epidemiology botulism

1. BOTULISM
EPIDEMIOLOGY AND PREVENTION
National Centre of Infectious and Parasitic Diseases
Sofia, Bulgaria
DEPARTMENT OF EPIDEMIOLOGY

2. ABOUT BOTULISM
• Botulism (“BOT-choo-liz-um”) is a rare but serious illness caused by a
toxin that attacks the body’s nerves and causes difficulty breathing,
muscle paralysis, and even death. This toxin is made by Clostridium
botulinum and sometimes Clostridium butyricum and Clostridium
baratii bacteria. These bacteria can be spread by food and sometimes by
other means.
• Infectious agent- Gram (+), rod shaped, spore forming that produce toxins in 7
antigenic forms (A-G) in anaerobic conditions by bacterium Clostridium
botulinum

3. • The bacteria that make botulinum toxin are found naturally in many places, but it’s rare for them
to make people sick. These bacteria make spores, which help the bacteria survive in the
environment, even in extreme conditions. The spores usually do not cause people to become sick,
even when they’re eaten. But under certain conditions, these spores can grow and make one of
the most lethal toxins known. The conditions are:
• Low-oxygen or no oxygen (anaerobic) environment
• Low acid
• Low sugar
• Low salt
• A certain temperature range
• A certain amount of water
For example, improperly home-canned, preserved, or fermented foods can provide the right
conditions for spores to grow and make botulinum toxin. When people eat these foods, they can
become seriously ill, or even die, if they don’t get proper medical treatment quickly.
Environment and conditions of botulism

4. KINDS OF BOTULISM
• Foodborne botulism can happen by eating foods
that have been contaminated with botulinum toxin.
Common sources of foodborne botulism
are homemade foods that have been improperly
canned, preserved, or fermented. Though
uncommon, store-bought foods also can be
contaminated with botulinum toxin.

5. KINDS OF BOTULISM
• Wound botulism can happen if the spores of the
bacteria get into a wound and make a toxin. People
who inject drugs have a greater chance of
getting wound botulism. Wound botulism has also
occurred in people after a traumatic injury, such as a
motorcycle accident, or surgery.

6. KINDS OF BOTULISM
• Infant botulism can happen if the spores of the
bacteria get into an infant’s intestines. The spores
grow and produce the toxin which causes illness.
• Do not feed honey to children younger than 12
months because it has been linked to some cases of
infant botulism.

7. Adult intestinal toxemia (also known as adult intestinal
colonization) botulism is a very rare kind of botulism that can
happen if the spores of the bacteria get into an adult’s intestines,
grow, and produce the toxin (similar to infant botulism).
Although we don’t know why people get this kind of botulism,
people who have serious health conditions that affect the gut
be more likely to get sick.
KINDS OF BOTULISM

8. INTESTINAL TOXEMIA

9. KINDS OF BOTULISM
• Iatrogenic botulism can happen if too much botulinum
toxin is injected for cosmetic reasons, such as for wrinkles,
or medical reasons, such as for migraine headaches.
All kinds of botulism
can be fatal and are
medical emergencies.

10. RISK GROUPS :
• People who eat home-canned or home-fermented
foods that haven’t been prepared safely;
• People who inject certain drugs, such as black tar
heroin;
• People who get botulinum toxin injections for
cosmetic reasons;
• INFANTS

11. SYMPTOMS :
• double vision
• blurred vision
• drooping eyelids
• slurred speech
• difficulty swallowing
• difficulty breathing
• a thick-feeling tongue
• dry mouth
• muscle weakness
Infants with botulism
may:
• appear lethargic
• Neck and peripheral
weakness (“floppy
baby”)be constipated
• have a weak cry
• have poor muscle tone
(appear “floppy”)

12. SYMPTOMS :
• These symptoms all result from muscle paralysis caused by the toxin. If
untreated, the disease may progress and symptoms may worsen to cause
paralysis of certain muscles, including those used in breathing and those in
the arms, legs, and trunk (part of the body from the neck to the pelvis area,
also called the torso). People with botulism may not show all of these
symptoms at once.
• In foodborne botulism, symptoms generally begin 18 to 36 hours after
eating a contaminated food. However, symptoms can begin as soon as 6
hours after or up to 10 days later.

