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Botulism

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by

Quinn Clarkson

on 8 July 2014

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Transcript of Botulism

BOTULISM
Clostridium botulinum
ETIOLOGY
Clostridium botulinum
Gram positive
Bacillus
Motile-peritrichous flagella
Endospore
Obligate anaerobe
Does not survive in oxygenated environments
Forms endospore to protect itself from environment
Exotoxin-producing (Botulinum toxin)
Neurotoxin
Symptoms occur over several days
Blocks acetylcholine at neuromuscular junction
RESERVOIR
It is most commonly found in soil and agricultural products
Cistern water (water tank)
Honey
PORTAL OF ENTRY
Gastrointestinal mucous membrane
Food botulism
Infant botulism
Most common form of botulism
Parenteral route
Wound botulism
Botox
Drug use/needle sharing
Respiratory mucous membrane
Inhalation botulism
Least common form of botulism
TRANSMISSION
Indirect-vehicle
Food
Improperly canned food
Environmental
Spores in soil
Indirect-fomite
Needles
SIGNS AND SYMPTOMS

Double vision
Blurred vision
Drooping eyelids
Slurred speech
Muscle weakness
Usually starts in muscles innervated by cranial nerves
Eye movements
Eyelids
Facial muscles
Muscles involved in chewing
Paralysis
Eventual death
Infant Botulism
Lethargy
Feed poorly
Constipation
"Floppy baby" syndrome
TREATMENT
Antitoxin
Heptavalent Botulism Antitoxin
Blocks action of neurotoxin
Enema
Removing contaminated food
Inducing vomiting
Antibiotics (Wound botulism)
Penicillin G
Surgery
Removing infected flesh
Respirator
If paralysis reaches respiratory muscles
Infant Botulism
Admitted to ICU
Given intravenous fluids to replenish nutrients
Botulism Immune Globulin Intravenous (BIGIV)
Intravenous antitoxin
Ventilator
PREVENTION
Make sure home-canned foods have been canned properly
High acid foods only require a boiling water bath
Low acid foods require a pressure canner at 240F
Children under 1 year shouldn't be fed honey
Avoid bloated cans
Dented cans are fine
Foamy canned foods
Wear gloves when gardening or working in the yard
Promptly seeking care for infected wounds
Covering open wounds when working/playing outside
Don't share or reuse needles, or just avoid drug use altogether.
BOTULINUM TOXIN
Botulinum is one of the most lethal toxins
The Botulinum neurotoxin binds to the acetylcholine receptors at the neuromuscular junction.
Binding is irreversible.
When the junction is blocked, the nerve cannot innervate the muscle, causing muscle weakness, and eventual paralysis.
The toxin is denatured at 175F.
C. botulinum
produces 7 forms of the toxin: Type A, B, C, D, E, F, and G.
Only types A, B, E, F, and H cause disease in humans.
Botulinum antitoxin inactivate only
unattached
botulinum.
Early antitoxin treatment (within 24 hours of symptoms) can preserve nerve endings.
It is not communicable from person to person
A vaccine against botulism exists but it is rarely used as its effectiveness has not been fully evaluated and it has demonstrated negative side effects, and treatments have been proven to be more effective.
RECOVERY
Botulism victims can recover completely.
Recovery time ranges from a few weeks to months.
Patients with severe cases may take years to recover completely.
Recovery depends on how quickly the receptors destroyed by the toxin are rebuilt.
BOTOX
Botox is a form of type A botulinum that has been approved by the FDA for clinical and cosmetic use.
It is also used to treat a variety of disorders:
Chronic migraines
Hyperhidrosis (extreme perspiration)
Cervical dystonia (neck spasms)
Blepharospasm (abnormal eye spasms)
Strabismus (cross-eyedness)
INHALATION BOTULISM
Very rare
Doesn't occur naturally
May occur in facilities that manufacture botox
i.e. accidental inhalation
Bioterrorism
Similar to anthrax
The lethal dose for humans is approx 2 nanograms
3 times greater than in food-borne cases
BOTULISM IS FUN!
Quinn Clarkson, Jeremy Chiu, and Josh Duncan
EPIDEMIOLOGY
On average, 110 cases are reported a year in the US
5-10% mortality for treated cases
60% mortality for untreated cases
Infant botulism accounts for 70% of reported cases
Wound botulism accounts for 30-40%
Virtually all cases of wound botulism attributed to drug use are reported in California
Botulism is endemic in California, Washington, Colorado, Oregon and Alaska
Account for more than half of the reported cases in the US since 1950
HISTORY
Botulinum toxin was first identified in infected sausage 1735 by Justinus Kerner
"Sausage poison"
Sausage was cased in the intestines of pigs
In 1897, Emile van Ermengem identified the bacteria that produced the toxin
Nomenclature comes from the Latin word for sausage,
botulus
Alan Scott and Edward Schantz produced a purified form of the toxin for clinical uses in the 1960s
In 1989, Dr. Richard Clark discovered botulinum as a method to reduce forehead wrinkles. It became FDA approved in 2002.
Spores have been found in marine sediments and in the intestinal tracts of animals, including fish.
Full transcript