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Encyclopedia > Botulism
Botulism
Classification & external resources
ICD-10 A05.1
ICD-9 005.1
DiseasesDB 2811
MedlinePlus 000598
eMedicine med/238  emerg/64
MeSH C01.252.410.222.151

Botulism (Latin, botulus, "sausage") is a rare, but serious paralytic illness caused by a nerve toxin, botulin, that is produced by the bacterium Clostridium botulinum. Botulinic toxin is one of the most powerful known toxins. About one microgram of botulin is a lethal dosage. It acts by blocking nerve function and leads to respiratory and musculoskeletal paralysis. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // A00-A79 - Bacterial infections, and other intestinal infectious diseases, and STDs (A00-A09) Intestinal infectious diseases (A00) Cholera (A01) Typhoid and paratyphoid fevers (A010) Typhoid fever (A02) Other Salmonella infections (A03) Shigellosis (A04) Other bacterial intestinal infections (A040) Enteropathogenic Escherichia coli infection (A045) Campylobacter enteritis (A046) Enteritis due to Yersinia... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... For other uses, see Latin (disambiguation). ... (noun) paralytic (a person suffering from paralysis) (adj) paralytic, paralytical (relating to the nature of paralysis) paralytic symptoms (adj) paralytic, paralyzed (affected or subject to paralysis) Drugs which induce paralization are called paralytics, such as Vecuronium, Pancuronium, & Succinylcholine. ... This article or section does not cite any references or sources. ... Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ... Binomial name Clostridium botulinum van Ermengem, 1896 Clostridium botulinum is a bacterium that produces the toxin botulin, the causative agent in botulism. ... Nerves (yellow) Nerves redirects here. ... The Respiratory System Among four-legged animals, the respiratory system generally includes tubes, such as the bronchi, used to carry air to the lungs, where gas exchange takes place. ... The human musculoskeletal system is the musculoskeletal system that gives us the ability to move. ... This article does not cite any references or sources. ...


There are three main kinds of botulism:

  • Foodborne botulism is caused by eating foods that contain the botulinum toxin.
  • Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin.
  • Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. This is the rarest type of botulism.

All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous as a public health problem because many people can be poisoned from a single contaminated food source. Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. ... An endospore is a dormant, tough, non-reproductive structure produced by a small number of bacteria from the Firmicute family. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine (or colon). ... Public health is concerned with threats to the overall health of a community based on population health analysis. ...


In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and 3% are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur during most years and usually are caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black tar heroin, especially in California.[1] In July 2007, a widespread recall was initiated due to botulism contamination of food manufactured by Castleberry's Food Company.[2] Shortly after in August 2007, the FDA issued a warning of botulism risk from canned French cut green beans manufactured by Lakeside Foods Inc, of Manitowoc, Wisconsin.[3] Black tar heroin Black tar heroin is a variety of heroin produced primarily in Mexico, but similar in appearance and texture to so called Home Bake Heroin from New Zealand. ... Official language(s) English Capital Sacramento Largest city Los Angeles Largest metro area Greater Los Angeles Area  Ranked 3rd  - Total 158,302 sq mi (410,000 km²)  - Width 250 miles (400 km)  - Length 770 miles (1,240 km)  - % water 4. ... Green common beans on the plant Green beans are the unripe fruits of any kind of bean, including the yardlong bean, the hyacinth bean, the pea, the winged bean, the carper (vellum) bean, and especially the common bean (Phaseolus vulgaris), whose pods are also usually called string beans in the...

Contents

Symptoms

Food-borne and wound botulism

Food-Borne

  • Classic symptoms of food-borne botulism usually occur between 12–36 hours after consuming the botulinum toxin. However, they can occur as early as 6 hours or as late as 10 days after.
  • Wound botulism has a longer incubation period, usually between 4–14 days.

