BOTULISM

DEFINITION:
Botulism is a paralytic disease caused by potent neurotoxins elaborated by clostridium botulinum. Illness
begins with cranial nerve involvement and proceed caudally to involve the extremities.
Classification:
1. Food-borne Botulism from ingestion of preformed toxin in food contaminated with C.
Botulinum
2. Wound Botulism from toxin produced in wound contaminated with the organism
3. Intestinal Botulism from ingestion of spores and production of toxin in the intestine of the
infants (infant botulism) or adult.
Botulinum because of its extraordinary potency, has long been considered a threat as an agent of
bioterrorism or biologic warfare that could be acquired by inhalation or ingestion.
Iatrogenic Botulism - can follow cosmetic or therapeutic use of toxin
ETIOLOGY:
C. Botulinum a species encompassing a heterogeneous group of anaerobic gram-positive organism
that form a subterminal spores
- Found in soil and Marine environment
Rare Strains of other clostridial species
1. C. Butyricum
2. C. Baratii
(Have been found to produce toxin)
C. Botulinum strains with proteolytic activity can digest food and produce a spoiled appearance,
nonproteolytic type leave the appearance of food unchanged.
8 Distinct toxin types described
(A, B, C1, C2, D, E, F and G), all except C2 are neurotoxins, whether ingested, inhaled, or produced in
intestine or a wound - enters the vascular system -- transported to peripheral cholinergic nerve
terminals, including neuromuscular junctions, postganglionic parasympathetic nerve endings, and
peripheral ganglia.
Note: CNS is not involved.


Steps in Neurotoxin activity
Binding - internalization in endocytic vesicle - translocation to the cytosol and proteolysis --
resulting in a blockage of the release of the neurotransmitter acetylcholine.
Toxins A, B, E and (rarely F) cause disease in human.
Type G (C. Argentinense) has been associated with sudden death but not with neuroparalytic illness.
Type C and D causes disease in animals.

EPIDEMIOLOGY:
Type A predominates in west of Rocky Mountains
Type B- east (u.s.a)
Type E Pacific northwest, Alaska and Great Lake area.
Food Borne Botulism home-canned food (Vegetables, fruit, and condiments) and less commonly with
meat and fish products
Occur:
1. Food to be preserved is contaminated with spores
2. Preservation does not inactivate the spores but kills other putrefactive bacteria that might
inhibit growth of C. Botulinum and provide anaerobic condition at a pH and temperature
that allow germination and toxin production
3. Food is not heated to a temperature that destroy toxin before being eaten.
Type E outbreaks frequently associated with Fish products
CLINICAL MANIFESTATIONS:
Food borne Botulism:
-After ingestion of food containing toxins
-Incubation period is usually 18 36 hours, depending on the toxin dose
-Symmetric descending paralysis is characteristic and can lead to respiratory failure and death.
-Cranial Nerve involvement marks the onset of symptoms, usually produce ( diplopia ,dysarthia,
dysphonia, and or dysphagia)
- Weakness progress, often rapidly, from the head to involve the neck, arms, thorax, and legs,
occasionally, weakness is asymmetric.
-Nausea and vomiting, and abdominal pain may precede or follow the onset of paralysis.
- Dizzness, blurred vision, dry mouth and sore throat.
- Patient is generally alert and oriented, but very drowsy, agitated and anxious.
- no fever
-ptosis is frequent
- Pupillary reflexes is depressed and fix or dilated pupil are noted
- Gag reflex may be suppressed
-Deep tendon may be normal or depressed.
- Sensory finding is usually absent.
-Paralytic ileus, severe constipation , urinary retention
Wound Botulism:
-Occurs