BOTULISM: A REVIEW STUDY

Roll No: 213224-11-0023 Registration No:224-1211-0464-21

Paper Name:Food Safety & Quality Control Paper Code:DSE-B1
 Understanding Botulism
 Botulism is potential fatal condition caused by toxins of Clostridium
botulinum; an aerobic, Gram-positive & spore forming bacteria.
 Various forms of this illness are such as food-borne botulism,
wound botulism, infant botulism, inhalation botulism.[1]
 Botulism toxin (BoNT), the most potent neurotoxins, can cause
paralysis by blocking presynaptic release of neurotransmitter (ACh)
at the neuromuscular junction.[2]
 Consuming contaminated food result in muscle weakness, blurred
vision, slurred speech, respiratory failure & muscular atrophy within
12-36hrs (range of 5hrs- 4days max).
 BoNT is heat sensitive & can be destroyed by boiling food (at 80°C
for 30mins) whereas the spore is heat resistant can not grow under
acidic condition (pH<4.6) but low pH can not degrade preformed
Botulism
 Types of Botulism
 Food-borne
botulism is the most
common in
improperly
preserved or canned
foods.
 Wound botulism
occurs when wound
is contaminated
with spores
 Infant can acquire
botulism by
ingesting spores
that colonize their
intestines and
produce toxins[4]
 Brief History
 Botulism was first recognized and associated with
spolied sausages in Germany, 1820.
 Ermengem isolated & identified the causative
organism in 1895
 Scantz & Sommer characterized and classified BoNT
 It was considered for potential use in biological
warfare during World War II & Cold War era.[5]
 BoNT, mainly Type A toxin found widespread use in
cosmetology[6]
Impact on Public Health
 Food safety concern
 High Mortality Rate
 Outbreak Preparedness
 Neurological Impact
 International Concerns
 Preventive Measures such as health campaigns to emphasize
proper food handling, storage & preservation as well as to educate
the public about the severity of this disease and other safety
practices.
 Vaccination Strategies
 Medical Training & Awareness
 Establishment of robust surveillance system to monitor cases of
botulism, to detect outbreaks early, to trace their origin and timely
Epidemiology
In India, infant
botulism is
mostly
prevalent.

The only known

prevention
measure for
infant botulism
is to avoid
feeding honey to
infants less than
12 months of
age. Treatment
may include
antitoxins,
intensive
medical care or
surgery of
infected wounds.
[8]
Clinical Manifestation
Clostridium botulinum Group I, Clostridium butyricum and
Clostridium sporogenes are closely related bacteria responsible
for foodborne, Infant and wound botulism.
 Symptoms typically begin 12-72hrs but the onset vary depending

on the route of exposure

 Progressive muscle weakness & numbness from upper body part

to the lower extremities.

 Diplopia or blurry vision

 Dry mouth, throat & Dysphagia or difficulty swallowing

 Dysarthria or difficulty speaking

 Respiratory compromise

 Autonomic dysfunction due to affected autonomic nervous system

 Descending Paralysis[9]
Pathogenesis
 Spore Ingestion or wound contamination
 Germination & Toxic Production
 Toxin Absorption
 Neuronal Binding and Uptake
 Inhibition of Neurotransmitter Release
 Descending Paralysis ie. starting from head & neck
muscles and progressing to the trunk and limbs
(Respiratory muscles also get affected and result in
respiratory failure)
 Recovery through regeneration of new nerve
ending[10]
Toxin: Mechanism of Action

BoNT Mechanism of Action

 BoNT, also called ‘miracle poison’
produced by C. botulinum commonly
found on plants, in soil, water and the
intestinal tracts of animals
 There are 7 serotypes of this toxin but
types A, B, E and rarely F are virulent
effect on human. Despite its toxicity,
Type A is widely used in medical
treatments for muscle spasms,
migraines and certain neurological
disorder. It also used as cosmetic
procedures to reduce wrinkles as known
as Botox. The LD50 of BoNT is 1-
3ng/kg body weight[11]
Diagnosis

Rapid diagnosis is
crucial for individual
recovery but
epidemiological
investigation includes
the isolation of C.
botulinum from the
patient and from
vehicle foods or other
sources of spores or
toxin and genotypic
analysis of the disease
isolates.

