Botulism

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What causes botulism?

Botulism develops due to neurotoxins synthesized by botulinum bacteria (and other Clostridium species). The toxin causes the disease and it prevents the spread of acetylcholine at the nerve endings. This result leads to symptoms associated with botulism.

What are the risk factors for botulism?

Consumption of improperly processed products to kill botuline bacteria and spores and to denature any toxins increases the risk of developing botulism (e.g. canned food production such as tomatoes or fish, some home canning methods) ). Some honeys may contain bacterial spores of botulinum in small amounts; Honey is not recommended to give to children under 1 year. Corn syrup has been thought to cause botulism for some time, but studies have confirmed that it is not a source of the toxin. The risk of developing botulism increases if the wounds are contaminated with soil or feces.

How many types of botulism are there?

There are three types of botulism classified by method of disease:

1. Food-related botulism results from consuming foods that contain the neurotoxin Botulina.
2. Wound botulism is due to a neurotoxin produced in wounds infected with Clostridium botulinum bacteria.
3. Infantile botulism occurs when a baby consumes sports of Botulina bacteria. Bacteria grow in the baby’s gut and release neurotoxins.

Three more types of botulism are classified, but they are rare.

1. Bacterial colonization of the adult intestine observed in older children and adults with abnormal gastrointestinal tract. In adults, this type of botulism is rare because normally Botulina bacteria are broken down by stomach acid and enzymatic activity. Typically, the adult form of this botulism in the gut is associated with abdominal surgical procedures.
2. Injectable botulism is observed in patients who have received high doses of neurotoxins such as Botox, Disport, Mioblok without the need for treatment.
3. Inhaled botulism is observed in laboratory workers working with neurotoxins. All six types of botulism can be fatal.

How serious is botulism?

Botulinum toxin is one of the most potent and deadly substances. At least 1 nanogram / kg can be fatal to humans, and scientists estimate that about 1 gram of botulinum toxin is capable of killing 1 million people. The small amount of toxin can be used as a weapon for bioterrorism because it is capable of killing people. All forms of botulism can be fatal and are an emergency. The toxin is quickly absorbed by the digestive system, so many people become poisoned even when they consume small amounts of contaminated food.

How does botulism neurotoxin (botulinum toxin) affect the body?

The neurotoxin actually paralyzes the nerves, so the muscles cannot contract. The neurotoxin enters nerve cells and prevents the release of acetylcholine, so it cannot control nerve muscles. If the nerve fibers cannot regenerate a new axon that can resist the neurotoxin, the paralysis between the nerve and the muscle remains constant. It therefore takes a very long time to get rid of botulism and is effective for a relatively long time when the neurotoxin is used for cosmetic and therapeutic purposes.

What kind of organism is Botulina (Clostridium botulinum)?

Clostridium botulinum is a common bacterial species worldwide. Bacteria are anaerobic, meaning that these organisms grow well at low or no oxygen levels at all. Clostridium bacteria are Gram-positive rod-forming bacteria that produce spores that allow them to survive until they are exposed to favorable conditions for growth. There are seven types of botulinum neurotoxins, indicated by the letters A to G. Only type A, B, E and F botulinum toxins cause disease in humans.

How common is botulism?

The application of new technologies in canning processes, especially those related to home canning or home food processing, has reduced the annual number of food-borne botulism to around 1000 worldwide. An average of 110 cases of botulism are reported each year in the United States. Of these, 25 percent are food-related botulism, about 72 percent are infant botulism, and the remainder (approximately 3 percent) are recent-onset wound botulism. Food botulism involving two or more people usually results from the use of contaminated canned goods. In recent years, the number of cases of botulism in food and children has decreased significantly.

What are the signs and symptoms of botulism?

The classic symptoms of botulism include:

• Hesitation in vision;
• Blurred vision;
• Hanging lids;
• Speech difficulty;
• Difficulty swallowing;
• Dry mouth;
• Weakness in muscles (leads to loose paralysis).

Classical symptoms can also be accompanied by other signs and symptoms:

• Dizziness;
• Fatigue;
• Constipation;
• Abdominal discomfort or pain;
• Nausea;
• Vomiting;
• Saliva flow;
• Speech difficulties;
• Difficulty swallowing;
• Respiratory disorders;
• Slow or absent reflexes;
• Urinary retention;
• Weakness of the face;
• Eye muscle weakness;
• Paralysis.

A medical examination may indicate a decrease in knee reflexes.

Babies with botulism look lethargic and weak, eat poorly, suffer from constipation, and have poor muscle tone. Constipation in children is often the first symptom.

These are all signs and symptoms associated with muscle paralysis due to bacterial neurocotoxin. If left untreated, these symptoms can lead to paralysis in various parts of the body, especially respiratory muscle paralysis, which can be fatal in many cases.