Common symptoms of either form usually include dry mouth, difficulty swallowing, slurred speech, drooping eyelids, muscle weakness, double and/or blurred vision, vomiting, blatter and sometimes diarrhea. These symptoms may progress to cause paralytic ileus with severe constipation, and eventually body paralysis. The respiratory muscles are affected as well, which may cause death due to respiratory failure. These are all symptoms of the muscle paralysis caused by the bacterial toxin. Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. ... The term symptom (from the Greek syn = con/plus and pipto = fall, together meaning co-exist) has two similar meanings in the context of physical and mental health: A symptom can be a physical condition which shows that one has a particular illness or disorder (see e. ... Ileus, formerly called iliac passion, refers to limited or absent intestinal passage. ... Constipation or irregularity, is a condition of the digestive system where a person (or animal) experiences hard feces that are difficult to egest; it may be extremely painful, and in severe cases (fecal impaction) lead to symptoms of bowel obstruction. ...


In all cases illness is caused by the toxin made by C. botulinum, not by the bacterium itself. The pattern of damage occurs because the toxin affects nerves that are firing more often.[4]


Infant botulism

Infant (first recognized in 1976) is the most common form of the ailment in the United States, but is rarely diagnosed in other countries. It affects about 100 infants per year in the United States, with the majority in the state of California (50–60%). Infants less than 12 months of age are susceptible, with 95% of cases occurring between the ages of 3 weeks and 6 months of age at presentation. The mode of action of this form is through colonization by germinating spores in the gut of an infant. The first symptom is usually constipation, followed by generalized weakness, loss of head control and difficulty feeding. Like the other forms of botulism, the symptoms are caused by the absorption of botulinum toxin, and typically progress to a symmetric descending flaccid paralysis. Death is the eventual outcome unless the infant receives artificial ventilation. Not to be confused with Gemination in phonetics. ... An endospore is a dormant, tough, non-reproductive structure produced by a small number of bacteria from the Firmicute family. ... A medical ventilator is a device designed to provide mechanical ventilation to a patient. ...


Honey, corn syrup, and other sweeteners are potentially dangerous for infants. This is partly because the digestive juices of an infant are less acidic than older children and adults, and may be less likely to destroy ingested spores. In addition, young infants do not yet have sufficient numbers of resident microbiota in their intestines to competitively exclude C. botulinum. Unopposed in the small intestine, the warm body temperature combined with an anaerobic environment creates a medium for botulinum spores to germinate, divide and produce toxin. Thus, C. botulinum is able to colonize the gut of an infant with relative ease, whereas older children and adults are not typically susceptible to ingested spores. C. botulinum spores are widely present in the environment, including honey. For this reason, it is advised that neither honey, nor any other sweetener, be given to children until after 12 months. Nevertheless, the majority of infants with botulism have no history of ingestion of honey, and the exact source of the offending spores is unclear about 85% of the time. Spores present in the soil are a leading candidate for most cases, and often a history of construction near the home of an affected infant may be obtained. For other uses, see Honey (disambiguation). ... Corn syrup is a syrup, made using corn starch as a feedstock, and composed mainly of glucose. ... Binomial name Microbiota decussata Kom. ...


Botulinum toxin

Botulinum toxin blocks the release of acetylcholine from nerve endings thus arresting their function. The C. botulinum bacterium produces toxin in an anaerobic environment, and the toxin is unstable to heating, so poisoning generally occurs from the use of improperly bottled or canned foods: typical instances of botulism would be home-bottled preserves used in salads. An unusual example of botulism occurred in Britain in the exceptionally hot, dry summer of 1976, when river levels dropped so low in some areas that feeding swans accidentally ingested material from anaerobic layers in a river (normally out of their reach), and were struck by botulism symptoms. Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum. ... The chemical compound acetylcholine, often abbreviated as ACh, was the first neurotransmitter to be identified. ... Illustration of the major elements in a prototypical synapse. ... Species 6-7 living, see text. ...


Botulinum toxin is also used cosmetically, for example in reducing facial wrinkles or excessive transpiration, and is commercially known as Botox. Cases of inadvertent botulism have occurred due to overdose or accidental intravenous injection of Botox. Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ...


