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Botulism: Causes, Prevention, and Treatment of Foodborne, Wound, and Infant Botulism, Lab Reports of Organic Chemistry

Ateneo de Manila University (ADMU)Organic Chemistry

Botulism is a potentially fatal neurotoxic disease caused by the ingestion of botulinum toxins, which can be found in contaminated foods such as home-canned vegetables, cured pork and ham, raw or smoked fish, honey, and corn syrup. the sources, diagnosis, prevention, and treatment of foodborne, wound, and infant botulism. It also provides information on the epidemiology, differential diagnosis, and complications of botulism, as well as the importance of good food hygiene and the WHO's 'Five keys to safer food'.

Typology: Lab Reports

2021/2022

Uploaded on 11/15/2022

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FINDINGS
BOTULISM
Foodborne botulism is a serious, potentially fatal disease. However, it is relatively rare. It is an
intoxication usually caused by ingestion of potent neurotoxins, the botulinum toxins, formed in
contaminated foods. Person to person transmission of botulism does not occur. Botulinum toxins are
neurotoxic and therefore affect the nervous system. Foodborne botulism is characterized by descending,
flaccid paralysis that can cause respiratory failure. The botulinum toxin has been found in a variety of
foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets;
fish, including canned tuna, fermented, salted and smoked fish; and meat products, such as ham and
sausage. The food implicated differs between countries and reflects local eating habits and food
preservation procedures. Occasionally, commercially prepared foods are involved.
SYMPTOMS
The Symptoms are not caused by the bacterium itself, but by the toxin produced by the bacterium.
Symptoms usually appear within 12 to 36 hours (within a minimum and maximum range of 4 hours to 8
days) after exposure. Incidence of botulism is low, but the mortality rate is high if prompt diagnosis and
appropriate, immediate treatment (early administration of antitoxin and intensive respiratory care) are
not given. Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred
vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhea, constipation and
abdominal swelling may also occur. The disease can progress to weakness in the neck and arms, after
which the respiratory muscles and muscles of the lower body are affected. There is no fever and no loss
of consciousness.
SOURCES OF BOTULISM
The most commonly tainted foods are:
• home-canned vegetables
• cured pork and ham
• raw or smoked fish
• honey
• corn syrup
For example, Home-canned foods and fermented fish and aquatic game from Alaska can be sources of
the toxin. Botulism does not grow in acidic foods with a pH of 4.5 or less.
MORTALITY RATE
The disease can be fatal in 5 to 10% of cases. The development of antitoxin and modern medical care
means that people with botulism have a much lower chance of dying than in the past, when about 50 in
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FINDINGS

BOTULISM

Foodborne botulism is a serious, potentially fatal disease. However, it is relatively rare. It is an intoxication usually caused by ingestion of potent neurotoxins, the botulinum toxins, formed in contaminated foods. Person to person transmission of botulism does not occur. Botulinum toxins are neurotoxic and therefore affect the nervous system. Foodborne botulism is characterized by descending, flaccid paralysis that can cause respiratory failure. The botulinum toxin has been found in a variety of foods, including low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products, such as ham and sausage. The food implicated differs between countries and reflects local eating habits and food preservation procedures. Occasionally, commercially prepared foods are involved. SYMPTOMS The Symptoms are not caused by the bacterium itself, but by the toxin produced by the bacterium. Symptoms usually appear within 12 to 36 hours (within a minimum and maximum range of 4 hours to 8 days) after exposure. Incidence of botulism is low, but the mortality rate is high if prompt diagnosis and appropriate, immediate treatment (early administration of antitoxin and intensive respiratory care) are not given. Early symptoms include marked fatigue, weakness and vertigo, usually followed by blurred vision, dry mouth and difficulty in swallowing and speaking. Vomiting, diarrhea, constipation and abdominal swelling may also occur. The disease can progress to weakness in the neck and arms, after which the respiratory muscles and muscles of the lower body are affected. There is no fever and no loss of consciousness. SOURCES OF BOTULISM The most commonly tainted foods are:

  • home-canned vegetables
  • cured pork and ham
  • raw or smoked fish
  • honey
  • corn syrup For example, Home-canned foods and fermented fish and aquatic game from Alaska can be sources of the toxin. Botulism does not grow in acidic foods with a pH of 4.5 or less. MORTALITY RATE The disease can be fatal in 5 to 10% of cases. The development of antitoxin and modern medical care means that people with botulism have a much lower chance of dying than in the past, when about 50 in

