Botulism disease symptoms appear by the action of clostridium botulinum. Prolonging Botulism treatment may lead to paralysis.

Botulism

Recognizing signs of botulism in canned food is crucial for your safety. Watch out for common indicators such as bulging cans, foul odor, and unusual texture. Stay informed and protect yourself from potential health risks associated with contaminated canned goods.

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

Overview

<p dir="ltr">Botulism or botulism poisoning is a rare illness. However, it is extremely serious and transmits through food, open wounds, and contaminated soil. If not treated early, botulism can cause breathing difficulties, paralysis, and death<br />
There are three main types of botulism, which include:</p>

<ul>
	<li>Infant botulism</li>
	<li>Food borne botulism</li>
	<li>Wound botulism</li>
</ul>

<p dir="ltr">The bacteria Clostridium botulinum produces a toxin, which causes botulism poisoning. Although it is very common, these bacteria are anaerobic and do not require oxygen to grow. Therefore, they can thrive in any condition. Some foods provide a potent breeding ground, for example, canned foods.</p>

<p>According to the Centre of Disease Control (CDC), around 145 cases of botulism are reported in the United States annually. Moreover, 3 to 5 percent of these cases die of botulism poisoning<sup><a href="#accordion">[1]</a></sup>.<br />
&nbsp;</p>

Signs And Symptoms

<h5><strong>Early Signs Of Botulism</strong><br />
&nbsp;</h5>

<ul>
	<li>Difficulty eating</li>
	<li>Irritability</li>
	<li>Tiredness</li>
	<li><a href="https://merisehat.pk/disease/constipation">Constipation</a></li>
	<li>Weak cry</li>
	<li>Drooping eyelids</li>
	<li>Drooling</li>
	<li>Muscle weakness that causes loss of head control and floppy movement</li>
	<li>Paralysis<br />
	&nbsp;</li>
</ul>

<h5><strong>Signs Of Food-Borne Or Wound Botulism&nbsp;</strong></h5>

<ul>
	<li>Dysphagia and difficulty speaking</li>
	<li>Facial weakness on both sides</li>
	<li>Trouble breathing</li>
	<li>Drooping eyelids</li>
	<li>Blurred vision</li>
	<li>Nausea, vomiting, abdominal cramps (only in food-borne botulism)</li>
	<li>Paralysis</li>
</ul>

<h5>&nbsp;</h5>

<h5><strong>Infant Botulism</strong></h5>

<p>The signs and symptoms of infant botulism include the following:</p>

<ul>
	<li>Poor feeding</li>
	<li>Constipation&nbsp;</li>
	<li>Bad temper</li>
	<li>Sagging of the eyelids</li>
	<li>Excessive drooling</li>
	<li>Flat facial expression</li>
	<li>Lethargy</li>
	<li>Breathing difficulties</li>
	<li>Improper or slow reflexes&nbsp;</li>
	<li>Weak and faint crying</li>
	<li>Poor or flopping muscle tone</li>
	<li>Absence of gag reflex</li>
	<li>Inability to focus with the eyes</li>
	<li>Weak sucking</li>
</ul>

<p dir="ltr">The symptoms of botulism are dependent on the type.&nbsp;<br />
&nbsp;</p>

<h5><strong>Foodborne Botulism</strong></h5>

<p>If the botulism is foodborne, the signs and symptoms are nausea, diarrhea, and vomiting. It is followed by constipation and distention of the abdomen. Furthermore, the patient may also feel lethargic and have breathing difficulties. The symptoms usually appear between eighteen to thirty-six hours after the contaminated food has been consumed. However, it may vary between three hours to eight days.<br />
&nbsp;</p>

<h5><strong>Wound Botulism</strong></h5>

<p dir="ltr">The first symptoms are experienced in the cranial nerves, which are the nerves that connect the brain to the spine, in wound botulism. After this, it spreads to the rest of the body, and the incubation period is between two days to two weeks.<br />
&nbsp;</p>

<h5><strong>Neurological Signs And Symptoms</strong></h5>

<p dir="ltr">The neurological signs and symptoms of adult botulism, food-borne botulism, and wound botulism are the same. However, the symptoms of wound botulism take longer to appear.</p>

<p dir="ltr">Blurred vision, double vision, and drooping of the eyelids are also common symptoms. Moreover, patients also experience facial weakness, xerostomia (dry mouth), dysphagia, and slurred speech. The muscles also become weak.<br />
&nbsp;</p>

