BOTULISM

Botulism is an illness produced by a toxin that is released by the soil bacterium Clostridium botulinum. One type of toxin is also produced by Clostridium baratii. The toxins affect nerves and can produce paralysis. The paralysis can affect the functioning of organs and tissues that are vital to life.

There are three main kinds of botulism. The first is conveyed by food containing the botulism toxin. Contaminated food can produce the illness after being ingested. Growth of the bacteria in the food may occur, but is not necessary for botulism. Just the presence of the toxin is sufficient. Thus, this form of botulism is a food intoxication (as compared with food poisoning, where bacterial growth is necessary). The second way that botulism can be produced is via infection of an open wound with Clostridium botulinum. Growth of the bacteria in the wound leads to the production of the toxin, which can diffuse into the bloodstream. The wound mode of toxin entry is commonly found in intravenous drug abusers. Finally, botulism can occur in young children following the consumption of the organism, typically when hands dirty from outdoor play are put into the mouth.

The latter means of acquiring botulism involves the form of the bacterium known as a spore. A spore is a biologically dormant but environmentally resilient casing around the bacterium's genetic material. The spore form allows the organism to survive through prolonged periods of inhospitable conditions. When conditions improve, such as when a spore in soil is ingested, resuscitation, growth of the bacterium, and toxin production can resume. For example, foodborne botulism is associated with canned foods where the food was not heated sufficiently prior to canning to kill the spores.

Botulism is relatively rare. In the United States, just over 100 cases are reported each year, on average. The number of cases of foodborne and infant botulism has not changed appreciably through the 1990s to the present day. Foodborne cases have tended to involve the improper preparation of home-canned foods.

There are seven known types of botulism toxin, based on their antigenic make-up. These are designated toxins A through G. Of these, only types A, B, E, and F typically cause botulism in humans, although involvement of type C toxin in infants has been reported, and may be particularly associated with the consumption of contaminated honey.

Infant botulism caused by toxin type C may be different from the other types of botulism in that the toxin is produced in the person following the ingestion of living Clostridium botulinum.

The toxins share similarities in their gross structure and in their mechanism of action. The toxins act by binding to the region of nerve cells that is involved in the release of a chemical known as a neurotransmitter. Neurotransmitters travel across the gap (synapse) separating neurons (nerve cells) and are essential to the continued propagation of a neural impulse. Accordingly, they are vital in maintaining the flow of a transmitted signal from nerve to nerve. Blocking nerve transmissions inhibits the means by which the body can initiate the movement of muscles. The result is paralysis. This paralysis produces a variety of symptoms including double or blurred vision, drooping eyelids, slurred speech, difficulties in swallowing, muscle weakness, paralysis of limbs and respiratory muscles.

The appearance of the symptoms of botulism vary depending on the route of toxin entry. For example, ingestion of toxin-contaminated food usually leads to symptoms within two to three days. However, symptoms can appear sooner or later depending on whether the quantity of toxin ingested is low or high.

The diagnosis of botulism and so the start of the appropriate therapy can be delayed, due to the relative infrequency of the malady and its similarity (in the early stages) with other maladies, such as Guillain-Barré syndrome and stroke. Diagnosis can involve the detection of toxin in the patient's serum, isolation of living bacteria from the feces, or by the ability of the patient's sample to produce botulism when introduced into test animals.

Clostridium botulinum requires an oxygen-free atmosphere to grow. Growth of the bacteria is associated with the production of gas. Thus, canned foods can display a bulging lid, due to the build-up of internal pressure. Recognition of this phenomenon and discarding of the unopened can is always a safe preventative measure.

Studies conducted by United States health authorities have shown that the different forms of the botulism toxin display some differences in their symptomatology and geographic distribution. Type A associated botulism is most prevalent in the western regions of the US, particularly in the Rocky Mountains. This toxin produces the most severe and long-lasting paralysis. Type B toxin is more common in the eastern regions of the country, especially in the Allegheny mountain range. The paralysis produced by type B toxin is less severe than with type A toxin. Type E botulism toxin is found more in the sediments of fresh water bodies, such as the Great Lakes. Finally, type F is distinctive as it is produced by Clostridium baratii.

Treatment for botulism often involves the administration of an antitoxin, which acts to block the binding of the toxin to the nerve cells. With time, paralysis fades. However, recovery can take a long time. If botulism is suspected soon after exposure to the bacteria, the stomach contents can be pumped out to remove the toxic bacteria, or the wound can be cleaned and disinfected. In cases of respiratory involvement, the patient may need mechanical assistance with breathing until lung function is restored. These measures have reduced the death rate from botulism to 8% from 50% over the past half century.

As dangerous as botulinum toxin is when ingested or when present in the bloodstream, the use of the toxin has been a boon to those seeking non-surgical removal of wrinkles. Intramuscular injection of the so-called "Botox" relaxes muscles and so relieves wrinkles. Thus far, no ill effects of the cosmetic enhancement have appeared. As well, Botox may offer relief to those suffering from the spastic muscle contractions that are a hallmark of cerebral palsy.