Botulinum and botulism

Botulism is a debilitating muscle disease caused by the toxin of a bacterium called Clostridium botulinum.
Botulinum is a bacterium that forms heat-resistant spores.
The spores develop in the absence of oxygen, grow and then expel the poison.

The Botox toxins are ingested through improperly prepared foods in which the bacteria or spores survive and produce toxins.

There are three main types of botulism:

1. Food botulism occurs when a person ingests the toxin formed that causes the disease a few hours to a few days later.
   Botox poisoning from food is an emergency for general health, because contaminated food can be eaten by other people besides the patient.
2. Infantile botulism occurs in a small number of sensitive children who have the botulinum bacterium in their intestinal tract.
   These bacteria are usually harmless to adults and older children because when the digestive system is more mature, the spores can be destroyed before they cause damage.
   Very young children have not yet developed the ability to digest the spores. Thus, if swallowed by a child, the spores can germinate and multiply, producing a toxin in the process.
   The toxin interferes with the normal interaction between nerves and muscles and can limit a child’s ability to move, eat, and breathe.
3. Wound botulism occurs when wounds are infected with botulinum bacteria that produce toxin.
   The cause may also be a drug injection (heroin) contaminated with bacteria.

Incubation period:

1. Food botulism: Children and adults: usually 12-36 hours, but can also occur after a few hours up to 8 days.
2. Wound botulism: 4 to 18 days

How does botulinum spread?

Botulism is caused by bacteria that have produced the toxin in a wound or in food. There is no dissemination from one person to another.

Symptoms of botulism in adults

Symptoms include:

• Xerostomia
• Nausea
• Vomit
• Swallowing disorders
• Speech disorders
• Visual disturbances such as double vision
• Ptosis (drooping) of the eyelid
• Increasing weakness to paralysis
• Botulism is referred to as descending flaccid paralysis because it begins at the neck muscles and then passes to the facial muscles, swallowing and respiratory muscles, and finally continues to the feet.
• Breathing difficulties

Symptoms of botulism in infants

• Constipation
• Weakness in sucking and food intake
• Weakened screaming
• Decreased movement of the limbs,
• Inability to control head movement
• Increasing weakness
• Paralysis
• Breathing difficulties

Symptoms of wound botulism

Most people who develop wound botulism inject themselves with a drug several times a day. It is therefore difficult to determine how long it takes for signs and symptoms to develop after the toxin enters the body.

Signs and symptoms include:

• Swallowing and speech difficulties
• Facial weakness on both sides of the face
• Blurry and double vision
• drooping eyelids
• Respiratory problems
• Paralysis

Cause of food botulism

Botulinum is an anaerobic bacterium that can develop only in the absence of oxygen. Food botulism occurs when Clostridium botulinum grows and produces toxins in the food before consumption.
Botulinum forms spores that are present in the environment, including in water, soil, rivers and sea.
Bacterial growth and formation of the toxin occur in products with low oxygen content and at certain combinations of temperature and pH.

This is more common in canned and improperly treated foods that have been canned and bottled at home.
Botulinum does not thrive in a highly acidic environment (pH below 4.6), so no toxin is formed in acidic foods.
However, a low pH cannot remove an already formed toxin.
To prevent bacterial growth and toxin formation, a combination of:

• Cook
• Low temperature
• Salinity
• Sugar content (at least 50% of the food)
• pH

Botulinum toxin is found in various foods, including preserved vegetables with low acidity, beans, spinach, mushrooms and beetroot, fish (including canned tuna), fermented foods, salted and smoked fish; Meat products such as ham and sausage.

The foods mentioned differ in terms of individual countries and local eating habits, as well as food preservation methods. Rarely, commercially prepared foods are affected.

Vegetables pickled in vinegar are safe because vinegar lowers the pH and the bacteria cannot survive under these circumstances, but only if the acetic acid content is above 2%.