<p dir="ltr">After the symptoms, paralysis sets in and, without treatment, the patient&rsquo;s breathing muscles become paralyzed eventually. It results in respiratory failure and death. Although, the patient remains conscious during the entire process.<br />
&nbsp;</p>

Causes

<p dir="ltr">The poison produced by Clostridium botulinum is present in the soil and exists in untreated water. It survives in this environment as a resistant spore.&nbsp;The spores that are produced can survive in canned food or food that hasn&rsquo;t been preserved following proper standards. The toxins are produced here, and when they are consumed even in small amounts, they can cause severe poisoning.&nbsp;</p>

<p dir="ltr">The several types of botulism are:</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Food-Borne Botulism</strong></h5>

<p dir="ltr">It is caused by consuming processed and canned foods.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Wound Botulism</strong></h5>

<p dir="ltr">It can occur when the organism enters an open wound, producing toxins within that wound. Injection drug users are at a greater risk of wound botulism.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Infant Botulism</strong></h5>

<p dir="ltr">When an infant consumes the bacteria or the spores of the bacteria, they grow in the gut. In the US, infant botulism is mostly from eating corn syrup and honey. Moreover, the bacteria can also occur naturally in the stool of an infant.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Iatrogenic Botulism</strong></h5>

<p dir="ltr">People who overdose on botulism toxin or botox can develop iatrogenic botulism. It happens due to the therapeutic administration of botox<sup><a href="#accordion">[2]</a></sup>.</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Adult Intestinal&nbsp;</strong><strong>Colonization</strong></h5>

<p>This is a very rare kind of botulism, and it occurs when C. botulinum colonizes the digestive tract of adults.<br />
&nbsp;</p>

Diagnosis

<p dir="ltr">The physicians usually start with a physical exam. They look for signs of botulism, for example, muscle weakness, drooping eyelids, and faint voices. Moreover, in the case of babies, they ask about what foods they have eaten.</p>

<p dir="ltr">Lab tests are done through either a blood sample or stool sample for confirmation. Other tests may also be required.</p>

<p dir="ltr">It is recommended that if you have leftovers of the food you&rsquo;ve eaten, you bring it to the hospital for testing.&nbsp;</p>

<p dir="ltr">The lab tests take a couple of days and your doctor&rsquo;s priority is usually to rule out all possible conditions. The symptoms of botulism are like that of a <a href="https://merisehat.pk/disease/stroke">stroke</a> and<a href="https://merisehat.pk/disease/guillain-barre-syndrome-108"> Guillain Barre syndrome</a>. The immune system attacks your nerves in both diseases and botulism, causing paralysis.</p>

<p dir="ltr">Other tests that are used to diagnose botulism are the following:</p>

<p dir="ltr">&nbsp;</p>

<h5><strong>Brain Scan</strong></h5>

<p dir="ltr">CT scan or MRI of the brain helps in ruling out other reasons for the symptoms, for example, stroke.</p>

<h5><strong>Spinal Tap</strong></h5>

<p dir="ltr">An exam of the CSF can show increased levels of protein. However, the CSF study is essentially normal in people who have botulism.</p>

<h5><strong>Nerve And Muscle Function Test</strong></h5>

<p dir="ltr">The diagnosis of botulism can be confirmed with electromyography.</p>

<h5><strong>Tensilon Test</strong></h5>

<p dir="ltr">Tensilon test rules out myasthenia gravis. It causes similar symptoms, and tests for these conditions are done during the lab tests.</p>

<p dir="ltr">&nbsp;</p>

Treatment

<p dir="ltr">Several treatments are tried for botulism depending on the case. They include the following:&nbsp;</p>

<p>&nbsp;</p>

<h5><strong>Antitoxins</strong></h5>

<p dir="ltr">Antitoxin medication is the main treatment for botulism. It interferes with the toxins in the bloodstream, and may also stop the symptoms from worsening.</p>

<h5><strong>Antibiotics</strong></h5>

<p dir="ltr">Antibiotics work in case of wound botulism. However, these bacteria-killing medications are not suitable for other types of botulism.</p>

<h5><strong>Breathing Aid</strong></h5>

<p dir="ltr">A breathing aid is beneficial for people whose breathing has been severely compromised due to botulism. The machine aids in breathing. However, if the illness is severe, a mechanical ventilation machine may also be required.<br />
&nbsp;</p>