How long does it take for botulism to start appearing?

In food botulism, symptoms usually begin 18 to 36 hours after consuming the contaminated food, but symptoms may appear 6 hours or 10 days later.

How do doctors deal with botulism?

In addition to primary care, they may consult other health professionals; for example, neurologists, infectious disease physicians, and pediatricians (if found in infants).

How do doctors diagnose botulism?

A patient’s history and physical examination may indicate botulism, but these examinations alone are not sufficient to diagnose botulism. Symptoms of other diseases, such as stroke, Guillain-Barre syndrome (another disease that causes muscle paralysis), and myasthenia gravis (which also causes drooping eyelids), are similar to the symptoms of botulism. Special tests may be required to rule out these other diseases. These tests may include brain imaging, spinal fluid analysis, nerve conduction studies (electromyography or EMG), and a Tensilon test to detect myasthenia gravis.

The most direct way to confirm the diagnosis is to detect botulinum neurotoxin in the patient’s blood or feces. This is done by injecting the patient’s blood or feces into the abdominal cavity of the mouse. An equal amount of blood or feces is taken from the patient, disinfected with antitoxin, and sent to mice. A similar sample is sent to another mouse without decontamination. If the disease is present, the first mouse survives and the second dies. These analyzes help differentiate botulism from Escherichia coli, Salmonella, and other infectious diseases.

Treatment and treatment of botulism

If the diagnosis of botulism is made early, food and wound botulism can be treated by neutralizing the neurotoxins with antitoxins. A trivalent antitoxin (effective against three neurotoxins: A, B, and E) is distributed to quarantine stations. Antitoxin prevents disease and deterioration, but recovery takes several weeks. Another hepatavalent antitoxin (effective against seven neurotoxins: A, B, C, D, E, F and G) is given for use in the military.

Doctors can remove any contaminated food from the intestines, vomit, and use enemas. Wounds usually require surgical treatment to remove toxin-producing bacteria. Well-maintained therapy in the hospital (intravenous fluid and respiratory support) is the basis of all types of botulism therapy.

Hugs can be used to remove toxins that are not fully digested; but magnesium salts, citrate, and sulfate are not used because they can add strength to the toxin. Antibiotics (high-dose, intravenous orgalipenicillin or other antibiotics) are not used in food botulism; only in wound botulism, surgical treatment may also be required. Consultations with an infectious disease specialist will contribute to a better outcome of treatment.

What are the complications of botulism?

Botulism can be fatal due to loss of ability to breathe. Over the past 50 years, the mortality rate from botulism has dropped significantly. Unfortunately, a patient with severe botulism may require not only an artificial respirator but also intensive medical and nursing care for several months to survive.

In 2009, the FDA tightened practical safety measures for three available toxins: Botox, Disport, and Mioblok.

What is the future of people with botulism?

The mortality rate in untreated botulism is about 50%. Patients with botulism currently have a mortality rate of approximately 3% -5%. Some patients with various paralysis may lie in bed for many months. In general, the earlier the diagnosis and treatment of the disease is started, the better the condition can be. However, the results can only be considered applicable to some patients with chronic fatigue and shortness of breath for years after initial diagnosis and treatment of botulism.

Can botulism be prevented?

Yes you can. Food-related botulism is often caused by such improperly prepared home-made canned foods.

Before canning at home, people need to follow strict sanitary-hygienic rules to destroy Clostridium bacteria and their spores and heat-treat to break down existing neurotoxins. Botulism neurotoxins break down at high temperatures (85 ° C for five minutes), so home-made canned food should be considered boiled for 10 minutes before consumption to ensure safety if possible.

Other commercially available canned goods should be discarded if they are swollen, appear to be under pressure, or emit an odor when used. Don’t taste such canned goods and don’t try to eat them!

Honey can contain Clostridium botulinum spores, and it is a source of infection for babies. Therefore, children under 1 year of age should not be fed with honey. Honey is relatively safe for those over 1 year old.

A doctor should be consulted immediately to prevent wound botulism. The wound is thoroughly washed and, if possible, surgery is performed.

Why are botulism neurotoxins (Botox) used for cosmetic treatment or to treat a specific medical condition?

Interestingly, very pure and diluted botulinum toxin is used to treat conditions characterized by abnormal muscle contractions. Some examples are neck flexion, spasmodic dysphonia, achalasia, dizziness, lower jaw dystonia, and blepharospasm.

Wrinkles result from normal muscle contraction. There will be no wrinkles without muscle contraction. Therefore, many people take Botox to reduce wrinkles on the skin (mainly on the face). The treatment of these wrinkles was approved in 2002 by the Food and Drug Administration. Possible side effects of this treatment include nausea and dysphasia (difficulty speaking), bruising, ptosis, and so on. Some doctors use botulinum toxin type A as a treatment for gastric complications of diabetes.