Dangerous Botulism Toxin Plays Many Roles

Botulism toxin is a curious molecule. It is the most poisonous substance known and is responsible for many deadly cases of food poisoning. On the other hand, many people have the toxin regularly injected into themselves to banish wrinkles or ease chronic pain. Still others worry that the toxin could be used as a weapon of mass murder. Clearly, it is a molecule whose benevolence or malevolence is in the eye of the beholder. In between the advertisements for Botox injections, newspaper and magazine readers occasionally may come across stories about outbreaks of botulism food poisoning. In July, for example, the Centers for Disease Control and Prevention issued a health advisory about canned chili sauce. The chili was linked to three cases of botulism in Texas, three in Ohio and two in Indiana. No one died, but two months later, some of the patients are still recovering from the experience. Botulism is caused by the bacterium, Clostridium botulinum, which produces a potent nerve toxin. (It is related to another bacterium, Clostridium tetani, which produces another potent nerve toxin called tetanus.) C. botulinum is commonly found in soil and may contaminate fruits and vegetables growing in that soil. Improper home-canning techniques or faulty industrial canning of contaminated foods can allow the bacteria to grow and produce toxin. Sodium nitrite, sorbic acid, antioxidants, and other preservatives are added to canned and processed foods to inhibit the growth of C. botulinum. Eating foods contaminated with the toxin causes blurred vision, slurred speech, drooping eyelids, muscle weakness and difficulty in swallowing. These are symptoms of

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muscle paralysis. Untreated, the paralysis will spread to the respiratory muscles causing them to fail. Death will follow. Fortunately, the death rate from botulism has fallen to about five percent over the last half century. The decline in deaths is due to the widespread use of antitoxin, intensive medical care, and mechanical ventilators. There are actually seven different types of botulinum toxins (types A through G). Types A, B and E typically cause human illness and a trivalent antitoxin preparation has been designed to block these toxins from binding to nerves and causing paralysis. Even with quick access to antitoxin, botulism paralysis can last for weeks or months and patients will require constant and expensive medical care. There are about a 110 cases of botulism reported in the U.S. each year. A tiny percent are from wound infections. A quarter of the cases are food-related. The rest, about 72%, are from infant botulism. Some cases of infant botulism may be caused by honey that contains spores of C. botulinum. The spores germinate in the infant intestine and the growing bacteria produce toxin. Other cases of infant botulism may involve casual exposure to contaminated dirt and dust. In August, two infants near Fort Meade contracted botulism, probably from airborne dust. C. botulinum is a natural contaminant that sometimes gets into unnatural things like tin cans and sausage. (Botulism once was known as the “sausage poison.”) Because of its ability to paralyze and kill, public health and federal officials have worried that the toxin might be used as a weapon. Well, maybe, if you could find the money and the technology to produce enough pure toxin, and then find a way to deliver it to a large number of people.

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In 2005, two Stanford University professors suggested using milk. Their article on the possible contamination of a large milk production facility so upset the federal government that Health and Human Services officials tried to keep the article from being published. They failed, and the ensuing publicity guaranteed that everyone read the article. In the article, the two professors wrote, “Irreducible uncertainties regarding the dose-response curve prevent us from quantifying the minimum effective release.” That’s a fancy way of saying, “We don’t know if this would really work.” Still, in the age of 9/11 and anthrax, fantastic schemes do not seem so fantastic. The Fed is spending millions of dollars to study botulinum toxins and antidotes, and stockpiling ventilators (also useful during flu pandemics). The University of Massachusetts recently built a two-story Botulinum Research Center to conduct toxin research, which is funded by Homeland Security and the Department of Defense. It’s scary to think that someone might slip a deadly nerve toxin into food or milk supplies. It’s possible, but not everything that is possible is probable. Those of us who have the great misfortune to experience botulism will likely get it from bad food, not bad people.

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