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Botulism - Wikipedia, the free encyclopedia. Botulism is a rare and potentially fatal illness caused by a toxin, produced by the bacterium Clostridium botulinum. The disease begins with weakness, trouble seeing, feeling tired, and trouble speaking. This may then be followed by weakness of the arms, chest muscles, and legs. The disease does not usually affect consciousness or cause a fever. The bacterial spores which cause it, are common in both soil and water. They produce the botulinum toxin when exposed to low oxygen levels and certain temperatures.
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Foodborne botulism happens when food containing the toxin is eaten. Infant botulism happens when the bacteria develops in the intestines and releases the toxin. This typically only occurs in children less than six months old, as protective mechanisms develop after that time. Wound botulism is found most often among those who inject street drugs. In this situation, spores enter a wound, and in the absence of oxygen, release the toxin. It is not passed directly between people.
The diagnosis is confirmed by finding the toxin or bacteria in the person in question. The toxin, though not the organism, is destroyed by heating it to more than 8. Honey can contain the organism, and for this reason, honey should not be fed to children under 1. Treatment is with an antitoxin. In those who lose their ability to breathe on their own, mechanical ventilation may be necessary for months. Antibiotics may be used for wound botulism. Death occurs in 5 to 1.
Botulism can affect many other animals. Double vision, drooping of both eyelids, loss of facial expression and swallowing problems may therefore occur. In addition to affecting the voluntary muscles, it can also cause disruptions in the autonomic nervous system. This is experienced as a dry mouth and throat (due to decreased production of saliva), postural hypotension (decreased blood pressure on standing, with resultant lightheadedness and risk of blackouts), and eventually constipation (due to decreased peristalsis). The weakness then spreads to the arms (starting in the shoulders and proceeding to the forearms) and legs (again from the thighs down to the feet). This may be experienced as dyspnea (difficulty breathing), but when severe can lead to respiratory failure, due to the buildup of unexhaled carbon dioxide and its resultant depressant effect on the brain. This may lead to coma and eventually death if untreated.
He is unable to move or open his eyes. He is not asleep or sedated. Infant botulism (also referred to as floppy baby syndrome) was first recognized in 1. United States. There were 1. United States in 2. Infants are susceptible to infant botulism in the first year of life, with more than 9. The infant gut may be colonized when the composition of the intestinal microflora (normal flora) is insufficient to competitively inhibit the growth of C.
Typical symptoms of infant botulism include constipation, lethargy, weakness, difficulty feeding and an altered cry, often progressing to a complete descending flaccid paralysis. Although constipation is usually the first symptom of infant botulism, it is commonly overlooked. For this reason honey is not recommended for infants less than one year of age. Clostridium botulinum is a ubiquitous soil- dwelling bacterium. Many infant botulism patients have been demonstrated to live near a construction site or an area of soil disturbance. The case fatality rate is less than 1% for hospitalized infants with botulism. Botulism can result in death due to respiratory failure.
However, in the past 5. A patient with severe botulism may require mechanical ventilation (breathing support through a ventilator) as well as intensive medical and nursing care, sometimes for several months. The respiratory failure and paralysis that occur with severe botulism may require a person to be on a breathing machine (ventilator) for weeks or months. The person may require rehabilitation therapy after leaving the hospital. Botulinum toxin is one of the most powerful known toxins: about one microgram is lethal to humans when inhaled. This causes paralysis. Advanced botulism can cause respiratory failure by paralysing the muscles of the chest; this can progress to respiratory arrest.
The pattern of damage occurs because the toxin affects nerves that fire (depolarise) at a higher frequency first. This occurs in infants who are colonized with the bacterium in the small intestine during the early stages of their lives. The bacterium then produces the toxin, which is absorbed into the bloodstream.
The consumption of honey during the first year of life has been identified as a risk factor for infant botulism; it is a factor in a fifth of all cases. Fish that has been pickled without the salinity or acidity of brine that contains acetic acid and high sodium levels, as well as smoked fish stored at too high a temperature, presents a risk, as does improperly canned food. Food borne botulism results from contaminated food in which C. This typically occurs in home- canned food substances and fermented uncooked dishes.
