PHAR1602 - Small Group Session

Toxins Botulinum toxin

Formative MCQ test (closed book):
Answer Code :
A : Answers 2 & 3 are correct
B : Answers 1 & 3 are correct
C : Answers 1 & 2 are correct
D : Answer 3 alone is correct
E : None of the answers is correct
1.
1)
2)
3)

Which of the following are forms of botulism:

respiratory botulism
wound botulism
infant botulism

2.
1)
2)
3)

Symptoms of botulism include:

rigid paralysis
a chancre on the skin
arching of the back

3.
1)
2)
3)

The botulinum toxin works by:

preventing the release of acetylcholine
binding to the motor end plate
preventing the release of glycine from vesicles

4.
1)
2)
3)

In the diagnosis of botulism:

PCR is used to confirm diagnosis before treatment is commenced
detection of Botulinum toxin is confirmed before treatment is commenced
clinical diagnosis is relied on in the first instance and confirmed via other
methods

5.
1)
2)
3)

Risk factors for botulism include:

home canned foods with a low acid content
washing chickens and turkeys in the sink before roasting
consumption of honey by infants under a year old

Question 1

List the forms of botulism?

Food-Borne Botulism, Human Botulism, Waterborne Botulism,
Wound Botulism, Infant Botilusm (World Health Organisation, 2015)

Question 2

What is the name of the organism that produces botulinum toxin

and where is it found in nature?
Clostridium Botulinium (anaerobic gram positive bacillus that forms
spores) under low-oxygen conditions, (Critchley EMR, Mitchell JD.
Human botulism. BrJ Hosp Med 1990;43:290-2.).
Soil: Type A and B toxins.
Oceans and Lakes: type E Toxin

Question 3

What do you know about this organism in terms of its physiology

and growth requirements?

Temperature range: 3-48C (38-118F)

Type A and B: 10-50C (50-122F)
Type E: 3-45C (38-113F)
Optimum Temperature for toxin development: 35C (95F)
pH range: 4.6 - 8.9
Lowest reported Aw for growth: 0.95

Question 4 How is botulism diagnosed and what other conditions might need to
be excluded?

Question 5
are there?

What type of toxin is botulinum toxin and what forms of the toxin

Question 6

Explain how botulinum toxin acts with aid of a diagram.

Action of botulinum toxin at cholinergic nerve

terminals. The heavy (H) chain of the toxin binds
selectively and irreversibly to high affinity receptors
at the presynaptic surface of cholinergic neurones,
and the toxin-receptor complex is taken up into the
cell by endocytosis. The disulphide bond between the
two chains is cleaved (by an unknown mechanism),
and the toxin escapes into the cytoplasm. The light
(L) chains of the seven serotypes interact with
different proteins (synaptosomal associated protein
(SNAP) 25, vesicle associated membrane protein
(VAMP) and syntaxin) in the nerve terminals to prevent fusion of acetylcholine
vesicles with the cell membrane and thereby impede its release. (Adapted from
Moore,6 with permission)

Question 7 A patient comes to you and says they have read about an outbreak
of botulism associated with curry sauce. They are worried they may be at risk.
You know there has recently been a small outbreak associated with a particular
brand x of korma curry sauce.
A) Think about the questions you might want to ask the patient?

B) Explain to the patient how the different forms of botulism are acquired?

C) What symptoms should the patient look out for if they are still concerned
and how long after consumption to the symptoms appear?

D) What would you say to that patient about the risk of contracting botulism
in the UK?

E)

How can botulism be treated?

F) What are the outcomes for a patient after botulism and what
complications can occur?

Question 8 A patient comes to see you to collect a prescription and

mentions that husband has been having botox treatment for their facial
spasms. They want to know your opinion about the safety of this potential
treatment as they have heard that it is a toxin that can cause illness.
Think about how you would answer a question like this:

Question 9 Outbreaks of botulism have been reported in the UK, what is

the main risk factor for this:

Question 10 What is the main risk factor for infant botulism and what
advice would you give to parents to prevent this:

Question 11 How might the symptoms of an infant with botulism differ

from an adult:

Question 12 Student directed learning

Write brief notes about the outbreak of botulism in 1989 associated with
hazelnut yoghurt. Discuss how this could have been avoided: