Botulism

Sabari Krishnan B. B.
RA1711014010088
 Lesson Plan
● Introduction

● Pathogenesis

● Diagnosis

● Treatment and Management

2
 What is Botulism?
● A paralytic disease caused by the potent neurotoxins produced by the bacteria Clostridium botulinum.

● Botulism is characterized by symmetrical, descending, flaccid paralysis of motor and autonomic nerves,
usually beginning with cranial nerves.

3
 Clostridium botulinum
● C. botulinum is an anaerobic Gram positive bacteria that form spores.

● They are found in almost all soil and marine environments.

● The spores are highly resistant to heat, light and other radiations. It can even
survive boiling for several hours at 100 oC! These spores germinate at
optimum conditions: anaerobic environment, warmth (10-50 oC), and mild
alkalinity.

● These bacteria produce the most potent toxin known: Botulinum toxin - a
dose of ~1 ng/kg body weight (LD50) can kill a human!
4
 Botulinum Toxins
● Botulinum toxins are synthesized as single polypeptide chains which has low potency. Later, this
polyprotein is cleaved by bacterial, gastric or endosomal proteases into a light chain and a heavy chain.
The light chain pronounces the toxicity of the neurotoxin.

● There are 8 different types of neurotoxins (exotoxins) produced by C. botulinum: Neurotoxins A-H

● Each type has different target organisms. Humans: mainly types A, B, E, F, and H.

● These toxins bind to the neuromuscular junctions and cause flaccid paralysis.

● However, all toxins can be inactivated by boiling: 100 oC for 15 minutes.

5
 Botulinum Toxins
Target Organism Botulinum Toxin Type

Humans A, B, E, F, and H
A, B, and E: particularly food-borne illness
E: particularly fish product-associated
illness

Birds C (causes avian limber-neck)

6
Other mammals mainly D
 How do you get Botulism?
● By ingestion of C. botulinum-contaminated food (bacteria, spores or toxin).

● By contamination of any wound by C. botulinum.

● By inhalation of spores!

7
 Types of Botulism
● Food-borne botulism: caused by consuming food contaminated by botulinum toxin.
Incubation period: 18-36 h. Particularly low-acid foods. Signs and symptoms: nausea,
diarrhea, diplopia, dysarthria, dysphonia, dysphagia, symmetrical flaccid paralysis,
respiratory muscle paralysis, but no fever. Incidence: 24 cases/year

● Intestinal botulism: mainly observed in infants and children. Caused by ingesting C.

botulinum spores which later germinate in the intestines and produce toxins. One of the
causes of sudden death in infants. Incidence: 71 cases/year; 20% from corn syrup or
honey.

● Wound botulism: C. botulinum spores can germinate on open wounds, then produce toxin!
8
9
 Pathogenesis

10
 Pathogenesis

11
 How is Botulism diagnosed?
● Mainly by clinical examination for symmetrical descending paralysis with proper mental intactness and
no fever.

● Biochemical and immunological assays to identify the presence of exotoxins in serum, stool, gastric
aspirate and suspected food: ELISA, Electrochemiluminescent (ECL) test. Culture of stool and gastric
aspirate take 5-7 days.

● Electromyography (EMG): to evaluate the electrical activity of skeletal muscles.

● Mouse neutralization antibody test. Results within 48 h.

12
 Differential Diagnosis of Botulism
● Guillain-Barré syndrome: rare, but serious autoimmune disorder of PNS.

● Lambert-Eaton syndrome: autoimmune disorder of the neuromuscular junctions.

● Myasthenia gravis: autoimmune disorder which cause progressive skeletal muscle weakness.

● Poliomyelitis (Polio): an irreversible paralysis caused by Poliovirus infection.

● Other disorders such as stroke, tick paralysis, psychiatric illnesses, diabetic complications, drug
intoxication, CNS infection by HSV, overexertion, etc.

13
 Treatment and Management
● Immediate intensive care is required for all age groups if suspected to have botulism. Ventilator to
prevent respiratory failure.

● Metronidazole, Penicillin, passive immunization with horse-derived antitoxin.

● Botulism vaccines are available for toxin types A, B, C, D and E.

● However, 9% of patients show hypersensitivity to equine-derived antitoxins.

● Prevention is better than cure… Avoid canned foods, or boil before consumption. Always keep raw fish
and meat away from cooked food in refrigerator to prevent cross-contamination.

14
 Summary

15
 Any
Thank you! Questions?

16