Botulism

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 25, 2016
StartDiseasesBotulism

Botulism is the name given to the condition of increasing paralysis created by the nerve toxin secreted by the bacteria, Clostridium botulinum. Characterized by progressive weakness and immobilization of limbs and eventually difficulty breathing and death, botulism is an extremely dangerous disease and should always be treated as a medical emergency.

Contents

Definition & Facts

The organism that causes botulism is a rod-shaped bacteria that exists primarily in soil. It requires very little oxygen to survive and creates spores to assist it in times when conditions are less than ideal for its survival. Once ingested, the bacteria multiplies and secretes the toxin, shutting down nerves and causing ascending weakness and eventually paralysis. If left untreated, the disease will eventually shut down the heart and lungs, causing coma and death. The majority of cases of botulism in the US are caused by improperly canned foods and there are about 150 cases per year reported to the Centers for Disease Control.

Transmission occurs from contaminated food in the most common forms, but there are also infant and wound forms of botulism as well. In the infant form, the spores of the disease are ingested by a young child, and it takes significantly less exposure to cause a very quick onset of the disease. Wound botulism occurs when the spores contact an open sore, cut, or puncture and spread into the blood from there.

Symptoms & Complaints

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SecurePHP: Permission error <html></div></html> Botulism toxicity is a progressive disease, meaning unlike other types of food poisoning, there's no quick-onset of vomiting or diarrhea. Instead, the primary complaints are blurred vision or double vision, droopy eyelids, slurred speech, poor muscle control, facial weakness, and weakness in general. In babies, this translates to poor feeding, lethargy, and general weakness in muscle tone.

As the weakness progresses, arms, legs, and then lungs and heart will begin to paralyze, eventually leading to the patient needing emergency intensive care while the disease is properly diagnosed and treated. The onset of symptoms can be anywhere from a few hours to up to 10 or more days after ingesting the poisoned food, or having a wound come into contact with botulinum bacteria.

Causes

The general weakness and increasing paralysis characteristic of botulism poisoning is caused primarily by the bacteria Clostridium botulinum, and less commonly by Clostridium butyricum and Clostridium barati. The primary routes of transmission are through contaminated food (around 60%) and entry through an open wound (about 20%).

The remaining types of botulism are infant and adult intestinal botulism, in which spores rather than live bacteria are ingested, where they grow and spread within the intestines. Lastly there is iatrogenic botulism, in which someone accidentally overdoses on botulinum toxin and this occurs primarily when a cosmetic surgery patient is given too much botox, either accidentally or cumulatively over many treatments.

In most cases, the bacteria releases the toxin as a result of it multiplying. The toxin damages the surrounding tissue and creates a condition of progressive muscle weakening that focuses on the outer extremities and the trunk of the body, ascending towards the heart and lungs. The more toxin in the body, the most pronounced and widespread the weakness.

Diagnosis & Tests

One main concern is identifying the cause of the muscle weakness, as there are other systemic diseases and conditions that can cause similar widespread muscle weakness such as blood clot in the brain, myasthenia gravis, and various viruses. Ruling them out can be as simple as a doctor knowing that the patient recently ate home-canned foods. In order to diagnose botulism as the cause of muscle weakness, a timeline needs to be established.

Botulism can be identified through either excluding these other diseases or through blood tests in the case of suspected wound botulism or by examining the cut itself. Because the testing for botulism can take time that a patient often doesn't have, a doctor may, after excluding other diagnoses, treat for botulism while they wait for absolute confirmation of the presence of botulinum bacteria.

Treatment & Therapy

Treating botulism once it's diagnosed correctly is fairly easy, but recovery is a long process. The bacteria itself will be treated with antibiotics to clear it from the patient's system, and then the damaging toxin will be cleared using an antitoxin administered by a doctor. Depending on the severity of the poisoning, the recovery time could take weeks or months, particularly if the disease reaches a stage in which heart or lung involvement were taking place.

If the patient had lung involvement, they may need to be on a ventilator and in an intensive care unit until their muscle strength returns. For less severe cases, physical therapy is administered and muscle weakness will slowly subside. For cases in which the cause was ingested food, a doctor may administer drugs to induce vomiting or diarrhea, in order to flush the offending bacteria and associated toxins out of the digestive system and help reduce the onset of symptoms. This gives the antibiotics and antitoxins less of an uphill battle once they've been administered.

Prevention & Prophylaxis

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Prevention of botulism is fairly simple, but there are always new ways of infection that spring up. The primary transmission route, improperly canned foods, can be avoided by heating up home-canned foods before eating them, generally for about 10 minutes. Heat destroys the botulinum toxin, so this is an effective way of ensuring safety.

For wound botulism, prompt medical attention to cuts and abrasions is always important. Being certain to clean and dress open wounds is essential for preventing transmission of botulinum bacteria, among other infectious agents. For infant botulism, it can be harder to prevent, as the disease is present in dirt, soil, and dust, and could be present all around the home. One of the main means of infection in babies is through honey, so the CDC recommends that no children under the age of 12 months be given honey under any circumstances.

In consumer products, special care needs to be paid to foods stored in oil, like garlic, peppers, or other vegetables. Oil is normally inhospitable for bacteria, but since botulinum requires so little oxygen to survive, it's always a good idea to store things like jarred, oiled vegetables in the fridge.

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