13. DIAGNOSIS
special tests:
• Brain scan
• Spinal fluid examination
• Nerve and muscle function tests
• (nerve conduction study [NCS]
• and electromyography [EMG])
• Tensilon test for myasthenia gravis
laboratory tests:
• The demonstration of botulinum toxin
in serum, stool, gastric aspirate of
incriminate food, or through culture C.
botulinum from gastric aspirate or
stool.
• Toxin in serum or positive wound
culture confirms diagnosis of wound
botulism.

14. DIAGNOSIS
• Differential diagnosis for adults
may include:Guillain-Barré
syndrome
• Myasthenia gravis
• Cerebrovascular accident (CVA)
• Bacterial or chemical food poisoning
• Tick paralysis
• Chemical intoxication (for example,
carbon monoxide, opioid
intoxication)
• Mushroom poisoning
• Poliomyelitis
• Psychiatric illness
• Differential diagnosis for infants
may include:Sepsis
• Meningitis
• Electrolyte-mineral imbalance
• Reye’s syndrome
• Congenital myopathy
• Werdnig-Hoffman disease
• Leigh disease

15. TREATMENT
• Intravenous administration of polyvalent botulinum antitoxin -
the toxin attacks the body’s nerves, and the antitoxin
prevents it from causing any more harm. It does not heal
the damage the toxin has already done.
• wound botulism - surgically remove the source of the
toxin-producing bacteria and antibiotic therapy.
• Death can result from respiratory failure or the
consequences of extended paralysis.

16. SURVIVAL AND COMPLICATIONS
• Botulism can result in death due to respiratory failure. However,
because of the development of antitoxin and modern medical
care, people with botulism today have a much lower chance of
dying than people did in the past. Fifty years ago, for every 100
people with botulism, 50 would die. Now, with antitoxin and
proper medical treatment, fewer than 5 of every 100 people with
botulism die.
• Even with antitoxin and intensive medical and nursing care, some
patients die from infections or other problems that are 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.

17. OCCURRENCE
• Worldwide, sporadic cases.
• Family and general outbreaks occur where food is prepared
or preserved by methods that do not destroy spores and
permit toxin formation.
• Cases rarely results from commercially processed products.
• Actual incidence of intestinal botulism is unknown because
physician awareness is limited.

18. TRANSMISSION
• Foodborne occurs- in food without sufficient heating or post production
cooking.
• Inhalation botulism occurred in laboratory workers.
• Contamination of wound by ground in soil.
• After dermal abscesses cause from heroin injection.

19. RESERVOIRS
• Spores, ubiquitous in soil worldwide, are frequent recovered
from agricultural products, including honey, and also found in
marine sediment and in the intestinal tract of animal and fish.

20. METHODS OF CONTROL
• Preventive measures: Good practices in food preparation
and hygiene, inactivation of spores in heat- sterilized,
canned products or inhibition of growth in all other
products. Refrigeration combined with control of salt
content and acidity will prevent growth and formation of
toxin. Food samples associated with cases must be obtained
immediately stored in sealed containers and sent to
reference laboratory.

21. METHODS OF CONTROL
• Control of patients, contacts and immediate environment. Report to local
health authority.
• Isolation- not required, hand washing indicated after handling soiled materials
including diapers.
• Management of contacts: The presumptive treatment with polyvalent (equine type
AB or ABE) antitoxin to asymptomatic contact should be weighted carefully and
kept under medical observation.
• Investigation of contacts and source of toxin: study recent food history of those
ill and recover all suspected foods for appropriate testing and disposal.
• There is vaccine against botulism , but its effectiveness have not be fully
evaluated.

24. • Suspicion of single case of botulism should immediately raise
the question of a group outbreak involving family and others.
Home-preserved foods are the prime suspect until ruled out. Any
foods implicated by epidemiological and laboratory findings require
immediate recall as immediate search for people sharing the same
foods. Foods, sera, gastric aspirate and stools from patients and
other exposed should be forwarded to a reference laboratory.
Epidemic measures:

25. BIODEFENSE MEASURE
• Some countries with biological weapons programs have
made the toxin that causes botulism. Some groups
have tried unsuccessfully to use the toxin to
intentionally harm people.
• The occurrence of even a single case if there is not
obvious source of wrong preserved foods raise the
possibility deliberate use of botulinum toxin and must
be reported immediately.

26. THANK YOU !