Botulism

An Overview

Botulism is a form of poisoning caused by exposure to Clostridium botulinum bacteria. These bacteria manufacture a chemical poison known as botulinum toxin that interferes with muscle function in many areas of the body, causing paralysis of individual muscles or groups of muscles. Exposure to this toxin is life threatening, since one of the muscles it can paralyze is the diaphragm, the muscle that controls breathing.
You can be exposed to the bacteria causing botulism in several ways, the most familiar being by eating contaminated food. In most food-borne cases of botulism in adults, home-canned foods are responsible. The bacteria that cause botulism exist in dirt and dust as a spore, but this form is inactive and does not produce toxin. When a spore is moved into a low-oxygen environment, however, such as an enclosed jar or can, it can reproduce and make its dangerous toxin.

Kinds of botulism

• Infant botulism can happen if the spores of the bacteria get into an infant’s intestines. The spores grow and produce the toxin which causes illness.
• Wound botulism can happen if the spores of the bacteria get into a wound and make a toxin. People who inject drugs have a greater chance of getting wound botulism. Wound botulism has also occurred in people after a traumatic injury, such as a motorcycle accident, or surgery.
• Foodborne botulism can happen by eating foods that have been contaminated with botulinum toxin. Common sources of foodborne botulism are homemade foods that have been improperly canned, preserved, or fermented. Though uncommon, store-bought foods also can be contaminated with botulinum toxin.
• Iatrogenic botulism can happen if too much botulinum toxin is injected for cosmetic reasons, such as for wrinkles, or medical reasons, such as for migraine headaches.
• Adult intestinal toxemia (also known as adult intestinal colonization) botulism is a very rare kind of botulism that can happen if the spores of the bacteria get into an adult’s intestines, grow, and produce the toxin (similar to infant botulism). Although we don’t know why people get this kind of botulism, people who have serious health conditions that affect the gut may be more likely to get sick.

Symptoms for Botulism

Symptoms of botulism usually start with weakness of the muscles that control the eyes, face, mouth, and throat. This weakness may spread to the neck, arms, torso, and legs. Botulism also can weaken the muscles involved in breathing, which can lead to difficulty breathing and even death. Signs and symptoms of foodborne botulism typically begin between 12 and 36 hours after the toxin gets into your body.
• Difficulty swallowing or speaking
• Dry mouth
• Facial weakness on both sides of the face
• Blurred or double vision
• Drooping eyelids
• Trouble breathing
• Nausea, vomiting and abdominal cramps
• Paralysis
• Constipation, which is often the first sign
• Floppy movements due to muscle weakness and trouble controlling the head
• Weak cry
• Irritability
• Drooling
• Drooping eyelids
• Tiredness

Causes of botulism

• preserved vegetables with low acid content, such as beets, spinach, mushrooms, and green beans
• canned tuna fish
• fermented, smoked, and salted fish
• meat products, such as ham and sausage
Wound botulism makes up 20 percent of all botulism cases, and is due to botulism spores entering an open wound, according to the CDC.

Foodborne botulism

The source of foodborne botulism is often home-canned foods that are low in acid, such as fruits, vegetables and fish. However, the disease has also occurred from spicy peppers (chiles), foil-wrapped baked potatoes and oil infused with garlic.

Wound botulism

When C. botulinum bacteria get into a wound — possibly caused by an injury you might not notice — they can multiply and produce toxin. Wound botulism has increased in recent decades in people who inject heroin, which can contain spores of the bacteria.

Infant botulism

Babies get infant botulism after consuming spores of the bacteria, which then grow and multiply in their intestinal tracts and make toxins. The source of infant botulism may be honey, but it’s more likely to be exposure to soil contaminated with the bacteria.

Diagnosis

To diagnose botulism, your doctor will check you for signs of muscle weakness or paralysis, such as drooping eyelids and a weak voice. Your doctor will also ask about the foods you’ve eaten in the past few days, and ask if you may have been exposed to the bacteria through a wound.
In cases of possible infant botulism, the doctor may ask if the child has eaten honey recently and has had constipation or sluggishness.
• electromyography (EMG) to evaluate muscle response
• imaging scans to detect any internal damage to the head or brain
• spinal fluid test to determine if infection or injury to the brain or spinal cord is causing symptoms

Treatment

Antitoxin

If you’re diagnosed early with foodborne or wound botulism, injected antitoxin reduces the risk of complications. The antitoxin attaches itself to toxin that’s still circulating in your bloodstream and keeps it from harming your nerves.

Antibiotics

Antibiotics are recommended for the treatment of wound botulism. However, these medications are not advised for other types of botulism because they can speed up the release of toxins.

Breathing assistance

If you’re having trouble breathing, you’ll probably need a mechanical ventilator for as long as several weeks as the effects of the toxin gradually lessen. The ventilator forces air into your lungs through a tube inserted in your airway through your nose or mouth.

Rehabilitation

As you recover, you may also need therapy to improve your speech, swallowing and other functions affected by the disease.

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 loosen the foil and store them in the refrigerator — not at room temperature.
• Store oils infused with garlic or herbs in the refrigerator.
• Follow proper techniques when canning food at home, ensuring you reach adequate heat and acidic levels.
• Be cautious of any fermented fish or other aquatic game foods.
• Throw away any open or bulging cans of commercially prepared food.
• Refrigerate oils infused with garlic or herbs.

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