Clostridium Clostridium botulinumbotulinum

and Botulismand Botulism

A A Caitlin, Farida, Nino, Natalie Caitlin, Farida, Nino, Natalie

and Simonand SimonPresentationPresentation

OUTLINEOUTLINE► Introduction to C. Introduction to C.

BotulinumBotulinum► Introduction to BotulismIntroduction to Botulism► Infant BotulismInfant Botulism► Food-Borne BotulismFood-Borne Botulism► Wound BotulismWound Botulism► BioterrorismBioterrorism

Clostridium Clostridium botulinumbotulinum

►Gram positive rodsGram positive rods► Spore formingSpore forming► Anaerobic bacteriaAnaerobic bacteria► Produces Produces toxin that toxin that

causes botulismcauses botulism ► Seven Seven neurotoxic neurotoxic

subtypes, labeled subtypes, labeled A-G A-G

► First recognized First recognized and isolated in and isolated in 1896 by Van 1896 by Van ErmengemErmengem

BotulismBotulism►Botulism is a neuroparalytic disease Botulism is a neuroparalytic disease ► It is caused by the potent protein toxin It is caused by the potent protein toxin

released from released from C. botulinumC. botulinum►Once released into the bloodstream it Once released into the bloodstream it

irreversibly binds to the acetylcholine irreversibly binds to the acetylcholine receptors in the neuromuscular junction receptors in the neuromuscular junction

► It alters the mechanism for acetylcholine It alters the mechanism for acetylcholine release, making the neuron release, making the neuron unresponsive to action potentials unresponsive to action potentials

►Three major types: Infant, food-borne, Three major types: Infant, food-borne, and woundand wound

►Potential bio-weapon due to its potencyPotential bio-weapon due to its potency

Infant BotulismInfant Botulism►Most common formMost common form►2 per 100,000 live births in US2 per 100,000 live births in US►Afflicts babies from 1 week – Afflicts babies from 1 week –

1 year1 year►Antigenic variations types A/BAntigenic variations types A/B►Caused by: Caused by:

Ingesting contaminated foodstuffIngesting contaminated foodstuff Lack of breast milkLack of breast milk Untreated natural honey and corn syrupUntreated natural honey and corn syrup Household dust containing Household dust containing C. botulinum C. botulinum

sporesspores

Infant BotulismInfant BotulismSigns and SymptomsSigns and Symptoms

► Poor feeding (weak sucking)Poor feeding (weak sucking)► Weak gagWeak gag► Weak cryWeak cry► Decreased movement Decreased movement ► Appearing lethargic Appearing lethargic ► Flat, blunted facial expressionFlat, blunted facial expression► Trouble swallowing Trouble swallowing ► Excessive droolingExcessive drooling► Muscle weaknessMuscle weakness► Breathing problems Breathing problems ► Ptosis (Drooping eyelids) Ptosis (Drooping eyelids) ► Poor head control Poor head control ► Decreased anal sphincter tone Decreased anal sphincter tone ► Decreased deep tendon Decreased deep tendon

reflexesreflexes

Treatment and Treatment and RecoveryRecovery

► New drug: BabyBIG®, New drug: BabyBIG®, Botulism Immune Botulism Immune Globulin Intravenous Globulin Intravenous (Human) (BIG-IV) (Human) (BIG-IV)

► Drastically reduces Drastically reduces lethargy, IV feeding lethargy, IV feeding and overall hospital and overall hospital staystay

► With early detection, With early detection, proper treatment, no proper treatment, no long term effects long term effects observedobserved

Food-borne BotulismFood-borne Botulism►Second most common formSecond most common form►Caused by eating food containing Caused by eating food containing

the toxin produced by the toxin produced by C. botulinumC. botulinum ►Antigenic variations types A/EAntigenic variations types A/E►Non-commercially canned food is at a Non-commercially canned food is at a

higher risk for being contaminated higher risk for being contaminated ►Dangerous because most contaminated Dangerous because most contaminated

foods cannot be detected until too latefoods cannot be detected until too late

Food-borne BotulismFood-borne BotulismSigns and SymptomsSigns and Symptoms

► 12 – 36 hrs after12 – 36 hrs after► Muscle weakness,Muscle weakness,► DiarrheaDiarrhea► Blurred vision Blurred vision ► VomitingVomiting► Eventual ParalysisEventual Paralysis Treatment and Treatment and

RecoveryRecovery► Equine Botulinum Equine Botulinum

AntitoxinAntitoxin► Lingering symptoms are Lingering symptoms are

fatigue and respiratory fatigue and respiratory difficulty difficulty

► With early detection, With early detection, proper treatment, no long proper treatment, no long term effects observedterm effects observed

PreventionPrevention► Inspect canned food forInspect canned food for

Bulging Bulging Loose lidsLoose lids MoldMold OdorOdor

► Proper home canning Proper home canning procedures:procedures: Hygiene Hygiene Time schedule,Time schedule, Proper processing Proper processing

methodmethod EquipmentEquipment

► Avoiding home canning Avoiding home canning or cheaply produced or cheaply produced commercial foodcommercial food

Wound BotulismWound Botulism►Least common, but on the riseLeast common, but on the rise►Occurs when spores inoculate a wound Occurs when spores inoculate a wound

and anaerobic conditions allow and anaerobic conditions allow germination and subsequent production germination and subsequent production of the toxin of the toxin

►Associated with IV drug use (rise in black Associated with IV drug use (rise in black tar heroine use), and medical equipmenttar heroine use), and medical equipment

ex. catheters ex. catheters ►Often misdiagnosed as other Often misdiagnosed as other

neurological syndromesneurological syndromes

BioterrorismBioterrorism

► C. botulinumC. botulinum is one pathogenic microorganism is one pathogenic microorganism that has been researched and developed into a that has been researched and developed into a biological weapon.biological weapon.

►Many countries, and now terrorists, have Many countries, and now terrorists, have developed and used developed and used botulinumbotulinum toxin as a toxin as a biological weapon.biological weapon. From 1990 to 1995, aerosols were dispersed From 1990 to 1995, aerosols were dispersed

at multiple sites in downtown Tokyo and at US at multiple sites in downtown Tokyo and at US military installations in Japan on at least 3 military installations in Japan on at least 3 occasions by Japanese terrorists.occasions by Japanese terrorists.

In 1995, Iraq revealed that it had deployed In 1995, Iraq revealed that it had deployed more than 11,000 L of more than 11,000 L of botulinumbotulinum toxin into toxin into specially designed SCUD missiles.specially designed SCUD missiles.

BioterrorismBioterrorism

► Smallpox and anthrax may beSmallpox and anthrax may begetting the most attention, but getting the most attention, but bio-defense researchers have long been bio-defense researchers have long been concerned about concerned about botulinumbotulinum toxin, toxin, the deadliest the deadliest of all potential toxic threats gram for gramof all potential toxic threats gram for gram..

► A biological attack with the A biological attack with the botulinumbotulinum toxin toxin would more likely be dispersed in an would more likely be dispersed in an aerosolized form.aerosolized form.

► Currently, the US military possesses limited Currently, the US military possesses limited quantities of an investigational heptavalent quantities of an investigational heptavalent antitoxin, which might be available in the antitoxin, which might be available in the event of a terrorist attackevent of a terrorist attack

QUESTIONSQUESTIONS