DEPARTMENT OF MICROBIOLOGY

FACULTY OF MEDICAL SCIENCES

UNIVERSITY OF SRI JAYEWARDENEPURA

Botulism
Learning Outcomes:
⮚ Be able to describe, the microbial aetiology, microbiological and immunological basis of
pathogenesis, treatment and prevention of botulism

⮚ Appraise the value of specimens, microbiological investigations and communication with the
microbiology laboratory in patient management

● The term botulism is derived from the Latin word ‘botulus’ meaning sausage due to outbreaks that
occurred related to consumption of sausages and home canned food.
● It is due to intoxication with a potent neurotoxin of Clostridium botulinum.

Microbiological basis of pathogenesis

⮚ Source of infection
- Contaminated food

⮚ Causative organism
- Clostridium botulinum

Botulinum Toxin
Produced during the growth of C. botulinum.
Seven antigenic types of the toxin; A-G.
Types
One of the most highly toxic substances
known to man.
A possible bioterrorism weapon
Heat labile toxin; hence destroyed by boiling
A neurotoxin - blocks the release of acetylcholine
at synapses in neuromuscular junctions
Clinical uses of Botulinum toxin (based on anti-
cholinergic properties)
Spasmodic torticolis - treatment of
choice
Hemifacial spasms

Department of Microbiology, Faculty of Medical Sciences, USJ,

Updated at the handout consensus meeting, June 2020
 Clostridium botulinum

● Gram positive spore bearing bacillus

● Worldwide in distribution
● It is found in soil and occasionally in animal faeces
● Spores of the organism are highly resistant to heat - withstand boiling for 3-5 hrs
● Spores germinate under anaerobic conditions
● A very potent neurotoxin is produced during the germination of spores

Three clinical types of botulism can be seen

Food poisoning (not common) Infant botulism Wound botulism (very

(very rare) rare)
Source of infection Food contaminated with toxins ?Contaminated Wound contamination
(canned food) honey with soil
?Intestinal flora
Mode of Ingestion Ingestion Direct contact of wound
transmission
Incubation period 12-36 hours 12- 36 hours 10 days
Symptoms Develop usually between 12-36 hrs Floppy baby
after ingestion syndrome Neurological symptoms
similar to food poison
Early symptoms Constipation except for GIT symptoms
dry mouth, nausea, diarrhoea (GIT
symptoms are not prominent)

Later cranial nerve dysfunction

- visual disturbances,
- difficulty in swallowing and speech
Thereafter weakness spreads to the
upper limb, trunk

Bulbar paralysis,respiratory paralysis

/ cardiac arrest and death

Clinical manifestations are due to the potent exotoxin produced by the organism

Contamination of the food/wound with Clostridium botulinum spores

Under anaerobic conditions
Germination of spores

Growth of vegetative bacteria

Production of toxin

The toxin is ingested with food and absorbed into the blood stream primarily in the duodenum and jejunum

Department of Microbiology, Faculty of Medical Sciences, USJ,

Updated at the handout consensus meeting, June 2020
Prevent release of acetylcholine at peripheral cholinergic synapses and neuromuscular junctions (This is
irreversible)

Flaccid paralysis

● Immunity to botulinum toxin does not develop even with severe disease, and the repeated occurrence of
botulism has been reported

Diagnosis

* Mainly clinical
* History is helpful
* Ingestion of canned food/ vacuum packed food
* Other affected patients etc
* Toxin may be demonstrated in the lab (not routinely done) from patients’ serum, gastric
secretions, faeces or leftover food.
* C. botulinum may be grown anaerobically from food remains and testing for toxin production
not usually done

Treatment

● Supportive treatment
● Antitoxin - must be promptly administered

Prevention

● Proper food handling and preparation

● Cans may swell due to production of gas by the Clostridium botulinum (not always) – discard such
cans
● The risk is higher with home canned/ bottled food. This can be reduced by boiling the food for more
than 20 min before consumption.
● In the event of an outbreak, foods suspected of being contaminated should be refrigerated until
retrieval by public health personnel.
● A pentavalent toxoid is available as a vaccine.

Department of Microbiology, Faculty of Medical Sciences, USJ,

Updated at the handout consensus meeting, June 2020