Botulism

Botulism, although rare, is a serious disease affecting the muscles and is caused by toxins released from bacteria called Clostridium botulinum.

This bacteria is present in soil and unpurified water all around the world. It forms spores that can survive in improperly canned food and release a toxin.

Even if a small amount of this toxin enters the body through improperly preserved food, it can cause severe poisoning.

It may also gain entry into our body through cuts on our skin.

The three most common types of botulism are:

• Foodborne botulism: The harmful bacteria can thrive and produce their toxin in canned food products as their environments will be devoid or having only little oxygen
• Wound botulism: If this bacteria enters a skin wound, a dangerous infection may be caused by the toxin.
• Infant botulism: This commonly occurs in few infants between the ages of 2 months and 8 months, who hold Clostridium botulinum bacterial spores in their intestinal tract.

The other types of botulism are called adult intestinal toxemia (adult intestinal colonization) botulism and iatrogenic botulism.

Adult intestinal toxemia is very rare and occurs in adults through the same mechanism as infant botulism.

Iatrogenic botulism occurs due to an accidental overdose of the botulinum toxin.

All types of botulism can prove to be lethal and should be considered medical emergencies, particularly food borne botulism- it is a public health emergency as several people may get poisoned by consumption of a contaminated food product.

Food borne botulism

The signs and symptoms of food borne botulism generally appear between 12 and 36 hours after the toxin enters your body.

Sometimes, the beginning symptoms may take a few hours to several days to appear, as it depends on the amount of toxin ingested.

The classic signs and symptoms of food borne botulism include:

• Abdominal cramps with nausea and vomiting
• Difficulty swallowing, speaking and breathing
• Dry mouth
• Facial weakness affecting both sides of your face
• Drooping eyelids
• Double vision or blurred vision
• General weakness with loss of muscle tone or paralysis

Wound botulism

Most people who develop wound botulism inject drugs several times a day, so it's difficult to know for sure how long it takes for signs and symptoms to develop after the toxin enters the body.

Wound botulism signs and symptoms include:

• Slurred speech and difficulty swallowing
• Facial weakness affecting both sides of the face
• Blurred or double vision
• Drooping eyelids
• Difficulty in breathing
• Paralysis or muscle weakness

Infant botulism

If the infant botulism is due to contaminated food such as honey, symptoms generally appear within 18 to 36 hours after the toxin gets into the baby's body.

Signs and symptoms include:

• Constipation is often the first sign
• Floppy movements due to muscle weakness and trouble controlling the head
• Weak cry
• Irritability
• Drooling
• Drooping eyelids
• Fatigue
• Difficulty sucking or feeding
• Paralysis

Botulism is a serious disease that can be fatal.

Hence, urgent medical attention should be sought for if you think that you have botulism.

Early diagnosis and treatment increases your chances of survival and decreases the risk of developing further complications.

Seeking prompt medical care also alerts public health authorities so that they can prevent other people from eating the contaminated food.

Botulism is caused by a bacteria called Clostridium botulinum that is found in soil, dust, and river or sea sediments.

This bacteria is harmful to us when they produce very poisonous toxins in the environment and in places deprived of oxygen such as in closed tins or bottles, stagnant soil or mud, and sometimes in the human body.

• Food borne botulism: The most common cause of food borne botulism is often from ingestion of home-canned foods that are low in acid, such as green beans, corn and beets. However, the disease may also occur from the intake of chili peppers, foil-wrapped baked potatoes and oil infused with garlic. When you eat food contaminated with the toxin, it leads to disruption of the nerve function, causing paralysis.
• Wound botulism: It is caused by C. botulinum bacteria when it enters a wound, possibly caused by an injury. The bacteria then multiplies and produces toxins. In recent years, wound botulism has increased in people who take injections of heroin, which can contain spores of the bacteria. It is most common in people who inject black tar heroin.
• Infant Botulism: Infant botulism may occur when a baby swallows a resistant form of the bacteria, called a spore, which will be present in contaminated soil or food such as honey. These spores do not cause any harm in older children and adults as they have developed defenses against these bacteria from about one year of age. In the intestinal tracts of infants, the bacterial spores multiply and produce toxins.

Benefits

It may be surprising to learn that a toxin so poisonous causing fatal complications can be beneficial too.

Scientists have discovered that the paralyzing effect of the botulinum toxin can be made useful in certain circumstances.

Botulinum toxin has been used to diminish facial wrinkles by preventing the muscle contraction beneath the skin.

It has been used for medical conditions such as eyelid spasms and severe underarm sweating.

Rarely, serious side effects have been reported with the use of botulinum toxin for medical reasons that include extension of muscle paralysis beyond the treated area.

Making diagnosis of botulism is done by physical examination.

