Botulism (Clostridium botulinum)

Table of Content 

• What is botulism?

• What are the types of botulism?

• How common is botulism? 

• Symptoms of botulism 

• Causes of botulism

• Complications of botulism

• Precautions of botulism

• Diagnosis of botulism 

• Treatment of botulism

• Take home points

Introduction 

Botulism, also called botulism poisoning, is a very rare but grave illness where mainly the nerves and muscles are affected which may lead to weakness and paralysis of muscles that assist in talking, swallowing, and movement. It is caused by the bacteria, Clostridium botulinum. 

This bacteria releases toxins that affect the nerves and weaken the muscles. It may also lead to trouble breathing and may eventually prove to be fatal. 

This bacteria may affect the patient through contaminated food, contact with contaminated soil, or open, untreated wounds. So, in this article, as we proceed further, we're going to talk about this particular ailment in greater detail and find out the causes, prevention, and the necessary treatment for it.

What is botulism?

Botulism is a rare but serious illness caused by a toxin that attacks the body’s nerves. It is caused by the toxins produced by a bacteria called Clostridium botulinum. The toxin causes difficulty breathing, muscle paralysis, and even death. The bacteria can produce the toxin in food, wounds, and the intestines of infants.

What are the types of botulism?

So now that we've got an idea about this illness, let's talk about its common types and how we can possibly contract them. Botulism is generally of 3 common types. They are: 

• Food Botulism 

• Infant Botulism 

• Wound Botulism

Apart from these, there are several other types too, which are usually rare but equally deadly. These are: 

• Iatrogenic Botulism  

• Adult Intestinal Toxemia Botulism 

Let's talk about these in greater detail:

• Food Botulism:

This particular type of botulism is possibly one of the most common types of this ailment. It is caused due to improperly stored and canned foods such as canned tomatoes, oil infused with herbs, garlic, cheese sauce, fish, unprotected and unrefrigerated foods etc.

This is primarily because the spores of Clostridium botulinum may enter inside and develop even in the absence of oxygen and release certain toxins which mix with your food and reach your body.

In fact, there have been surging cases of canned food such as sardines, tuna, meat, fruits etc. spreading this deadly bacteria that is causing botulism among humans.

• Infant Botulism:

Another common type in our list is infant botulism. As the name suggests, it is botulism in babies. The spores of the causative bacteria, Clostridium botulinum, may get inside the baby's system because of being mixed in soil and being ingested or being inhaled which is when the contaminated soil particles get mixed in air i.e. airborne. It travels inside the alimentary tract and reaches the intestines where it develops and releases the toxins which cause botulism poisoning. 

It also happens when the spores are present in honey which if ingested by a child who's under 12 months of age, may travel down the tract and reach the intestines where they grow and release toxins. Botulism due to ingestion of spores may not happen in older children and adults, but babies are at great risk in these cases.

It is the reason why children  below 1 year of  age are recommended to be kept away from honey.

• Wound Botulism:

Next up on our list is wound botulism. This particular type of botulism happens after the spores of Clostridium botulinum enter into the bloodstream of the patient due to open wounds and then release the toxins into the blood. 

It may also happen due to infected syringes, most commonly among people who take in drugs via needles and leave the punctured area untreated and uncovered, which then serves as a gateway for the spores.

Though uncommon, it may also happen after medical surgeries. 

• Iatrogenic Botulism:

The next type that we are going to refer to is among the rare types of botulism that occur. This happens when the patient takes incorrect amounts or rather excessive amounts of Botulinum toxins which are actually available in Botox injections. Botox injections consist of a highly purified and diluted form of the organism Clostridium botulinum, which is injected inside the body of the patient due to certain cosmetic procedures or as a medication for migraine headaches.  

In either case, it would be best advised to take these injections under the supervision of certified medical professionals.

• Adult Intestinal Toxemia Botulism

This is also known as Adult intestinal colonization. Even though it affects adults the manner in which the infection occurs has striking similarity to the infant botulism. Sure,the spores get inside the body of the patient, grow in the intestines and release the toxins that cause Botulism. 

This is one of the rare kinds of Botulism and people having digestive problems are actually more susceptible to this kind of Botulism.

How common is botulism?

Botulism is a rare but serious illness caused by a toxin produced by the bacteria Clostridium botulinum. Every year about 110 cases of botulism is reported in the US. About twenty-five percent of these cases are foodborne botulism. Approximately seventy percent of these cases are infant botulism.

Symptoms of botulism

So how would you figure out if you might be affected by Botulism. The symptoms of botulism can vary according to time and the amount of spores or toxins taken in by the patient. Let's discuss the symptoms according to the types of Botulism :

• Symptoms of Foodborne botulism- 

The symptoms may commence usually ranging from 12 to 36 hours, or even a few days depending on the amount of toxins consumed by the patient. The symptoms observed are as follows : 

1. Problem swallowing and also problem talking

2. Dryness of mouth

3. Weakness felt on both sides of face

4. Blurriness in vision

5. Drooping eyelids

6. Problem breathing

7. Feeling nauseated, puking and also having pain in the abdominal region

8. Paralysis

• Symptoms of Infant botulism-

Symptoms of botulism in infants occur usually around 18 to 36 hours after the spores enter the body. Here are the symptoms of infant botulism: 

1. Constipation

2. Floppy movements which happen due to weakness in muscles. There is also trouble controlling the head.

3. Weak cry

4. Irritability 

5. Drooling 

6. Droopy eyelids 

7. Tiredness 

8. Trouble feeding 

9. Paralysis

• Wound botulism-

Symptoms in this particular type appear after 10 days of the toxins being released post the entry. They are:

