By Olivia Anderson

Though foodborne illness caused by the botulism toxin has been alluded to in many historical cases, it was not till the 19 th century that symptoms of some foodborne illnesses were attributed to Clostridium botulinum The first reported cases of a foodborne illness that would later be attributed to the botulism toxin were made by German medical officer Justinus Kerner between 1817 and 1822 Kerner based his discover on an outbreak of food poisoning caused by blood sausage in Southern Germany In 1895, the Clostridium botulinum pathogen was officially discovered by Emile Pierre van Ermengem,a professor of bacteriology at the University of Ghent, after an outbreak in Belgium HISTORY OF BOTULISM

Botulism is a disease caused by the toxin produced by Clostridium botulinum bacteria Symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness The toxin produces a paralytic response in the body, which is the source of muscle weakness and loss of control Botulism is considered a medical emergency and a public health emergency, since one contaminated food source may infect large amounts of people. WHAT IS BOTULISM?

Clostridium botulinum is a rod shaped, anaerobic bacteria that forms heat resistant spores The bacteria can survive cooking processes and can be stored indefinitely in its spore form Active forms of the bacteria can be killed by heating at 80 degrees Celsius for ten or more minutes BOTULISM: A PATHOGENIC BACTERIA

Clostridium botulinum bacteria are gram positive, meaning they have a thick layer of peptidoglycan The bacteria are anaerobic, so they can survive with little or no oxygen, which makes stored food a good environment The bacteria produce a neurotoxin that targets musculature so that the individual may experience involuntary action or parlysis VIRULENCE FACTORS

Clostridium botulinum bacteria possess plasmids that contain the DNA to produce a neurotoxin This botulism toxin mediates the blockage of acetylcholine release into neuromuscular synapses which results in an inability for muscles to function The toxin can also bind to acetylcholine itself, which produces the same effect in the infected individual PATHOPHYSIOLOGY

Currently, the botulism toxin is known to cause five different types of the disease including: Foodborne botulism Wound botulism Infant botulism Adult intestinal toxemia Iatrogenic botulism CLASSIFICATIONS OF BOTULISM

Caused by ingestion of the Clostridium botulinum bacteria Usually cases manifest as a result of consuming improperly canned and fermented foods, such as home pickled eggs and vegetables and homemade sausages and other mean products FOODBORNE BOTULISM

Occurs when wounds are exposed to Clostridium botulinum bacteria Most cases appear in puncture wounds and bites that are not properly disinfected or dressed WOUND BOTULISM

Occurs when infants ingest Clostridium botulinum bacteria Cases usually occur when infants are introduced to new bottled/canned foods that are improperly sealed from the environment Cases are often related to exposure to raw honey before two years INFANT BOTULISM

Occurs in the same manner as infant botulism, by ingestion of Clostridium botulinum bacteria The bacteria mature in the intestinal tract This type of botulism is rare due to the strain of botulism bacteria that is capable of maturing and surviving in the digestive system ADULT INTESTINAL TOXEMIA

Caused by excess of the newest form of the botulism toxin, a manmade substance that mimics that produced by bacteria Often used as a beauty treatment, but overdoses can cause adverse effects IATROGENIC BOTULISM

Depending on the category of botulism, transmission may occur either by ingestion or by a physical insertion into the body (such as a puncture wound) Generally, ingested botulism is a result of improperly stored food items, or those that were stored without any type of heat treatment, such as raw honey TRANSMISSION

Botulism can be prevented by making certain that all canned foods reach optimum temperatures before sealing, and that they are prepared with no cross contamination Generally, clostridium botulinum bacteria are not spread from person to person, but from a food source to a person, but to prevent wound botulism, make sure to clean and sterilize wounds thoroughly The USDA provides a home-canning guide as an effort to educate individuals and help prevent foodborne illness For patients that experience respiratory failure in response to the toxin, respirators are used to provide easier breathing. Patients are also treated with an anti-toxin, that blocks the action of the toxin on cholinergic synapses and allows neuromuscular action to occur PREVENTION AND TREATMENT

Five-month old infant male is admitted to hospital in Massachusetts in November, 1983 because of severe lethargy and lack of “developmental milestones” past three weeks of age Upon examination, the child had flaccid extremities and no motor control of his head or neck, as well as no sucking abilities Initially treated with IV hydration and saline enemas, and later nasogastric feedings, which improved health some A stool specimen revealed Clostridium botulinum bacteria and botulinal toxin The child was diagnosed with infant botulism after the specimen was analyzed on the fourth day of hospitalization CASE STUDY: INFANT BOTULISM

The enemas were given to flush the toxin out of the infant’s body to speed up treatment The child’s gradual muscular improvement was a result of the IV hydration and enemas, as well as the anti toxin CASE STUDY CONT.

The FDA estimates that there are between 100 and 110 cases of botulism per year in the United States, though cases can go undiagnosed because of mild or less persistent symptoms In 2010, Oregon had only one reported case of botulism CASE STATISTICS

Raise awareness for foodborne illnesses, especially in home-processed foods Because botulism is considered a medical emergency, it is important to know the symptoms Botulism can be an expensive disease to treat, especially because of the low number of cases; pharmaceuticals for its treatment are not widely produced and diagnosis can take time, so prevention of botulism is key IMPORTANCE OF BOTULISM

Botox is a pharmaceutical drug produced and prescribed to patients to eliminate facial lines and wrinkles temporarily and to treat some neuromuscular diseases Botox is an altered form of the toxin produced by Clostridium botulinum bacteria The drug is injected under the skin and temporarily paralyzes some muscles and nerves for the desired aesthetic affect BOTOX: BOTULISM AS A BEAUTY TREATMENT

Botox. (2014, July 14). Retrieved July 12, 2015, from MedlinePlus website: Botulism. (2014, April 25). Retrieved July 12, 2015, from Centers for Disease Control and Prevention website: Chan-Tack, K. M., & Chandrasekar, P. H. (2015, March 23). Botulism. Retrieved July 12, 2015, from Medscape website: overview#a6http://emedicine.medscape.com/article/ overview#a6 Foodborne Pathogenic Microorganisms and Natural Toxins Handbook Clostridium botulinum. (2014, December 12). Retrieved July 12, 2015, from US FDA website: htm REFERENCES