You may initially consult your primary care doctor for evaluation of your symptoms, after which you will be referred to a hospital for immediate treatment.

At the hospital, you will be seen by a doctor who specializes in neurology or infectious diseases.

Carry all your regular medications along with you, and inform your doctor about any vitamins or supplements you are taking.

Write down the questions you want to ask your doctor.

If you do not have enough time to write down the questions before your first appointment, write down any questions you want to ask during your follow-up appointments.

For botulism, some basic questions you may ask your doctor include:

• What is the reason for my infection/botulism?
• Will I have any chronic problems?
• What side effects can be expected from treatment?
• Are there any restrictions in my regular diet?
• What preventive measures should be taken in the future?

Your doctor may ask you a number of questions, such as:

• When did you first notice your initial symptoms?
• Do your symptoms appear occasionally or are they continuous?
• Did you ingest any canned food recently?
• In case your infant has botulism, has he or she consumed honey?
• Has anybody other than yourself consumed the food that is suspected of causing your illness?

Examination and analysis

In order to diagnose botulism, your doctor will perform a thorough physical examination during which the signs of muscle weakness or paralysis, such as drooping of eyelids or a weak voice will be checked.

Your doctor will also ask about the foods you have consumed in the past few days, or about any wound that may have been exposed to the bacteria.

In suspected cases of infant botulism, the doctor may ask whether the child has consumed honey recently or experienced constipation or sluggishness.

An analysis of blood, stool or vomit may be done to check for the presence of the toxin, which can be a confirmatory test to establish the diagnosis of an infant or food borne botulism, but as these tests take a longer time, your doctor's clinical examination may be the primary means of diagnosis.

There are several treatment methods for botulism.

In cases of food borne botulism, doctors wash out any contaminated food still in your digestive system by inducing vomiting and prescribing medications that induce bowel movements (enemas).

If there is wound botulism, your doctor will surgically remove the infected tissue and prescribe appropriate antibiotics.

The difficulty breathing and muscle paralysis that occurs with severe botulism may be treated by maintaining ventilation through a breathing machine (ventilator) for several weeks to months, along with intensive medical and nursing care.

Other treatment options

• Antitoxin: An antitoxin acts by blocking the action of the toxin circulating in the blood. Injected antitoxins, if given at an early stage of food borne or wound botulism, helps to prevent the worsening of symptoms and decrease the risk of complications. The antitoxin gets attached to the toxin that is circulating in your bloodstream and prevents it from causing harm to your nerves. The antitoxin cannot reverse the damage that is already been done, but nerves are capable of regeneration. Most patients recover completely, but it may take several months and require extended rehabilitation therapy. For infant botulism, a different type of antitoxin called botulism immune globulin is used.
• Antibiotics: Antibiotics are prescribed for the treatment of wound botulism. However, these medications are not recommended for other types of botulism as these can accelerate the release of the toxins.
• Breathing assistance: If you have difficulty breathing, you will need a mechanical ventilator for several weeks until the effects of the toxin slowly get reduced. The ventilator forcefully drives air into your lungs from a tube inserted in your airway, either through your nose or mouth.
• Rehabilitation therapy: This therapy is initiated as you recover and includes methods to improve your speech, swallowing techniques and other functions that were affected by the toxin.

Botulism is a preventable disease in most cases.

Food borne botulism is most often a result of using home-canned foods such as asparagus, green beans, beets and corn that is prepared by following improper canning methods.

Therefore, make sure you use the following techniques while canning foods at home so that any botulism germs present in the food get destroyed:

• Pressure cook these foods at 250 F (121° C) for 20-100 minutes, depending on the food.
• Boil these foods for at least 10 minutes before eating them.
• Prepare and store the food safely: Oils that are infused with garlic or other herbs should be stored in a refrigerator. Potatoes that have been baked while being wrapped around an aluminum foil should remain hot until served or stored in a refrigerator.
• Avoid eating preserved food if its container appears puffed or if the food smells spoiled. However, taste and smell do not always indicate the presence of C. botulinum. Some strains do not make the food taste or smell bad.

• Infant botulism: To decrease the risk of infant botulism, avoid feeding honey — even a small amount — to children under the age of 12 months. Honey may contain the bacteria that causes infant botulism. However, most cases of infant botulism occurring through ingestion of contaminated dust or soil cannot be prevented as these bacteria may be present inside our homes on the carpets, floors, and counter tops even when you maintain cleanliness.
• Wound botulism: To prevent wound botulism, seek prompt medical care for an infected wound and never use injectable street drugs.

As the botulinum toxin affects muscle control all throughout your body, it may lead to many serious complications.

The most common danger is respiratory failure that may result in death.

Other complications may include:

• Long-lasting weakness
• Fatigue and shortness of breath for a long period of time
• Difficulty swallowing and slurred speech