Diagnosis

Physicians may examination suggest botulism. However, these clues are often not enough to allow a diagnosis of botulism. Other diseases such as Guillain-Barré syndrome, 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, cerebrospinal fluid examination, nerve conduction test (electromyography, or EMG), and an Edrophonium Chloride (Tensilon) test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's serum or stool by injecting serum or stool into mice and looking for signs of botulism that can be blocked by specific antisera. Guillain-Barré syndrome (GBS) or acute inflammatory demyelinating polyradiculoneuropathy is an acute, autoimmune disease that affects the peripheral nervous system and is usually triggered by an acute infectious process. ... For other uses, see Stroke (disambiguation). ... Myasthenia gravis (sometimes abbreviated MG; from the Greek myastheneia, lit. ... Cerebrospinal fluid (CSF), Liquor cerebrospinalis, is a clear bodily fluid that occupies the subarachnoid space in the brain (the space between the skull and the cerebral cortex—more specifically, between the arachnoid and pia layers of the meninges). ... Electromyography (EMG) is a technique for evaluating and recording physiologic properties of muscles at rest and while contracting. ... Sources Brenner, G. M. (2000). ... Blood plasma is the liquid component of blood, in which the blood cells are suspended. ...


Treatment

The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing passive immunity with a horse-derived antitoxin, which blocks the action of toxin circulating in the blood.[5] This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Image File history File links Unbalanced_scales. ... This article does not cite any references or sources. ... Categories: Possible copyright violations ... An antitoxin is an antibody with the ability to neutralize a specific toxin. ... It has been suggested that Clyster be merged into this article or section. ...


Besides supportive care, infant botulism can be treated with human botulism immune globulin (BabyBIG), when available. Supply is extremely limited, but is available through the California Department of Health Services. This dramatically decreases the length of illness for most infants. Paradoxically, antibiotics (especially aminoglycosides or clindamycin) may cause dramatic acceleration of paralysis as the affected bacteria release toxin. Visual stimulation should be performed during the time the infant is paralyzed as well, in order to promote the normal development of visual pathways in the brain during this critical developmental period. Aminoglycosides are a group of antibiotics that are effective against certain types of bacteria. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ...


Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.


There are two primary Botulinum Antitoxins available for treatment of wound and foodborne botulism. Trivalent (A,B,E) Botulinum Antitoxin is derived from equine sources utilizing whole antibodies (Fab & Fc portions). This antitoxin is available from the local health department via the CDC. The second antitoxin is heptavalent (A,B,C,D,E,F,G) Botulinum Antitoxin which is derived from "despeciated" equine IgG antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated. This is available from the US Army. On June 1, 2006 the US Department of Health and Human Services awarded a $363 million contract with Cangene Corporation for 200,000 doses of Heptavalent Botulinum Antitoxin over five years for delivery into the Strategic National Stockpile beginning in 2007.[6] Wikipedia does not yet have an article with this exact name. ... The Centers for Disease Control and Prevention (CDC) in Atlanta is recognized as the lead United States agency for protecting the public health and safety of people by providing credible information to enhance health decisions, and promoting health through strong partnerships with state health departments and other organizations. ... Hepta- is a prefix indicating seven of something. ... Schematic of antibody binding to an antigen An antibody is a protein complex used by the immune system to identify and neutralize foreign objects like bacteria and viruses. ... The Army is the branch of the United States armed forces which has primary responsibility for land-based military operations. ... is the 152nd day of the year (153rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The United States Department of Health and Human Services, often abbreviated HHS, is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. ... The Strategic National Stockpile (SNS) is the United States national repository of antibiotics, chemical antidotes, antitoxins, vaccines, life-support medications, IV administration supplies, airway maintenance supplies and medical/surgical items. ...


