Botulism

INTRODUCTION Botulism is a neuroparalytic disease it is intoxication associated with inadequate food preservation the name botulism comes from the Latin word botulus meaning sausage. It is caused by the potent protein toxin released from Clostridium botulinum

CAUSATIVE AGENT

Clostridium botulinum Gram positive Rodshape ,Spore forming Anaerobic bacteria Produces toxin that causes botulism Seven neurotoxic subtypes, labeled o A-G Create spores that can remain dormant for 30 years or more Spores extremely resistant to environmental stressors, such as heat and UV light First recognized and isolated in 1896 by Van Ermengem

Classification of C. botulinum

There are seven types of C. botulinum A, B, C, D, E, F, and G based on the serological specificity of the neurotoxin produced Types A, B, E, and, very rarely, F are associated with human botulism (foodborne, wound and infant types). Types C and D affect animals. Type G has not been linked to illness up to this date.

BOTULINUM TOXIN Consist of light and heavy chains Light chain zinc endopeptidase The bioactive component Colorless, odorless Environmental survival Inactivated by heat >85C for 5 min pH <4.5

Botulism Toxin Mechanism

CATEGORIES OF BOTULISM Foodborne botulism o caused by eating foods that contain botulism toxin Intestinal botulism (infant and child/adult) o caused by ingesting spores of the bacteria which germinate and produce toxin in the intestines Wound botulism o C. botulinum spores germinate in the wound Inhalation botulism o Aerosolized toxin is inhaled o does not occur naturally and may be indicative of bioterrorism TRANSMISSION Home-canned goods (foodborne) particularly low-acid foods such as asparagus, beets, and corn Honey (ingestion) can contain C. botulinum spores not recommended for infants <12 months old Crush injuries, injection drug use (wound)

CLINICAL FEATURES Classic symptoms of botulism poisoning include: o blurred/double vision o muscle weakness o drooping eyelids o slurred speech o difficulty swallowing o patient is afebrile and alert Infants with botulism will present with: o weak cry o poor feeding o constipation o poor muscle tone, floppy baby syndrome DIAGNOSIS Clinical diagnosis Diagnostic tests help confirm o Toxin neutralization mouse bioassay Serum, stool, or suspect foods o Infant botulism C botulinum organism or toxin in feces Differential diagnosis o Guillain-Barre, myasthenia gravis

o o o o

Unique features to help in diagnosis Disproportionate cranial nerve palsies More hyptonia in facial muscles than below neck Lack of sensory changes

TREATMENT Supportive care o Enteral tube feeding or parenteral nutrition o Mechanical ventilation o Treatment of secondary infections o Avoid aminoglycosides and clindamycin o Worsens neuromuscular Passive immunization - equine antitoxin o Antibodies to Types A, B and E toxins o Binds and inactivates circulating toxin o Stops further damage but doesnt reverse o Administer ASAP for best outcome o Dose per package insert Heptavalent equine antitoxin o Investigational o Effective against all toxins PREVENTION AND CONTROL Natural disease o Boil home-canned foods 10 minutes o Restrict honey from < 1 year old o Seek medical care for wounds o Avoid injectable street drugs Inspect canned food for o Bulging o Loose lids o Mold o Odor Proper home canning procedures: o Hygiene o Time schedule, o Proper processing method o Equipment Avoiding home canning or cheaply produced commercial food Standard precautions only No person-to-person transmission

PUBLIC HEALTH ASPECT As a Bioterrorism Agent Botulinum toxin a major threat because o Extreme potency and lethality o Ease of production o Ease of transport o Need for prolonged intensive care Top 6 potential biological warfare agents Listed as Category A agent: High priori Most toxic substance known o 1 gram crystalline toxin can kill > 1 million people if dispersed and inhaled evenly o Point source aerosol release Incapacitate/kill 10% of people downwind within 500 meters Spores can be isolated from the soil, making the agent easily attainable. Botulism could be released into the food supply, where it would initially be difficult to differentiate a bioterrorism outbreak from a naturally occurring foodborne outbreak. Finally, the time and resources needed to care for large numbers of botulism patients as a result of a bioterrorism event would be staggering.