every 100 people with botulism died. Today, fewer than 5 of every 100 people with botulism die. Even with antitoxin and intensive medical and nursing care, some people with botulism die from respiratory failure. Others die from infections or other problems caused by being paralyzed for weeks or months. EPIDEMIOLOGY Since 1973, the Centers for Disease Control and Prevention (CDC) has maintained the National Botulism Surveillance System to monitor cases of botulism in the United States. In the 5 years from 2011 through 2015, an average of 162 annual cases of botulism was reported. The respective proportions of each botulism type ranged from 71% to 88% for infant botulism, 1% to 20% for foodborne botulism, 5%-10% for wound botulism, and 1% to 4% for botulism of other or unknown origin. With the exception of rare, large outbreaks (i.e., an outbreak of foodborne botulism in Ohio in April 2015 accounted for 27 cases alone), the total number of botulism cases and relative proportions of each subtype have remained relatively stable over the past 10 years. There have been no reported cases of botulism due to bioterrorism in the United States, and only one reported case of iatrogenic botulism, which resulted from the use of an unlicensed, highly concentrated form of BoNT. DIAGNOSIS Diagnosis is usually based on clinical history and clinical examination followed by laboratory confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or a culture of C. botulinum from stool, wound or food. Doctors treat botulism with a drug called an antitoxin, which prevents the toxin from causing any more harm. Antitoxin does not heal the damage the toxin has already done. Depending on how severe your symptoms are, you may need to stay in the hospital for weeks or even months before you are well enough to go home. According to the synopsis of the case, the history of food intake of the patient was home-canned vegetables which can cause foodborne botulism toxins that can be found on low-acid preserved vegetables, such as green beans, spinach, mushrooms, and beets; fish, including canned tuna, fermented, salted and smoked fish; and meat products, such as ham and sausage. Differential diagnosis and complications are the following:

  • Basilar artery stroke
  • Diphtheria
  • Encephalitis
  • Familial Mediterranean fever
  • Hypermagnesemia
  • Hyperthyroidism and thyrotoxicosis
  • Neurasthenia
  • Poliomyelitis
  • Tick paralysis
  • The cerebrovascular disease of the brainstem
  • Nosocomial infections
  • UTI
  • Thrombophlebitis
  • Deep vein thrombosis
  • Pressure sores
  • Contractures
  • Failure to thrive
  • Boil home-processed foods for at least 10 minutes before eating, even if no signs of food spoilage are evident
  • Do not taste canned food items to see if they are still good. Throw away any cans that are bulging, leaking, or appear damaged
  • Keep potatoes that have been baked in foil hot until eaten
  • Not give honey or corn syrup to infants under 12 months of age.
  • Ensure all foods are well-cooked
  • Keep oils infused with garlic or herbs in a refrigerator Boiling can destroy both the vegetative, or non-spore, form of the bacterium, and the toxin it produces.However, while boiling for 10 minutes can kill the toxin, to destroy the spore form requires heating to at least 248 degrees Fahrenheit, or 120 degrees Celsius, under pressure, for at least 30 minutes in an autoclave or a pressure cooker. This is because the spores are highly resistant to harsh environments, and they can remain viable even after several hours of normal boiling. The spores can be killed by very high temperatures such as those used in commercial canning. The World Health Organization’s (WHO) “Five keys to safer food” the importance of:
  • keeping clean
  • separating raw and cooked food
  • cooking thoroughly
  • keeping food at safe temperatures
  • using safe water and raw materials This is important when people are traveling, especially to countries where access to clean water, hygiene, and refrigeration facilities may be limited. Botulism cannot always be prevented. The toxin may be presented in house dust, even after cleaning. Parents should be aware of any signs that a child is sick, and take early action as appropriate. TREATMENT Patients with botulism will need to be hospitalized. Infants will be given Botulism Immune Globulin Intravenous-Human, also known as BIG-V or BabyBIG. Those with respiratory problems will be on a ventilator, and they may need the ventilator for weeks or months, as well as intensive nursing. Over time, the paralysis may improve. A patient with suspected botulism will immediately be given injections of antitoxins, even before diagnostic test results have returned. If the infection results from a wound, the wound needs to be treated surgically. The area around the wound is removed, in a process known as debridement. Antibiotics may also be prescribed to prevent any secondary infection. As botulism is diagnosed, the physician should contact the Center very away. If your suspicions are high and your symptoms are getting worse, you should get antitoxin as away. One vial is the recommended dose for adults. Poison Control should be consulted when determining the dose for newborns, children,

and adolescents. Frequent clinical evaluations of ventilation, perfusion, and upper airway integrity, as well as continuous pulse oximetry, spirometry, and arterial blood gas measurement, should all be part of close monitoring. If a patient's upper airway is compromised or their vital capacity is less than 30% of what it should be, intubation should be explored. Following antitoxin treatment, excision and antibiotic therapy are recommended for wound botulism. For penicillin-allergic patients, appropriate regimens include three million units of Penicillin G intravenously (IV) every four hours or metronidazole 500 mg every eight hours. Aminoglycosides are generally prohibited since they have been demonstrated to increase botulism-induced neuromuscular inhibition. Because of the possibility of BoNT release during cell lysis, antibiotics should not be utilized in newborn botulism. In cases of severe organ dysfunction, whole parenteral feeding is used, while in cases of foodborne botulism without severe ileus, whole bowel irrigation is used. Other measures

  • Aggressive supportive care in an ICU setting
  • Monitor airway as respiratory failure is common
  • Monitor vitals, oxygenation, and arterial blood gases
  • Intubation if there is the slightest hint of respiratory distress
  • Some patients require tracheostomy to manage secretions
  • Do not administer magnesium salts as they can potentiate the neuromuscular block
  • Insert Foley and provide stress ulcer prophylaxis VACCINES An investigational pentavalent botulinum toxoid is available for persons at elevated risk for BoNT exposure, such as laboratory workers and military personnel. No FDA-approved vaccine exists for the general public. The pentavalent toxoid is not being considered for public use due to cost, the number of required vaccinations, and the recent decline in immunogenicity.