Complications

Botulism can result respiratory failure. However, in the past 50 years, the proportion of patients with botulism who die has fallen from about 50% to 8% due to improved supportive care. A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid their recovery. // In animal physiology, respiration is the transport of oxygen from the ambient air to the tissue cells and the transport of carbon dioxide in the opposite direction. ... A medical ventilator is a device designed to provide mechanical ventilation to a patient. ... The word fatigue is used in everyday living to describe a range of afflictions, varying from a general state of lethargy to a specific work induced burning sensation within muscle. ...


Infant botulism has no long-term side effects, but can be complicated by nosocomial adverse events. The case fatality rate is less than 1% for hospitalized infants with botulism. A nosocomial infection is an infection that is caused by staying in a hospital. ... In epidemiology, Case fatality refers the rate of death among people who already have a condition. ...


Prevention

While commercially canned goods are required to undergo a "botulinum cook" (121°C for 3 minutes) and so rarely cause botulism, there have been notable exceptions (such as the 1978 Alaskan salmon outbreak and the 2007 Castleberry's Food Co. outbreak). Foodborne botulism has more frequently been from home-canned foods with low acid content, such as carrot juice, asparagus, green beans, beets, and corn. However, outbreaks of botulism have resulted from more unusual sources. In July, 2002, fourteen Alaskans ate muktuk (whale meat) from a beached whale, and eight of them developed symptoms of botulism, two of them requiring mechanical ventilation [1]. Other origins of infection include garlic or herbs[7] stored covered in oil,[2] chile peppers, improperly handled baked potatoes wrapped in aluminium foil [8], and home-canned or fermented fish. Persons who do home canning should follow strict hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated [8]. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Canned foods may also indicate botulism infestation by outward bulges in the can which result from gas production (perhaps during bacterial growth) causing increased pressure inside the can; it would be safest to simply throw such cans away as the bacteria which grew may have been botulism. Wound botulism can be prevented by promptly seeking medical care for infected wounds, and by avoiding punctures by unsterile things such as needles used for street drug injections. It is also being currently researched at USAMIRIID under BSL-4. Carrot juice is juice produced from carrots, often marketed as a health drink. ... Binomial name Asparagus officinalis Asparagus Asparagus is the name of a vegetable obtained from one species within the genus Asparagus, specifically the young shoots of Asparagus officinalis. ... For other uses, see Bean (disambiguation). ... Binomial name Carolus Linnaeus Beta vulgaris, commonly known as beet is a flowering plant species in the family Chenopodiaceae. ... This article is about the maize plant. ... Also see: 2002 (number). ... Official language(s) None[1] Spoken language(s) English 85. ... A mass stranding of Pilot Whales A beached whale is a whale which has become stranded on land, usually on a beach. ... mechanical or forced ventilation is the use of powered equipment, e. ... Binomial name L. Allium sativum L., commonly known as garlic, is a species in the onion family Alliaceae. ... It has been suggested that this article or section be merged with vegetable oil. ... Species C. annuum (incl. ... For other uses, see Potato (disambiguation). ... “Aluminum” redirects here. ... Prepared Fermented Fish Fermented Fish is an Eskimo food that is eaten raw and frozen. ... Hygiene refers to practices associated with ensuring good health and cleanliness. ...


Case study

On July 2, 1971, FDA released a public warning after learning that a New York man had died and his wife had become seriously ill due to botulism after eating a can of Bon Vivant vichyssoise soup. The company commenced a recall of the 6,444 cans of vichyssoise soup made in the same batch as the can known to be contaminated. An effectiveness check of the recall revealed a number of swollen or otherwise suspect cans among Bon Vivant's other products, leading the FDA to question the company's processing practices not only for the vichyssoise, but for all Bon Vivant products. Despite the fact that only five cans of soup were found to be contaminated with the botulin toxin (all from the batch initially recalled), the FDA extended the recall to include all Bon Vivant products, and shut down the company’s Newark, New Jersey, plant on July 7, 1971. The ordeal destroyed public confidence in the company’s products and the Bon Vivant name. Bon Vivant filed for bankruptcy within a month of the announcement of the recall. is the 183rd day of the year (184th in leap years) in the Gregorian calendar. ... Year 1971 (MCMLXXI) was a common year starting on Friday (link will display full calendar) of the 1971 Gregorian calendar. ... Vichyssoise ([1], commonly mispronounced ) is a French-style soup made of puréed leeks, onions, potatoes, cream, and chicken stock. ... is the 188th day of the year (189th in leap years) in the Gregorian calendar. ... Year 1971 (MCMLXXI) was a common year starting on Friday (link will display full calendar) of the 1971 Gregorian calendar. ...


