What is Botulism?
Botulism is a bacterial infection that results from intoxication of the body. In the recent past, type and sources of food that human beings consume, type of duties people engage in, and analysis of the historical background of the disease has helped in unlocking the reasons for the disease outbreaks. A person with acute flaccid paralysis among other features should be suspected to have botulism. In order to curb the spread of the disease, medical practitioners are always keen to ask people with similar disease because most people do not take adequate precautionary measures, as the disease is rare. It is for this reason that medical study of botulism is important in medicine.
Epidemiology of Botulism
In the conventional methods of food preservation, there have been a number of reported cases of illness. Explorers in the olden days gave account of a number of disease outbreaks that claimed lives of the people. Medical researches establish that the descriptions given by the then explorers resemble those of foodborne botulism. In Nelson’s observation on the disease as reported in Health and social Services, (1998), the food preservation methods that the ethnographers described support perfect conditions under which botulism toxins are produced.
The first case of botulism was reported in the year 1735 in Germany after consumption of German sausage. “In 1870, a German physician by the name of Muller derived the name botulism from Latin word for sausage,” (Davis, 2011). In the Arctic region, the first case of botulism outbreak was reported in the beginning the 20th century. This followed a series of other cases in Canada in the year 1919 and from that time, there have been a series of botulism outbreaks involving over 200 people. In sum, Health and Social Services, (1998) notes,
The first reported outbreaks in Greenland (Muller and Thomsen 1968) occurred in 1967 and 25 additional outbreaks have been reported since. Rabeau (1959) recorded the first outbreak in Alaska in 1947 which involved beluga whale flipper consumed in the village of Kotzebue. Outbreaks among Siberian Eskimos in Russia are not well reported.
For a population that does not consume traditionally preserved food, there have been insignificant case of botulism reported. The most common type of botulism in the Arctic region is type E.
Etiologic Agents of Botulism
Botulism is a rare disease that affects human beings and whenever a person suffers from this infection, the repercussions are always serious. This medical condition results from intoxication of severe potent toxins that are preformed in foodstuff that people consume. Intoxication occurs due to a bacterial infection caused by Clostridium botulinum. According to available medical research on the disease, there is no human-to-human transmission of the disease. In addition, there are a total of seven recognized manifestation of botulism where type C, D, and E intoxicate fish, birds, and mammals, (Grifiths et al., 2010).
On the other hand, type A, B, E, and F (very rare) are responsible for human botulism. Report by World Health Organization, (WHO), (2002) indicates that, “The sporulated form of the bacterium is commonly found in soils, aquatic sediments and fish. The spores are heat-resistant.” As mentioned above, this disease is foodborne but at some instances, it can be transmitted via infections in intestine or wound in children. The bacterium that cause botulism have spores all over places and the spores develop vegetation-like bacteria, which produces toxic substances in an anaerobic condition, (Wingfield and Palmer, 2009).
Pathogenesis of Botulism
The seven different types of botulism have different levels of intoxication and the time it takes in the nervous system. As noted by Dembek et al., (2011), “All botulinum toxins serotype inhibit acetylcholine release, but they act through different intracellular protein targets, exhibit different durations of effect, and have different potencies,” (340). All the seven types of toxin can enter the body and cause harm if they are given enough exposure. In inhalation botulism, the toxins enter the body through the pulmonary tract whereas for infant and foodborne botulism, they enter via the gastrointestinal tract. As already been mentioned in the paper, wounds are also potentially entry points for intoxication.
Once inside the body by absorption, they get into the circulation system where the toxins are transferred to marginal sides of the cholinergic synapses where the toxins then move to the neuromuscular junctions. “The toxin binds to high affinity presynaptic receptors and is transported into the nerve cell through receptor mediated endocytosis,” (Dembek et al., 2011, p. 340). Having entered the nerve cells, toxins block the neurotransmission release also known as acetycholine; thus, resulting to neuromuscular paralysis.
Management and Prognosis of Botulism
- Most patients have bulbar palsy that makes it difficult for them to speak, swallow, and see.