<p dir="ltr">The CDC has reported sixty-five percent cases of botulism in infants and children under the age of one year<sup><a href="#accordion">[3]</a></sup>. Infant botulism is mostly because of exposure to soil that is contaminated, or by eating foods with botulism spores. Corn syrup and honey are the two main examples of contaminated foods. The spores grow in the intestinal tracts of infants, releasing the toxin. Furthermore, adults and older children have a natural defence mechanism to fight against the bacteria from growing.</p>

<p dir="ltr">According to CDC, fifteen percent of the cases of botulism are because by contaminated food, which means they are food-borne<sup><a href="#accordion">[4]</a></sup>. It can be either due to commercially canned food or food that is canned at home. The WHO has reported that botulism toxin is found in preserved vegetables, canned tuna fish, fermented or smoked fish, and meat products like sausages.</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">Twenty percent of the cases are of wound botulism, where the spores enter the wounds<sup><a href="#accordion">[5]</a></sup>. Moreover, CDC claims that the cases have risen because of drug use. In addition, spores are commonly present in heroin and cocaine.</p>

<p dir="ltr">Botulism cannot be transferred from one person to another. The toxins must be consumed through food, or enter through wounds, to cause symptoms of botulism poisoning.<br />
&nbsp;</p>

<p dir="ltr">When you make food at home, make sure all the containers and utensils that are being used are clean. Clean the food and store it carefully to prevent tainting it before canning.</p>

<p dir="ltr">High temperatures kill botulism toxins and if you are eating canned food at home, boil it for ten minutes to kill the bacteria. In addition, proper refrigeration can also help prevent the growth of C. botulinum.</p>

<p dir="ltr">&nbsp;</p>

<p dir="ltr">Following are the signs of food that have botulism:<br />
&nbsp;</p>

<ul>
	<li>There is a bulge in the can</li>
	<li>Foam or liquid spurts out from the container when it is opened</li>
	<li>Foul-smelling contents</li>
</ul>

<p dir="ltr">If you ever see a container that has a bulge in it, avoid opening it and throw it immediately. Moreover, if the food smells bad, don&rsquo;t even taste it.</p>

<p dir="ltr">Other things that people should keep in mind are:<br />
&nbsp;</p>

<ul>
	<li>Keep oils that are infused with garlic and herbs in the refrigerator.</li>
	<li>If potatoes are wrapped in foil, they are prone to botulism toxins thriving in them. Always make sure your potatoes are hot or keep them in the fridge after opening.</li>
	<li>Boiling the foods for at least five minutes can destroy the botulism toxin.</li>
	<li>Avoid giving honey and corn syrup to babies under the age of one year.</li>
	<li>Drug addicts should never share needles, especially black tar heroin. A doctor should be able to help you with your addiction.<br />
	&nbsp;</li>
</ul>

Key Points

<ul>
	<li>Clostridium botulinum bacterium produces botulinum toxins that grow in the absence of oxygen or in low-oxygen conditions.</li>
	<li>The toxin blocks the functions of the nerves, leading to muscle paralysis and breathing difficulties.</li>
	<li>Botulism toxin is known to be fatal.</li>
	<li>The types of botulism found in humans are food-borne, wound botulism, infant botulism, and inhalation botulism.</li>
	<li>The most common source of foodborne botulism is canned food and fermented foods.</li>
	<li>Botulism is a notification priority disease in Pakistan, and any presenting cases should be reported to the authorities immediately.<br />
	&nbsp;</li>
</ul>

[1] Jeffery, I.A. and Karim, S., 2021. Botulism. StatPearls.

[2] Coban, A., Matur, Z., Hanagasi, H.A. and Parman, Y., 2010. Iatrogenic botulism after botulinum toxin type A injections. Clinical neuropharmacology, 33(3), pp.158-160.

[3] Van Horn, N.L. and Street, M., 2018. Infantile botulism.

[4] Lúquez, C., Edwards, L., Griffin, C. and Sobel, J., 2021. Foodborne Botulism Outbreaks in the United States, 2001–2017. Frontiers in Microbiology, p.1982.

[5] Kiyokawa, M. and Haning, H., 2021. A Case Report of Wound Botulism—Rare Disease on the Rise with the Opioid Crisis. Hawai'i Journal of Health & Social Welfare, 80(4), p.88.