Mortality rate

Between 1910 and 1919, the death rate from botulism was 70 percent in the United States. Death rates from botulism dropped to 9 percent in the 1980s, and 2 percent in the early 1990s, mainly because of the development of artificial respirators. Up to 60% of botulism cases can be fatal if left untreated.


The World Health Organization (WHO) reports that the current mortality rate is 5% (type B) to 10% (type A). Other sources report that, in the U.S., the overall mortality rate is about 7.5%, but the mortality rate among adults 60 years and older is 30%. The mortality rate for wound botulism is about 10%. The infant botulism mortality rate is about 1.3%. “WHO” redirects here. ...


One study showed that approximately 5 percent of children whose death was attributed to Sudden Infant Death Syndrome had actually died of botulism.


See also

Foodborne illness outbreaks in the United States. ... Botulin toxin or botox is the toxic compound produced by the bacterium Clostridium botulinum. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

References

  1. ^ Passaro DJ, Werner SB, McGee J, Mac Kenzie WR, Vugia DJ. Wound botulism associated with black tar heroin among injecting drug users. JAMA 1998;279:859-63. PMID 9516001.
  2. ^ http://www.cdc.gov/botulism/botulism.htm
  3. ^ http://www.fda.gov/bbs/topics/NEWS/2007/NEW01676.html
  4. ^ Oxford Textbook of Medicine, 4th Ed., Section 7.55
  5. ^ Shapiro, Roger L. MD; Charles Hatheway, PhD; and David L. Swerdlow, MD Botulism in the United States: A Clinical and Epidemiologic Review Annals of Internal Medicine. 1 August 1998 Volume 129 Issue 3 Pages 221-228
  6. ^ http://mmrs.fema.gov/news/publichealth/2006/aug/nph2006-08-03a.aspx
  7. ^ Oil Infusions and the Risk of Botulism, Colorado State University Cooperative Extension, Safefood new - Summer 1998 - Vol 2 / No. 4
  8. ^ a b Botulism Linked to Baked Potatoes. Retrieved on 2007-03-21.

Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era. ... is the 80th day of the year (81st in leap years) in the Gregorian calendar. ...

Further reading

  • Clostridium Botulinum In The Food Chain, By Dr. Rhodri Evans, Department of Industrial Microbiology, University College, Dublin, Belfield, Dublin 4. Published in Hygiene Review 1997, under the auspices of The Society of Food Hygiene Technology. [3]

External links

  • National Center for Home Food Preservation Factsheet
  • Botulism (Technical information from the CDC)
  • Clostridium Botulinum (FDA/CFSAN)
  • Botulism (WHO)

  Results from FactBites:
 
Botulism - Wikipedia, the free encyclopedia (1399 words)
Botulism (from Latin botulus, "sausage") is a rare but serious paralytic illness caused by a nerve toxin, botulin, that is produced by the bacterium Clostridium botulinum.
An unusual example of botulism occurred in Britain in the unusually hot, dry summer of 1976, when river levels dropped so low in some areas that feeding swans accidentally ingested material from anaerobic layers in a river (normally out of their reach), and were struck by botulism symptoms.
Furthermore each case of botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.
Botulism - definition of Botulism in Encyclopedia (1189 words)
The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of fl-tar heroin, especially in California.
Classic symptoms of botulism occur between 12-36 hours after uptake of the botulinum toxin, but they can occur as early as 6 hours or as late as 10 days.
Foodborne botulism has often been from home-canned foods with low acid content, such as asparagus, green beans, beets, and corn.
  More results at FactBites »

 
 

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