Symptoms usually appear 1. This has become more common in intravenous drug users since the 1. The toxin from all of these acts in the same way and produces similar symptoms: the motor nerve endings are prevented from releasing acetylcholine, causing flaccid paralysis and symptoms of blurred vision, ptosis, nausea, vomiting, diarrhea and/or constipation, cramps, and respiratory difficulty. Botulinum toxin is broken into 8 neurotoxins (labeled as types A, B, C . Human botulism is caused mainly by types A, B, E, and (rarely) F. Types C and D cause toxicity only in other animals.
However, further information about type H has not been disclosed because of its potential for abuse as a lethal bioweapon and lack of a known antitoxin. Their natural habitats are in the soil, in the silt that comprises the bottom sediment of streams, lakes and coastal waters and ocean, while some types are natural inhabitants of the intestinal tracts of mammals (e. The spores can survive in their inert form for many years. Unfortunately, little is known about the natural factors that control phage infection and replication within the bacteria.
In the wild, decomposing vegetation and invertebrates combined with warm temperatures can provide ideal conditions for the botulism bacteria to activate and produce toxin that may affect feeding birds and other animals. Spores are not killed by boiling, but botulism is uncommon because special, rarely obtained conditions are necessary for botulinum toxin production from C. All forms of botulism lead to paralysis that typically starts with the muscles of the face and then spreads towards the limbs. In light of this life- threatening complication, all suspected cases of botulism are treated as medical emergencies, and public health officials are usually involved to identify the source and take steps to prevent further cases from occurring. Confirmation of the diagnosis is made by testing of a stool or enema specimen with the mouse bioassay. Physicians may consider diagnosing botulism if the patient's history and physical examination suggest botulism.
However, these clues are often not enough to allow a diagnosis. Other diseases such as Guillain. 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. A definite diagnosis can be made if botulinum toxin is identified in the food, stomach or intestinal contents, vomit or feces. The toxin is occasionally found in the blood in peracute cases. Botulinum toxin can be detected by a variety of techniques, including enzyme- linked immunosorbent assays (ELISAs), electrochemiluminescent (ECL) tests and mouse inoculation or feeding trials. The toxins can be typed with neutralization tests in mice.
In toxicoinfectious botulism, the organism can be cultured from tissues. On egg yolk medium, toxin- producing colonies usually display surface iridescence that extends beyond the colony. In older children and adults the normal intestinal bacteria suppress development of C. Foodborne botulism is the rarest form though, accounting for only around 1. US). However, outbreaks of botulism have resulted from more unusual sources. In July 2. 00. 2, fourteen Alaskans ate muktuk (whale meat) from a beached whale, and eight of them developed symptoms of botulism, two of them requiring mechanical ventilation. When making home preserves, only acidic fruit such as apples, pears, stone fruits and berries should be bottled.
Tropical fruit and tomatoes are low in acidity and must have some acidity added before they are bottled. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, home- canned foods are best boiled for 1. Contamination of a canned food solely with C. Only sufficient thermal processing during production should be used as a food safety control. Vaccine. Respiratory failure due to paralysis may require mechanical ventilation for 2 to 8 weeks, plus intensive medical and nursing care.
After this time, paralysis generally improves as new neuromuscular connections are formed. Wounds should be treated, usually surgically, to remove the source of the toxin- producing bacteria.
FDA in 2. 00. 3 for the treatment of infant botulism. In the United States, this antitoxin is available from the local health department via the CDC. The second antitoxin, heptavalent (A,B,C,D,E,F,G) botulinum antitoxin, is derived from . This less immunogenic antitoxin is effective against all known strains of botulism where not contraindicated. The case fatality rate is less than 1% for hospitalized infants with botulism. Of these, roughly 6.
From 1. 97. 4 to 1. U. S. Thirty- nine percent (1. Alaska, all of which were attributable to traditional Alaska aboriginal foods. In the lower 4. 9 states, home- canned food was implicated in 7.