-canned foods. Most wound botulism cases are associated with black-tar heroin injection, especially in California.

What Kind of germ is Clostridium

botulinum?

Clostridium botulinum is the name of a group of bacteria. They can be

found in soil .

These rod-shaped organisms grow best in low oxygen

conditions. The bacteria form spores which allow them to

survive in a dormant state until exposed to conditions that can

support their growth .

There are seven types of botulism toxin designated by the letters A through G;

only types A, B, E and F cause illness in humans.

Common Causes…1- Infant botulism:

Babies get infant botulism after consuming spores of bacteria , which then grow & multiplying their intestinal tracts & make toxins.

The source of infant botulism may be honey, but it is more likely to be exposure to soil contaminated with the bacteria.

Common Causes…

2- Wound botulism:

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

Common Causes…

3- Food borne botulism:

-The source of food borne botulism is often home-canned foods that are low in acid , such as green beans.

-the common source of the illness in Alaska is fermented seafood. -When you eat food containing the toxin , it disturbs nerve function , causing

paralysis.

Mechanism…

The toxin is a zinc-dependent protease that cleaves one or more of the fusion proteins by which neuronal vesicles release Ach (Acetylcholine) into the

neuromuscular junction .

Signs and Symptoms…

1-ADULT TOXICITY

BOTULISM

NEUROTOXINS

INHIBIT

NEUROTRANSMITTERS

FROM

FUNCTIONIN

G PROPERL

Y SO

INHIBIT MOTOR CONTRO

L

THE PATIENT

EXPERIENCE PARALYSIS

FROM

TOP

TO BOTT

OM

AND

EXTREMITIES

SYMPTOMS GENERALLY APPEAR 12 TO 72 HOURS

AFTER EATING

CONTAMINATED FOOD

WHEN PARALYS

IS REACHES

THE CHEST DEATH FROM

INABILITY TO BREATH RESULTS

UNLESS PATIENT

IS VENTILATED

Signs and Symptoms… 1-nausea2-vomiting

3-fatigue

4-dizziness

5-double vision

6-dry skin/mouth7-drooping eyelid

8-difficulty swallowing

9-slurred speech

10-muscle weakness

11-paralysis

12-lack of fever

Signs and Symptoms…

2-Infant toxicity Infant botulism takes on a different form - symptoms include:

1-leathergy 2-poor appetite 3-constipation 4-drooping eyelid 5-paralysis

Signs and Symptoms…

Long term effect of botulism:• The majority of botulism patient never fully recover.• After (3 months to 1 year) of recovery persistent side effects are more likely

permanent including dizziness, dry mouth, fatigue and less peaceful psychological state than before illness.

Tests and Diagnosis…

To diagnose botulism, The physician will check for signs of muscle weakness or paralysis, such as drooping eyelids and a

weak voice.

He will also inquire about: 1. the foods you've eaten in the past few days, 2. ask if the patient has been exposed to the

bacteria through a wound.

Tests and Diagnosis…

Other diseases such as stroke, and

myasthenia gravis can appear similar to botulism, and special tests may be needed

to exclude these other conditions .

These tests may include a brain scan,

spinal fluid examination, nerve

conduction test (electromyography,

or EMG), and a tensilon test for myasthenia gravis .

Tests for botulinum toxin and for

bacteria that cause botulism can be

performed at some state health department

laboratories and at CDC.

In case of possible infant Botulism…

The physician may ask if the child has

eaten honey recently

and has had constipation or

sluggishness.

Analysis of blood, stool or vomit for evidence of the toxin may help confirm a

foodborne botulism diagnosis, but because

these tests may take days,clinical examination is the

primary means of diagnosis.

treatment…• Terminate exposure.• Supportive and symptomatic treatment:

Supportive care for botulism includes monitoring of respiratory function. Respiratory failure due to paralysis may require mechanical ventilation for 2 to 8 weeks, plus intensive medical and nursing care. After this time, paralysis generally improves as new neuromuscular connections are formed.• History and physical examination.• Prevent any further absorption:

physicians may try to remove contaminated food still in the digestive tract by inducing vomiting and/or using enemas.

Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria.

treatment…• Specific antidote:

In adults, botulism can be treated by passive immunization with a horse-derived antitoxin, which blocks the action of the toxin circulating in the blood.

In infants, horse-derived antitoxin is sometimes avoided for fear of infants developing serum sickness or lasting hypersensitivity to horse-derived proteins. To avoid this, a human-derived antitoxin has been developed and approved by the U.S. FDA in 2003 for the treatment of infant botulism. This human-derived antitoxin has been shown to be both safe and effective for the treatment of infant botulism.• Clinical follow up of the patient.

Prevention…

Use proper canning

techniques

Be sure to use proper

techniques when canning foods at home to ensure that

any germs 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.

Prevention…

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 store them in the

refrigerator .. not at room temperature.

Store oils infused with garlic or herbs in the refrigerator.

Prevention…

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

Infant botulism

Botox Toxicity…In cosmetic applications, injection of botulinum toxin can be used to prevent development of wrinkles by paralyzing facial muscles. Following treatment, results are usually seen within 3-5 days, however it can take up to 2 weeks to see full results.Excessive doses may be expected to produce neuromuscular weakness.Symptoms of overdose are likely not to be present immediately following injection. If accidental injection or overdose be suspected, the person should be medically supervised for several weeks for signs and symptoms of toxicity.

Case…Sarah, a twenty-one year old student at Iowa State University had spent Thanksgiving day with relatives at her grandparent’s farm. During her drive back to campus on Friday morning her vision became blurry, and she was forced to pull over to the side of the road. As she sat in her car, her vision worsened. She opened the car hood in hope of attracting aid and tried to relax. In a short time, a highway patrol officer pulled over and approached Sarah. By this time, Sarah was having trouble swallowing and speaking clearly. The officer helped Sarah to his car and rushed her to the emergency room at a nearby hospital.In the ER, Sarah was able to describe her symptoms to a physician. The physician made note of what Sarah had eaten during the last 24 hours and was especially interested in the fact that Sarah’s grandmother canned all of her own vegetables.

Case…The physician observed that Sarah’s breathing was becoming labored. She ordered Sarah’s blood sampled, her gastrointestinal tract pumped, and a mechanical respirator prepared for use. Fearing that Sarah suffered from a case of botulism, she asked that Sarah’s grandparents be contacted and samples of the Thanksgiving meal retained, if possible, and sent to a local clinic for analysis.

Questions:1- What are the signs and symptoms that indicate Botulism in Sarah’s Case?2- Why didn’t her physician prescribe Antibiotics?

Final Notes…

References…1 .Centers for Disease Control and Prevention :

:// . .http www cdc gov2 .:// . . /http www mayoclinic org

3 .:// . . /http www medicinenet com4 .:// . . /http www mhhe com