BOTULISM
By Olivia Anderson
HISTORY OF BOTULISM
• Though foodborne illness caused by the botulism toxin has been alluded to
in many historical cases, it was not till the 19 th century that symptoms of
some foodborne illnesses were attributed to Clostridium botulinum
• The first reported cases of a foodborne illness that would later be
attributed to the botulism toxin were made by German medical officer
Justinus Kerner between 1817 and 1822
• Kerner based his discover on an outbreak of food poisoning caused by
blood sausage in Southern Germany
• In 1895, the Clostridium botulinum pathogen was officially discovered by
Emile Pierre van Ermengem,a professor of bacteriology at the University
of Ghent, after an outbreak in Belgium
WHAT IS BOTULISM?
• Botulism is a disease caused by the toxin produced by Clostridium
botulinum bacteria
• Symptoms include double vision, blurred vision, drooping eyelids, slurred
speech, difficulty swallowing, dry mouth, and muscle weakness
• The toxin produces a paralytic response in the body, which is the source of
muscle weakness and loss of control
• Botulism is considered a medical emergency and a public health
emergency, since one contaminated food source may infect large amounts
of people.
BOTULISM: A PATHOGENIC
BACTERIA
• Clostridium botulinum is a rod shaped, anaerobic bacteria that forms heat
resistant spores
• The bacteria can survive cooking processes and can be stored indefinitely
in its spore form
• Active forms of the bacteria can be killed by heating at 80 degrees Celsius
for ten or more minutes
VIRULENCE FACTORS
• Clostridium botulinum bacteria are gram positive, meaning they have a
thick layer of peptidoglycan
• The bacteria are anaerobic, so they can survive with little or no oxygen,
which makes stored food a good environment
• The bacteria produce a neurotoxin that targets musculature so that the
individual may experience involuntary action or parlysis
PATHOPHYSIOLOGY
• Clostridium botulinum bacteria possess plasmids that contain the DNA to
produce a neurotoxin
• This botulism toxin mediates the blockage of acetylcholine release into
neuromuscular synapses which results in an inability for muscles to
function
• The toxin can also bind to acetylcholine itself, which produces the same
effect in the infected individual
CLASSIFICATIONS OF BOTULISM
Currently, the botulism toxin is known to cause five different types of the
disease including:
• Foodborne botulism
• Wound botulism
• Infant botulism
• Adult intestinal toxemia
• Iatrogenic botulism
FOODBORNE BOTULISM
• Caused by ingestion of the Clostridium botulinum bacteria
• Usually cases manifest as a result of consuming improperly canned and
fermented foods, such as home pickled eggs and vegetables and
homemade sausages and other mean products
WOUND BOTULISM
• Occurs when wounds are exposed to Clostridium botulinum bacteria
• Most cases appear in puncture wounds and bites that are not properly
disinfected or dressed
INFANT BOTULISM
• Occurs when infants ingest Clostridium botulinum bacteria
• Cases usually occur when infants are introduced to new bottled/canned
foods that are improperly sealed from the environment
• Cases are often related to exposure to raw honey before two years
ADULT INTESTINAL TOXEMIA
• Occurs in the same manner as infant botulism, by ingestion of Clostridium
botulinum bacteria
• The bacteria mature in the intestinal tract
• This type of botulism is rare due to the strain of botulism bacteria that is
capable of maturing and surviving in the digestive system
IATROGENIC BOTULISM
• Caused by excess of the newest form of the botulism toxin, a manmade
substance that mimics that produced by bacteria
• Often used as a beauty treatment, but overdoses can cause adverse effects
TRANSMISSION
• Depending on the category of botulism, transmission may occur either by
ingestion or by a physical insertion into the body (such as a puncture
wound)
• Generally, ingested botulism is a result of improperly stored food items, or
those that were stored without any type of heat treatment, such as raw
honey
PREVENTION AND TREATMENT
• Botulism can be prevented by making certain that all canned foods reach
optimum temperatures before sealing, and that they are prepared with no
cross contamination
• Generally, clostridium botulinum bacteria are not spread from person to
person, but from a food source to a person, but to prevent wound
botulism, make sure to clean and sterilize wounds thoroughly
• The USDA provides a home-canning guide as an effort to educate
individuals and help prevent foodborne illness
• For patients that experience respiratory failure in response to the toxin,
respirators are used to provide easier breathing.
• Patients are also treated with an anti-toxin, that blocks the action of the
toxin on cholinergic synapses and allows neuromuscular action to occur
CASE STUDY:
INFANT BOTULISM
• Five-month old infant male is admitted to hospital in Massachusetts in
November, 1983 because of severe lethargy and lack of “developmental
milestones” past three weeks of age
• Upon examination, the child had flaccid extremities and no motor control
of his head or neck, as well as no sucking abilities
• Initially treated with IV hydration and saline enemas, and later nasogastric
feedings, which improved health some
• A stool specimen revealed Clostridium botulinum bacteria and botulinal
toxin
• The child was diagnosed with infant botulism after the specimen was
analyzed on the fourth day of hospitalization
CASE STUDY CONT.
• The enemas were given to flush the toxin out of the infant’s body to speed
up treatment
• The child’s gradual muscular improvement was a result of the IV hydration
and enemas, as well as the anti toxin
CASE STATISTICS
• The FDA estimates that there are between 100 and 110 cases of botulism
per year in the United States, though cases can go undiagnosed because of
mild or less persistent symptoms
• In 2010, Oregon had only one reported case of botulism
IMPORTANCE OF BOTULISM
• Raise awareness for foodborne illnesses, especially in home-processed
foods
• Because botulism is considered a medical emergency, it is important to
know the symptoms
• Botulism can be an expensive disease to treat, especially because of the
low number of cases; pharmaceuticals for its treatment are not widely
produced and diagnosis can take time, so prevention of botulism is key
BOTOX:
BOTULISM AS A BEAUTY TREATMENT
• Botox is a pharmaceutical drug produced and prescribed to patients to
eliminate facial lines and wrinkles temporarily and to treat some
neuromuscular diseases
• Botox is an altered form of the toxin produced by Clostridium botulinum
bacteria
• The drug is injected under the skin and temporarily paralyzes some
muscles and nerves for the desired aesthetic affect
REFERENCES
Botox. (2014, July 14). Retrieved July 12, 2015, from MedlinePlus website:
http://www.nlm.nih.gov/medlineplus/botox.html
Botulism. (2014, April 25). Retrieved July 12, 2015, from Centers for Disease Control and
Prevention website: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism
Chan-Tack, K. M., & Chandrasekar, P. H. (2015, March 23). Botulism. Retrieved July 12,
2015, from Medscape website: http://emedicine.medscape.com/article/213311overview#a6
Foodborne Pathogenic Microorganisms and Natural Toxins Handbook Clostridium
botulinum. (2014, December 12). Retrieved July 12, 2015, from US FDA website:
http://www.fda.gov/food/foodborneillnesscontaminants/causesofillnessbadbugbook/ucm
070000.htm