clinical disease

1. Clostridium botulinum
GATHER BY BEHROUZ LATIFI

2. Introduction
 Clostridium botulinum:
 Gram Positive Rod , Spread everywhere
including water, earth, vegetable…
 Spore forming ,inactivated at higher temp
Anaerobic
 Spore forming ,inactivated at higher temp
Anaerobic
 Seven neurotoxin whose subtypes labeled
A_G ,All causes flaccid paralysis

3. Classification
 Class : Clostridia
 Order : Clostridiale
 Family : Clostridiaceae
 Genus : Clostridium
 Species: C. botulinum

4. History and Epidmiology
 Botulism = Botulus
For the first time the disease was eating sausages
 In U.S.A average 145 cases each year
 Approximately 15% food borne
 Approximately 65% infant form
 Approximately 20% wound form
 In IRAN : Gilan whit 79 case during 5 year the most and
Western Azerbaijan whit 4 case during 5 year
least

5. Transmission
 1) Ingestion
organism
spores
neurotoxin
 2) Wound contamination
 3) Inhalation

6. Botulism Pathagenesis
 Toxin inter blood stream from mucosal or wound
 bind to peripheral cholinergic nerve ending
 inhibits release of acetylcholine. preventing muscle from contracting
 can result from airway obstruction or paralysis of respiratory muscles
 secondry complication related to prolonged ventilatory supportand
intensive care

7. Human disease
 human contaminated by neurotoxin type A, B, E, F
 Type A is powerful toxin know in the earth
 type A Infection dos 0.09ng/kg So that a person weighing 90kg with
0.9ng toxin A dies
 three form disease :
 Foodborne
 Wound
 Infant

8. Food borne botulism
 Second most common form
 caused by toxin ingested form
 contamination food including conserve, packing food, vegetable, hot
dog, kielbasa

9. Food borne botulism symptoms
 12-36 h after
 Muscle weakness
 Diarrhea
 Blurred vision
 Vomiting
 Eventual paralysis

10. Wound botulism
 Organism and spore inter wound
 Develop under anaerobic conditions
 From ground in dirt or gravel
 It does not penetrate intact skin
 Associated whit addicts of black _ tar heroin

11. Infant botulism
 Babies eat honey
 Most common form
 Affects babies from 1 week _ 1 year
 Caused by
 Ingestion contaminated food stuff
 Lack of breast milk
 House hold dust containing spores

12. Infant clinical signs
 Poor feeding
 Many gag
 Weak cry
 Decreased movement
 Appearing lethargic
 Flat, blunted facial expression
 Decreased muscle tone( hypotonia )

13. Adult clinical signs
 Nausea, vomiting, diarrhea
 Double vision
 Difficulty speaking or swallowing
 Descending weakness or paralysis
 Shoulders to arms to thighs to caw
 Symmetrical flaccid paralysis
 Respiratory muscle paralysis
 Causes temporary muscle paralysis that may take 3 to 6 months

14. Diagnosis
 clinical signs
 Toxin in serum, stool, suspected food, gastric aspirate
 Culture of stool or gastric aspirate
(egg yolk agar , sxt )
 Mouse neutralization test

15. Treatment
 Botulinum anti toxin
 Botulism immunoglobulin
 Washing the stomach and the administration of antitoxin three valent( A
,B , E)
Penicillin , Metronidazole , Guanidine hydrochloride

16. Animal botulism
 Cattle and sheep (type C , D)
 Doge ( type C and few D )
 Horses ( type B , C )
 Foal ( type B )
 Birds , poultry ( type C , E )

17. Achalasia
 Clinical: a primary esophageal motility disorder characterized by the
absence of esophageal peristalsis and impaired relaxation of the lower
esophageal sphincter (LES) in response to swallowing
 Pathophysiology: a failure of smooth muscle fibers to relax, which can
cause a sphincter to remain closed and fail to open when needed
 Treatment:
Mechanical(pneumatic dilation)
Medical(botulinum toxin)
Surgery( heller myotomy )

18. botox
 Botulinum toxin A

19. Bioterrorism
 Many countries :
 Botulinum toxin as a biological weapon potential
bioterrorism threat
 A one-liter bottle of the toxin (type A ) could kill the entire
population of Earth

20. Thanks…