1. Trouble speaking and swallowing 

2. Weakness on both sides of the face

3. Blurriness and double vision 

4. Droopy eyelids 

5. Problem breathing 

6. Paralysis 

7. Sometimes fever may also occur

• Symptoms of Iatrogenic botulism- 

Even though rare, but if someone contracts this kind of botulism due to unsupervised medical or cosmetic treatment, they may experience certain common symptoms: 

1. Facial Paralysis 

2. Muscle weakness

3. Headaches

• Symptoms of Adult Intestinal Toxemia Botulism-

Some symptoms of this rare type of botulism include:

1. Nausea

2. Vomiting

3. Weakness in muscles

4. Decreased bowel sounds

5. Pain in the abdomen

6. Distended abdomen 

7. Constipation

Nevertheless, one must certainly make an appointment with their doctor in order to get themselves checked for any such kind of infection as they would know their patients better.

Causes of botulism

Botulism is an illness that is caused by a toxin produced by a bacteria called Clostridium botulinum. While the bacteria and its spores are widespread in the environment, it doesn't affect everyone as special conditions are needed to be present for botulism to occur. Here are the main causes of botulism:

Causes of Foodborne botulism:

1. Contaminated food.

2. Improperly canned or preserved food.

Causes of Infant botulism: 

1. Consumption of honey as it can contain spores of Clostridium botulinum.

2. Exposure to contaminated soil and food. 

Causes of Wound botulism:

1. Open wounds that get contaminated with the spores of Clostridium botulinum.

Causes of Iatrogenic botulism:

1. Rare, specifically arises from medical or cosmetic procedures involving botulinum toxin.

Complications of botulism 

There can be several complications due to botulinum toxin which may range from muscle weakness to breathing problems. In fact, maximum casualties in people having botulism may happen due to the respiratory issues caused by this toxin. Some complications are:

1. Difficulty in talking or swallowing.

2. Long lasting muscle weakness 

3. Breathing problems.

Precautions of botulism 

Even though this illness is rare, yet, one must take all actions and steps necessary to protect themselves and their loved ones from such kind of consequences:

Precautions of Food borne botulism

Some precautionary steps that can be taken by one to protect themselves from food borne botulism are:

1. Store food properly as in a refrigerator and avoid keeping it outside.

2. Try to pressure cook the foods even if canned at 121 degrees Celsius for 10 to 100 minutes or depending on the type of food.

3. If possible, try boiling the food for at least 10 minutes before serving.

4. Avoid canned food if the can is bulging or the seal seems to be tampered or broken. Often you may be tempted to check the food by smell or taste but many strains of Clostridium botulinum may get away with that kind of test as it's not necessary for the food to smell only if affected.

5. Store oil infused herbs and other food items in the refrigerator. Make it a note, to throw them out after four days of storing.

6. Try to refrigerate canned foods after opening the cans.

7. If you like wrapping food such as potatoes, in aluminum foils then it is recommended to eat the food while it's still hot. Otherwise, carefully loosen the foil and place the potatoes in the refrigerator. 

Precautions of Infant Botulism

To reduce the risk of infant botulism, keep your baby away from honey (even processed foods containing honey), as much as possible, before the age of 1 year. Even a taste should be prevented.

Precautions of Wound botulism

To keep yourself protected from wound botulism, some necessary steps that you can take are:

1. Keep your wounds protected as even small cuts may go unnoticed.

2. Take necessary first aid to protect your wounds from any such harmful bacteria.

3. Keep yourself away from street drugs. 

4. If you feel like your wound is infected, seek medical help right away.

Precautions of Iatrogenic Botulism

To protect yourself from this type of botulism make it a point to take any cosmetic or medical treatment by a licensed medical professional.

Diagnosis of botulism 

The symptoms might not only be enough for diagnosis as many other ailments have nearly the same symptoms as what we've discussed above. So, if you feel that you might have contracted this deadly illness, then, your first motive should be to make an appointment with your doctor and let them know of all your symptoms and allow them to carry out the necessary tests. Some of these may include:

1. Brain scan

2. Spinal fluid exam

3. Nerve and muscle function test

Apart from these, your healthcare provider may also carry out certain tests to figure the presence of toxins in your blood, stool and vomit. Food samples can also be tested. Your doctor may also check for any weak or paralyzed muscles.Test results may take several days to show up so your healthcare provider might start off without the procedures immediately. 

Treatment of botulism

There's no specific treatment to cure the illness. You might be prescribed some antitoxins to prevent the toxins from damaging the nerves. Apart from this,your body may take several days, months or even years to recover, so you might be kept in the hospital for the necessary treatment. If the toxins have caused breathing problems, then the patient may be kept in the ventilator until they don't require it and any paralysis affecting breathing is cured and the breathing has improved.

In case of wound botulism, the wounded part where the toxins have been released might be removed surgically. Then, certain antibiotics are prescribed to prevent the infection from returning.

Though mild nerve damage can heal, if given the right treatment,antitoxins only do the work of preventing any further nerve damage.

However, on receiving the right treatment, the patient can heal within the expected time, which depends on the severity of the infection. 

Take home points

• Botulism exists in various forms, including foodborne, infant, wound, and inhalation botulism, each with its unique mode of transmission.

• Early recognition of symptoms like blurred vision, drooping eyelids, and difficulty swallowing is crucial for seeking immediate medical attention.

• While the botulinum toxin is highly potent, prompt administration of antitoxin and supportive care can significantly improve the chances of recovery.

• Safe food handling practices, proper wound care, and responsible honey consumption for infants are essential for preventing botulism outbreaks.