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DR.PRINCE C P
Associate Professor , Department of Microbiology
Mother Theresa Post Graduate & Research Institute of Health Sciences
(Government of Puducherry Institution)
Botulism
 Clostridium botulinum, which produces the condition
known as botulism
 Category A toxin.
 It is an anaerobic, Gram-positive bacterium commonly
found in soil that works by blocking acetylcholine
release and inhibiting nerve conduction.
Botulinum toxin
 Botulinum toxin is the most lethal toxin known,
approximately 15,000 times more toxic than nerve gas
or chemical exposure.
 There are seven types of botulism toxins, A through G.
 The most naturally occurring of these are A, B and G,
and the only types that cause botulism or other illness
in humans are A, B, E and F.
Weapon of terror
 Botulism has been used as a weapon of terror in the past.
During World War II, the infamous Unit 731, the Japanese
biological warfare group, fed cultures of Clostridium botulinum
to prisoners during the Japanese occupation of Manchuria,
killing them.
 It was suspected that Germany had weaponized botulism as
well, and several other countries were suspected to have done
research into the use of botulism as a weapon.
 More recently, between 1990 and 1995, aerosols were dispersed
on at least three occasions by the Japanese cult Aum Shinrikyo,
who would later go on to release sarin gas in the Tokyo subway,
to disastrous effect. These releases of botulism failed for various
reasons, but the ease with which Aum Shinrikyo was able to
culture Clostridium botulinum from the soil is one reason that
this toxin would make an excellent bioweapon.
.
 After the Persian Gulf War, Iraq admitted that it had
put concentrated botulinum into missiles during the
war, although had not used them.
 These weapons have not yet been found, and the
amount of botulinum contained in them constitute
over 3 times the amount needed to kill the entire
current human population if it were aerosolized
Botox
 The commercially available product known as Botox
contains Type A of the Botulinum toxin, but only in very
small quantities.
 Botox would therefore make a poor bioterrorist weapon
because prohibitively large amounts of botox would be
necessary to cause even a single death.
 However, in January 2005, it appeared that there were a
number of cases of botulism poisonings resulting from
administration of Botox injections.
 After investigation, it was discovered that instead of the
costlier Botox, the physicians or clinical medical personnel
involved in these cases were actually injecting raw botulism
or botulinum bacteria into patients, which could be fatal in
high enough doses.
There are three forms of botulism
 These are foodborne botulism, infant botulism, and wound botulism.
 Foodborne botulism is the most well-known form of botulism, and it
occurs when an individual eats food contaminated with the toxin
produced by C. botulinum. Although not usually due to terrorism,
foodborne botulism is considered a public health emergency because
more than one person has the potential to eat the same food before it is
identified as the source of the botulism outbreak.
 Heating of food generally inactivates the toxin.
 Infant botulism occurs in a small number of infants each year who
have C. botulinum in their intestinal tract from ingesting botulism
spores. These spores are very common and can be found in food such
as honey.
 Wound botulism occurs when wounds are infected with soil
containing C. botulinum.
 A final form of botulism, aerosolized botulism, is man-made, and
occurs when the toxin is inhaled into the lungs.
 Routes of infection for botulinum used as a biological
weapon include dispersion by aerosolization and deliberate
contamination of food, water or beverages.
 Contamination of water, although it is feasible, is unlikely.
 The most likely route of terroristic dissemination is
through aerosolization of the toxin, which would be
extremely lethal.
 It is estimated that 1 gram of aerosolized botulinum toxin
could kill up to 1.5 million people. Despite its potential
lethality, botulism is not capable of being spread person-
to-person.
 Since botulism is naturally occurring, there are several signs you
can look for that may indicate that an outbreak of botulism is
not natural, but may in fact be the result of a biological attack.
 Any outbreak of a large number of cases of flaccid, descending
paralysis has the potential to be a terrorist attack.
 A particularly telling sign is if the outbreak occurs with an
unusual botulinum toxin type, such as Type C, D, F or G.
 An outbreak that has a common geographic factor, such as
location, but no common dietary exposure, is likely to be an
aerosolized, and thus biological attack.
 Finally, multiple simultaneous outbreaks with no common
source is also a potential sign of attack.
 In any case of botulism encountered, it is important to take a
careful travel, activity and dietary history to look both for signs
of intentional exposure, as well as to identify the source of the
outbreak, and other individuals who might have been exposed.