Moreover, MRI, CT
scan, electromyography
are used as supportive
method.[12]
 Treatment & Precaution
 On March 22, 2013, the FDA approved the first botulism antitoxin that can neutralize all 7 known
botulinum nerve toxin serotypes. The heptavalent antitoxin is derived from horse plasma and is the
only drug available for treating botulism in patients older than 1 year, including adults, which prevents
the toxin from causing any more harm. Antitoxin does not heal the damage the toxin has already
done. However, recovery can take several weeks to months.
 For cases of food-borne botulism, health care providers sometimes clear out the digestive system by
causing vomiting and giving drugs to help you move your bowels. If you have wound botulism, a
provider may need to clean, drain or remove infected tissue in a surgery. Antibiotics are introduced to
patients.[13]
 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. Patients who survive botulism may
have fatigue and shortness of breath for years afterward and may need long-term therapy to help them
recover.[14]

Therefore safety protocol must be followed sincerely. Common people to doctors or laboratory
technicians to people engaged in food industries must be aware of severity of the disease.
Campaigns should be held and infants need extra attention to avoid fatal consequences. Moreover,
 AIMS & OBJECTIVES
To investigate & understand the causes of the disease, transmission & prevention of
botulism, a potentially deadly illness cause by toxin produced by Clostridium botulinum
bacteria.
Objectives include studying the bacterium biology, developing detection methods &

devising strategies for prevention & treatment.

This study also aims at discussing botulism neurotoxin, its structure, mechanism of

action ,its serotypes and the reasons for wide use of type A, the various indications and
contraindications of the use of botulinum neurotoxin and finally the precautions taken when
botulinum neurotoxin is used as a treatment approach.
Assess the public health impact of Clostridium botulinum , including the development of

guidelines for surveillance, diagnosis and management of botulism cases.

Objective also include practice of safe food handling method, storage condition& potential

sources of contamination to develop strategies to prevent botulism outbreaks associated