- Patients with botulism will also have blurred vision due to diplopia, ptosis, and because of infections in the eye, there is likelihood of enlarged pupils lethargic reactions.
- Botulism has classic triad that is manifested in an acute, balanced and descending flaccid paralysis, no fever, and a clear sensorium.
- As noted above, flaccid paralysis reduces progressively due to loss of head management power, weakness of the body in general, and weakened tendon reflexes in a matter of days after the infection. Airway obstruction and paralysis of muscles that help in the respiratory system is the reason why assisted ventilation is helpful for a patient with botulism.
- Respiratory difficulties are responsible for causing death and it results from paralysis of respiratory muscles.
- In foodborne botulism, there are observable gastrointestinal symptoms that causes abdominal pains that emanate from stomach cramps. One would be nauseated, feel like vomiting, or suffer from diarrhea.
There are two main components in the prevention of botulism: passive immunization and proper and supportive care. It is advisable to keep neurological progression as low as possible through antitoxin administration after a clinical diagnosis. Trivalent antitoxin, ABE was in use until the US FDA suspended its use due to medical concerns. However, as Khardori, (2006) note, “Currently two separate equine antitoxins are available through CDC – botulism antitoxin bivalent for type A and B toxins (licensed by the FDA) and botulism type E (an investigational product).” One vial is always adequate to suppress foodborne botulism; however, if there are cases of international exposure, it is in order that patients’ serums are retested for the disease after this administration. Equine has successfully treated children, pregnant women, and patients who have been immunocompromised. The treatment has some adverse effects in form of anaphylaxis, sickness in the serum, urticaria, and mild hypersensitivity.
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Another care for a patient with botulism is supportive care. This is vital in insuring that the airway remains protected in order to improve respiratory functions of a botulism patient. According to Khardori, (2006), “For airway protection and improved respiratory function patients should be kept in a reverse Trendlenburg position, i.e. head of the bed tilted approximately 20-25 degrees above the horizontal level,” (p. 174). Whereas maintaining proper nutritional support for the patients, it is advisable that ventilation of rooms is assisted by at least 20% and 60% for adults and children respectively. Alternatively, use of antibiotics remains uncertain except for treatment of other secondary infections. Wound botulism is treatable by use of penicillin G as it reduces bacterial load due to minimal toxins production.
Foodborne botulism has reduced since the 1950s due to supportive care like assisted ventilation and intensive care programs. Deaths caused by botulism in the olden days were mainly due to negligence of the severity of botulism. The disease may result to death after two weeks of infection and according to a number of studies; the disease has a 15 to 44% mortality rate, (Khardori, 2006).
VI.Prevention and Treatment of Botulism
Since botulism is caused by poor food storage, the first remedy for a botulism infection is to adopt proper food preservation and hygienic food handling. To prevent toxicities, inactivating bacteria spores via heat sterilization and food canning will result to inhibition of their growth. In industrial food production, pasteurization of foodstuffs under intense heat or hot smoked foodstuffs can be sufficient to kill all spores that encourage vegetative growth of the toxins. The strategic prevention mechanism for the occurrence of botulism lies in the inhibition of the toxins. This implies that through refrigeration and use of salt and acidic compounds are viable in the prevention of botulism.
Alternatively, is botulism is suspected to have resulted from exposure to toxic aerosols, in is advisable that a patient’s clothes are taken and dumped in a polythene bag until when they are washed with soap and water. Such a measure will prevent multiple exposures and reduce chances of further infections. Proper bathing by an infected patient should then follow. As a precautionary measure, it WHO, 2002 advice that, “Food and water samples associated with suspect cases must be obtained immediately, stored in proper sealed containers, and sent to reference laboratories in order to help prevent further cases.”
Following a clinical diagnosis to affirm the case of botulism, a patient should be given antitoxin drugs as soon as possible. In extreme infection of botulism, treatment of such a patient requires aided medical like physical ventilation that may go for weeks or months. Another treatment of botulism would be the administration of antibiotics; however, this only applies to wound botulism. Consequently, vaccination is another way of treating botulism but the method is not popular due to lack of adequate proven result and the fact that vaccination has side effects.