 Symptoms usually begin 12 to 72 hours after ingestion of
botulism, although symptoms may begin as early as 2 hours
or as late as 8 days later.
 It is not known how soon symptoms would begin after an
aerosolized attack, because there are so few recorded cases,
but it is likely that the incubation period would be similar.
 Symptoms include double or blurred vision, drooping
eyelids, slurred speech, difficulty swallowing, dry mouth
and muscle weakness.
 Infants with botulism poisoning appear lethargic, feed
poorly, are constipated, and have a weak cry and poor
muscle tone.
 Pets and farm animals can also get botulism from eating
contaminated food or inhaling the toxin. However, they
cannot transmit the disease to humans.
 The symmetric descending flaccid paralysis seen in patients with
botulism is the hallmark of this type of poisoning.
 Paralysis begins in the muscles of the head and neck, and if
untreated, continue down to the arms, legs, and eventually
respiratory muscles.
 The botulinum toxin does not penetrate the brain parenchyma,
so patients are not confused. However, the lack of a gag reflex
produced by botulism may require intubation.
 Untreated patients with botulism may eventually die of upper
airway obstruction produced by the paralysis of the respiratory
muscles. Currently, only about 8% of patients with botulism die.
 There are several other conditions that may look similar to
botulism in presentation, such as Guillan Barre syndrome,
stroke and myasthenia gravis.
 These conditions can be excluded through testing such as
brain scans, spinal fluid examinations, nerve conduction
tests and tensilon tests.
 However, the best way to confirm a diagnosis of botulism is
to inject serum or stool from the infected patient into mice
and look for signs of botulism in the mice.
 These sorts of tests can be performed at most state health
laboratories, but a physician making an on-the-spot
diagnosis does not have immediate access to this kind of
testing.
 Once botulism is diagnosed, treatment for botulism is
mainly supportive, such as enteral and parenteral feeding,
ventilation, and treatment of secondary infections in an
intensive care setting.
 Respiratory failure may require that patients be put on a
ventilator, or breathing machine for extended periods.
 Timely administration of equine antitoxin provides passive
immunization of the botulinum toxin, and prevents
patients from worsening. While it stops the further
progression of paralysis, it does NOT reverse the paralysis
that has already occurred, so the sooner the antitoxin can
be administered, the better.
 The antitoxin is not usually given for treatment of infant
botulism.
Thank you

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Botulism/ Clostridium botulinum.ppt prepared by Dr PRINCE C P.

  • 1. DR.PRINCE C P Associate Professor , Department of Microbiology Mother Theresa Post Graduate & Research Institute of Health Sciences (Government of Puducherry Institution)
  • 2. Botulism  Clostridium botulinum, which produces the condition known as botulism  Category A toxin.  It is an anaerobic, Gram-positive bacterium commonly found in soil that works by blocking acetylcholine release and inhibiting nerve conduction.
  • 3. Botulinum toxin  Botulinum toxin is the most lethal toxin known, approximately 15,000 times more toxic than nerve gas or chemical exposure.  There are seven types of botulism toxins, A through G.  The most naturally occurring of these are A, B and G, and the only types that cause botulism or other illness in humans are A, B, E and F.
  • 4. Weapon of terror  Botulism has been used as a weapon of terror in the past. During World War II, the infamous Unit 731, the Japanese biological warfare group, fed cultures of Clostridium botulinum to prisoners during the Japanese occupation of Manchuria, killing them.  It was suspected that Germany had weaponized botulism as well, and several other countries were suspected to have done research into the use of botulism as a weapon.  More recently, between 1990 and 1995, aerosols were dispersed on at least three occasions by the Japanese cult Aum Shinrikyo, who would later go on to release sarin gas in the Tokyo subway, to disastrous effect. These releases of botulism failed for various reasons, but the ease with which Aum Shinrikyo was able to culture Clostridium botulinum from the soil is one reason that this toxin would make an excellent bioweapon. .
  • 5.  After the Persian Gulf War, Iraq admitted that it had put concentrated botulinum into missiles during the war, although had not used them.  These weapons have not yet been found, and the amount of botulinum contained in them constitute over 3 times the amount needed to kill the entire current human population if it were aerosolized
  • 6. Botox  The commercially available product known as Botox contains Type A of the Botulinum toxin, but only in very small quantities.  Botox would therefore make a poor bioterrorist weapon because prohibitively large amounts of botox would be necessary to cause even a single death.  However, in January 2005, it appeared that there were a number of cases of botulism poisonings resulting from administration of Botox injections.  After investigation, it was discovered that instead of the costlier Botox, the physicians or clinical medical personnel involved in these cases were actually injecting raw botulism or botulinum bacteria into patients, which could be fatal in high enough doses.