 Review Of Literature
 Dominick A. Centurioni et al.2022, focused on alternative method to detect this neurotoxin to
reduce animal testing as mouse bioassay is the gold standard method. Cell based assays have been
suggested as a replacement for the MBA. It can be more sensitive than MBA where neuronal
celllines are preferred. Besides it, Endopeptidase mass spectroscopy assay can also be standardized
as it is highly senstive and fast yet expensive. Moreover, Real time PCR with nucleic acid,
Genomic comparative methods like NGS & MLST & Bioinformatics with WGS are helpful too.
 S. Mohanty et al.2001 stated that purified BoNT represents most dramatic role in modern time like
Botox. It makes this toxin also very valuable but vaccine is essential for widescale immunization.
Currently a pentavalent botulism toxoid is available to induce active immunity. They also proposed
the necessity of alternative detection method as MBA can be false negative in case of infant &
wound botulism.
 Larry M. Bush et al.2023 proposed a general idea about botulism. It emphasized on food-borne
botulism and its prevention. It also gave an importance on respiratory impairment due to botulism.
 Richard A. Harris et al.2020 discussed on adult intestinal toxemia botulism. They considered
intestinal colonisation of BoNT includes previous bowel or gastric surgery, anatomical bowel
abnormalities, Crohn’s disease, IBS, antimicrobial therapy. This type of botulism toxin can be
detected from patient’s blood serum, stood and it considered both gastrointestinal symptoms as well
as cranial nerve palsies.
 Davide Lonati et al.2020 emphasized on food-borne botulism regarding clinical diagnosis & medical
treatment. As, in initial symptoms can be confused with more common clinical i.e. Stroke, myasthenia
gravis, Guillain-Barre syndrome, tick paralysis or tetrodotoxin poisoning.
 Muhammad Tanveer Munir et al.2023 reviewed physical treatments eg. Heating, pressure like HHP,
irradiation & non therma; application to control C. botulism hazards in food. As the spores are heat
resistant, low and medium dose ionizing irradiations are effective for a log reduction in cell and spores
respectively whereas very high doses are required to inactivate BoNTS (12log of C botulinium type –A
spore is the standard for commercial sterilization). These condition also depend upon various factors like
vagigetative state, growth conditions, injury status, food matrix & the method like pH, temp etc. Moreover,
these techniques provide an opportunity to combine different physical; treatments to achieve synergistic or
additive effects.
 Christine Rasetti-Escargueil et al.2020 approached on epidemiological study of human botulism in
France.Food –borne botulism ,type-B is mostly prevelance whereas infant botulism is rare.
 Subha Ranjan Dutta et al.2016 observed the fascinating aspect of the development of this potent toxin into
a significant therapeutic utility. It is the first biological toxin that is licensed for the treatment of human
diseases. This toxin has an immense positive effect on facial rejuvination (botox, laser resurfacing, botox &
fillers, hyperhidrosis, crow’s feet, vertical lip rhytids, mentalis crease), management of Frey’s syndrome
and hypersialorrhea, treatment of primary axillary hyperhidrosis, neuromuscular correction of gummy
smile, treatment of cerebal palsy in children and depression, spasticity managements and also used in
migraine surgery and to treat disorders of autonomic nervous system and dysphagia and oculi muscle.
Conclusion
 In conclusion, botulism is a rare but potentially severe
neuroparalytic disease caused by exposure to botulinum
neurotoxins (BoNTs). The diversity of its manifestations,
including foodborne, wound, infant, and intestinal toxemia
botulism, presents unique challenges for diagnosis, treatment, and
prevention. BoNTs, classified into seven serotypes, are among the
most potent toxins known, exerting their lethal effects by
inhibiting acetylcholine release at neuromuscular junctions.
Public awareness and adherence to food safety practices play
pivotal roles in preventing this rare but serious illness. Ongoing
efforts in research and surveillance contribute to a more robust
understanding of botulism and, ultimately, enhance our ability to
combat and mitigate its impact on public health. Moreover, it is
necessary to investigate further how to use this toxin to aid
medical treatment for human well-being.
 Reference
 1. Centurioni, D. A., Egan, C.T., & Perry, M. J. (2022). Current Developments in Diagnostic Assays for Laboratory Confirmation and Investigation of Botulism. Journal
of clinical microbiology, 60(4), e0013920. https://doi.org/10.1128/jcm.00139-20.
 2.Mohanty, S., Dhawan, B., & Chaudhry, R. (2001). Botulism: An update. Indian journal of medical microbiology, 19(2), 35–43
 3.Retrieved from. https://www.msdmanuals.com/en-in/professional/infectious-diseases/anaerobic-bacteria/botulism
 4.Harris, R. A., Anniballi, F., & Austin, J. W. (2020). Adult Intestinal Toxemia Botulism. Toxins, 12(2), 81.https://doi.org/10.3390/toxins12020081
 5.Lonati, D., Schicchi, A., Crevani, M., Buscaglia, E., Scaravaggi, G., Maida, F., Cirronis, M., Petrolini, V. M., & Locatelli, C. A. (2020). Foodborne Botulism: Clinical
Diagnosis and Medical Treatment. Toxins, 12(8), 509. https://doi.org/10.3390/toxins12080509
 6. Munir, M. T., Mtimet, N., Guillier, L., Meurens, F., Fravalo, P., Federighi, M., & Kooh, P. (2023). Physical Treatments to Control Clostridium botulinum Hazards in
Food. Foods (Basel, Switzerland), 12(8), 1580. https://doi.org/10.3390/foods12081580
 7.Rasetti-Escargueil, C., Lemichez, E., & Popoff, M. R. (2020). Human Botulism in France, 1875-2016. Toxins, 12(5), 338. https://doi.org/10.3390/toxins12050338
 8.Dutta, S. R., Passi, D., Singh, M., Singh, P., Sharma, S., & Sharma, A. (2016). Botulinum toxin the poison that heals: A brief review. National journal of maxillofacial
surgery, 7(1), 10–16. https://doi.org/10.4103/0975-5950.196133
 9. Jeffery IA, Karim S. Botulism. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459273/
 10.Rao, A. K., Sobel, J., Chatham-Stephens, K., & Luquez, C. (2021). Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR. Recommendations
and reports : Morbidity and mortality weekly report. Recommendations and reports, 70(2), 1–30. https://doi.org/10.15585/mmwr.rr7002a1
 11. Kolho, E., Lindström, M., & Forss, N. (2012). Botulismi--vaikeasti tunnistettava sairaus [Botulism]. Duodecim; laaketieteellinen aikakauskirja, 128(19), 1963–1969
 12.Sobel J. (2005). Botulism. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 41(8), 1167–1173.
https://doi.org/10.1086/444507
 13.Brook I. (2006). Botulism: the challenge of diagnosis and treatment. Reviews in neurological diseases, 3(4), 182–189.
 14.Marcus, N., & Hourvitz, A. (2002). Harefuah, 141 Spec No, 73–120
 15.Cherington M. (1998). Clinical spectrum of botulism. Muscle & nerve, 21(6), 701–710. https://doi.org/10.1002/(sici)1097-4598(199806)21:6<701::aid-
mus1>3.0.co;2-b
THANK YOU