diease

Botulism


OVERVIEW OF Botulism :

It is caused by the foodborne disease, serious and fatal disease. It is very dangerous and resulting in ingestion of neurotoxins, the botulinum toxins, formed in contaminated foods.Botulism is not transferred by person to person contacts.


STRUCTURE of Botulism :

Botulism is a gram negative bacterium spore forming bacteria.


CAUSES :

Botulism is caused by the bacteria is called Clostridium tetani.

Improperly processed food

Fermented foods

Open wounds

Aerosols

Contaminated foods


PATHOPHYSIOLOGY :

Pathophysiology:

Botulin neurotoxin enters through the bloodstream through the ingestion of food or from the mucosal surfaces. And results in binding to the peripheral nerve endings. The toxin botulin results in blockade of neurotransmission in the cholinergic nervous system. It results in inhibition of the acetylcholine release at the presynaptic clefts in the muscle nervous junction orelse at the acetylcholine receptors itself. This leads to the flaccid paralysis. Starting from the cranial nerves  towards the spinal nerves


ROUTES OF TRANSMISSION :

Clostridium botulinium is an anaerobic bacterium,meaning that it can survive without the presence of oxygen. Foodborne botulism occurs when the food is contaminated with the botulism toxin and the prior to consumption. The bacteria is also present in the river,soil and sand.

The growth of the bacterium usually occurs in the low oxygen content and contamination in the foods mainly in the processed foods such as home made preservative foods might results in the toxin production of the bacterias.

The botulinium toxin is not produced in the acidic environment and also in low salt level and low pH levels. Hence the toxin is not produced properly is such environments.

The botulinum toxin has been found in a variety of foods, including low-acid preserved vegetables, green beans, spinach, mushrooms, and beets.fish, including canned tuna, fermented, salted and smoked fish and meat products, such as ham and sausage.

They are heat resistant bacteria and hence the packaged foods are not

Infant botulism:

It occurs mostly in the young children under the age group of 6 years. It differs from food borne botulism because the ingestion of the botulism in the infants results in gut malformation  C.botulinium multiply in the gut and small intestine of the infants and increase in the formation of the spores ,since the immune system is weakened in the infants.

 The infants cannot reveal what is happening in them.  Constipation, loss of appetite,tiredness , altered cryness are the symptoms of the infant botulism. The infant are allowed to ingest honey for 1 year since spore formation of the bacteria in honey is higher in amount.

Wound botulism

It is a rare disorder and it occurs as a result of open skin and entry of bacteris through this cut. This might be common in patients when injecting black tar heroin.

Inhalation botulism

This type of botulism does not occurs naturally and the mechanism by which the inhalaltional botulism occurs is by bioterrorism or man made events cases.

Following inhalation of the toxin, symptoms become visible between 1–3 days, with longer onset times for lower levels of intoxication. Symptoms proceed in a similar manner to ingestion of botulinum toxin and results in muscular paralysis and respiratory failure.

If exposure to the toxin via aerosol inhalation is suspected, additional exposure of the patient to the toxin and the surroundings people should be prevented. The patient's clothing must be removed and stored in plastic bags until it can be washed thoroughly with soap and water. The patient should shower and be decontaminated immediately.

Other types of intoxication

Waterborne botulism could theoretically result from the ingestion of the pre-formed toxin. However, as common water treatment processes (such as boiling, disinfection with 0.1% hypochlorite bleach solution) destroy the toxin, the risk is considered low.

Botulism of undetermined origin usually involves adult cases where no food or wound source can be identified. These cases are comparable to infant botulism and may occur when the normal gut flora has been altered as a result of surgical procedures or antibiotic therapy.

Adverse effects of the pure toxin have been reported as a result of its medical and/or cosmetic use in patients, see more on 'Botox' below.

'Botox'

The bacterium C. botulinum is the same bacterium that is used to produce Botox, a pharmaceutical product predominantly injected for clinical and cosmetic use. Botox treatments employ the purified and heavily diluted botulinum neurotoxin type A. Treatment is administered in the medical setting, tailored according to the needs of the patient and is usually well tolerated although occasional side effects are observed


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • Difficulty swallowing
  • Muscle weakness
  • Double vision
  • Drooping eyelids
  • Blurry vision
  • Slurred speech
  • Difficulty breathing
  • Vomiting
  • Nausea
  • Stomach pain
  • Diarrhea
  • Constipation
  • Poor feeding
  • Drooping eyelids


DIAGNOSTIC :

The physician might do the physical examination inorder to obtain the diagnosis. He/she might check the voice, mucle examination or drooping of eye lids.

They might advise for the urine or blood to analyse the presence of bacterium.

Other tests that may be done to diagnose botulism include:

Brain scan:

 A  Magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain can help rule out other reasons for your symptoms, such as a stroke. It reveals the cross section of the brain anatomy and it is very much useful in the diagnosis of brain dysfunction caused by the botulinium neurotoxin.

Spinal fluid exam:

 A spinal fluid also known as spinal tap is formed might show the increase in the certain protein levels.

Nerve and muscle function tests: it is done by the electromyelography.Electromyelographic show how well the muscle responses to the electrical or nerve signals from the brain. This can be taken as a confirmatory test for botulism

Tensilon test: Tensilon (endorphonium) is injected into the muscle and the muscle gains the strength and it is values. This test is mainly used to differentiate the myasthenia gravis.


TREATMENT AND PROGNOSIS :

Botulisum antitoxin is the first drug of choice in the treatment of the botulisum.

Antibiotics if needed to enhance the action of other drugs

Breathing: in inhalational or if the ingested botulism causing bacteria causes severe arrest of respiration results in difficulty in breathing and paralyses of breathing muscles might occur in the severe cases. In such complicated cases ventilations might be sometimes required to provide support to the lung.

Also physicians might induce vomit to remove the undigested food

Enemas are used to evacuate unabsorbed toxins.


PROGNOSIS :

Untreated patients tends to show mortality rate of 50 % .  in some cases even the treated and cured cases shows the fatality rate of 3-5%. Still some patients might suffer from paralysis for many months.


PREVENTION :

Avoid using packaged foods

Avoid using ingestion of honey in children below 2 years of age.

Properly cook the food also heat it before intaking the food

Wash your hands and  follow sterilization protocol  before eating the meals.

When the skin is open try to coat it with betadine to prevent from sepsis and also from botulinum toxin entry in to the body.


Recovery Period :

Recovery period:

Once it affects the lungs and causes respiratory problems it might leads to ecovery period of 30-120 days. In others it is purely depends upon the individuals immune system action and also response to the antitoxin activity


Medicines used in the Treatment :

botulinum antitoxin