  • 7. There are three forms of botulism  These are foodborne botulism, infant botulism, and wound botulism.  Foodborne botulism is the most well-known form of botulism, and it occurs when an individual eats food contaminated with the toxin produced by C. botulinum. Although not usually due to terrorism, foodborne botulism is considered a public health emergency because more than one person has the potential to eat the same food before it is identified as the source of the botulism outbreak.  Heating of food generally inactivates the toxin.  Infant botulism occurs in a small number of infants each year who have C. botulinum in their intestinal tract from ingesting botulism spores. These spores are very common and can be found in food such as honey.  Wound botulism occurs when wounds are infected with soil containing C. botulinum.  A final form of botulism, aerosolized botulism, is man-made, and occurs when the toxin is inhaled into the lungs.
  • 8.  Routes of infection for botulinum used as a biological weapon include dispersion by aerosolization and deliberate contamination of food, water or beverages.  Contamination of water, although it is feasible, is unlikely.  The most likely route of terroristic dissemination is through aerosolization of the toxin, which would be extremely lethal.  It is estimated that 1 gram of aerosolized botulinum toxin could kill up to 1.5 million people. Despite its potential lethality, botulism is not capable of being spread person- to-person.
  • 9.  Since botulism is naturally occurring, there are several signs you can look for that may indicate that an outbreak of botulism is not natural, but may in fact be the result of a biological attack.  Any outbreak of a large number of cases of flaccid, descending paralysis has the potential to be a terrorist attack.  A particularly telling sign is if the outbreak occurs with an unusual botulinum toxin type, such as Type C, D, F or G.  An outbreak that has a common geographic factor, such as location, but no common dietary exposure, is likely to be an aerosolized, and thus biological attack.  Finally, multiple simultaneous outbreaks with no common source is also a potential sign of attack.  In any case of botulism encountered, it is important to take a careful travel, activity and dietary history to look both for signs of intentional exposure, as well as to identify the source of the outbreak, and other individuals who might have been exposed.
  • 10.  Symptoms usually begin 12 to 72 hours after ingestion of botulism, although symptoms may begin as early as 2 hours or as late as 8 days later.  It is not known how soon symptoms would begin after an aerosolized attack, because there are so few recorded cases, but it is likely that the incubation period would be similar.  Symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth and muscle weakness.  Infants with botulism poisoning appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.  Pets and farm animals can also get botulism from eating contaminated food or inhaling the toxin. However, they cannot transmit the disease to humans.
  • 11.  The symmetric descending flaccid paralysis seen in patients with botulism is the hallmark of this type of poisoning.  Paralysis begins in the muscles of the head and neck, and if untreated, continue down to the arms, legs, and eventually respiratory muscles.  The botulinum toxin does not penetrate the brain parenchyma, so patients are not confused. However, the lack of a gag reflex produced by botulism may require intubation.  Untreated patients with botulism may eventually die of upper airway obstruction produced by the paralysis of the respiratory muscles. Currently, only about 8% of patients with botulism die.
  • 12.  There are several other conditions that may look similar to botulism in presentation, such as Guillan Barre syndrome, stroke and myasthenia gravis.  These conditions can be excluded through testing such as brain scans, spinal fluid examinations, nerve conduction tests and tensilon tests.  However, the best way to confirm a diagnosis of botulism is to inject serum or stool from the infected patient into mice and look for signs of botulism in the mice.  These sorts of tests can be performed at most state health laboratories, but a physician making an on-the-spot diagnosis does not have immediate access to this kind of testing.
  • 13.  Once botulism is diagnosed, treatment for botulism is mainly supportive, such as enteral and parenteral feeding, ventilation, and treatment of secondary infections in an intensive care setting.  Respiratory failure may require that patients be put on a ventilator, or breathing machine for extended periods.  Timely administration of equine antitoxin provides passive immunization of the botulinum toxin, and prevents patients from worsening. While it stops the further progression of paralysis, it does NOT reverse the paralysis that has already occurred, so the sooner the antitoxin can be administered, the better.  The antitoxin is not usually given for treatment of infant botulism.