An introduction about Botulism toxicity along with signs & symptoms, prevention, diagnosis, treatment, a case and references.

1. Botulism

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. Signs and Symptoms… 1-ADULT TOXICITY
BOTULISM NEUROTOXINS
INHIBIT NEUROTRANSMITTERS
FROM FUNCTIONING PROPERLY
SO INHIBIT MOTOR CONTROL
THE PATIENT EXPERIENCE PARALYSIS FROM TOP
TO BOTTOM AND EXTREMITIES
SYMPTOMS GENERALLY APPEAR 12 TO 72 HOURS AFTER
EATING CONTAMINATED FOOD
WHEN PARALYSIS REACHES THE CHEST DEATH FROM INABILITY TO BREATH
RESULTS UNLESS PATIENT IS VENTILATED

9. Signs and Symptoms…
1-nausea
2-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

10. 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

11. 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.

12. 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.

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.

18. 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.

19. 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
•To prevent wound
botulism and other
serious bloodborne
diseases, never inject
or inhale street drugs.
Wound
botulism

20. 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.

21. 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.

22. 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?

23. Final Notes…

24. References…
1. Centers for Disease Control and Prevention:
http://www.cdc.gov
2. http://www.mayoclinic.org/
3. http://www.medicinenet.com/
4. http://www.mhhe.com/