If food is frozen immediately after its preparation, the spores do not die, but they cannot produce botulinum toxin either. You can therefore eat the food without worries.

You should avoid canned foods where the container is unusually bloated (for example, the lid of a jam can that “clicks” on pressure) or if a foul smell rises.

How is Botox poisoning diagnosed?

The diagnosis of botulism is made by the combined assessment of a patient’s symptoms, medical history and instrumental examination to rule out other diseases similar to botulism, such as stroke, myasthenia gravis and Guillain-Barrè syndrome.

The doctor suspects botulism if the patient shows the following triad:

1. Descending muscle paralysis
2. No fever
3. Normal state of consciousness

The examinations can be: cranial CT, examination of cerebrospinal fluid and nerve conduction velocity (electromyography).

The most direct way to confirm the diagnosis is to detect the botulinum toxin in the patient’s blood or stool. The bacteria can also be isolated from the stool of a person with food botulism or infantile botulism.

In wound botulism, the toxin is detected from the wound swab or from a skin sample taken.

Treatment of botulism and medication

In the case of food botulism, doctors sometimes have to empty the digestive system by inducing vomiting and prescribing medication for bowel evacuation.
With wound botulism, it may be necessary to surgically remove the infected tissue.

Antitoxin
If you arrive at an early diagnosis of food botulism or wound botulism, you can inject an antitoxin to reduce the risk of complications.
The antitoxin attaches itself to the toxin that is still in the bloodstream and prevents the nerves from being damaged. The antitoxin cannot reverse any damage that has already occurred. Fortunately, nerves can regenerate up to a certain point.
Many people recover completely, but this can also require months and long rehabilitation therapy.
Another type of medication used for botulism is known as immunoglobulin, which is used to treat infants.

Assisted ventilation
In case of breathing problems due to paralysis of the diaphragmatic muscles, mechanical ventilation is required for a few weeks until the effect of the botulinum toxin decreases.
Mechanical ventilation forces air into the lungs through a tube into the airways through the nose or mouth.

Rehabilitation
During the recovery process, therapy may be needed to improve speech, swallowing, and other functions impaired by the disease.

Preventing botulism

1.Pay attention to hygiene in the kitchen when preparing canned food.
For most people, botulism is a problem if the food to be eaten has not been properly preserved.

For example, bacteria may be present in the food if:

• Fish without enough salt or acid are placed in brine to kill the bacteria
• Smoked and preserved fish are stored at too high a temperature
• Fruits and vegetables don’t contain enough acid to kill bacteria
• Canned food is not properly sealed: meat sauces, tomato sauce
• Honey products for children under one year of age and for people who have a weakened immune system

2.Food should be prepared carefully, here are some recommendations:

• Remove dirt. Botulinum bacteria colonize the soil. Therefore, foods that are still soiled with soil can pose a danger, especially lettuce.
• Baked potatoes – brush potatoes before baking.
• Potatoes wrapped with aluminum foil and cooked should be kept hot until consumed or stored in the refrigerator.
• Mushrooms should be cleaned before consumption and soil remains removed.
• Food cooked in the house should be cooked for 10 minutes (for example, jam) before it is consumed.
• Homemade canned tomatoes and homemade cheese must be stored in the refrigerator.
• For any dish prepared with milk or dairy products, it is better to store it immediately in the refrigerator, freeze it or consume it immediately after preparation.
• Heat-treated containers for food where the hermetic seal is damaged should be disposed of, for example food cans with holes or rust.

3.Know when to throw something away. This is perhaps one of the most important skills for the chef when food has not been well preserved before consumption:

• If the food in the can forms foam, creates bubbles or if a bad smell occurs, it is better to throw it away.
• If the lid opens too easily, you should throw the product away.
• If mold occurs or the food has lost its color, you should stop eating it.
• If in doubt, always throw the food away.

The CDC (Center of Disease Control in the USA) also recommends that consumers check the signs that suggest contamination of homemade food, including:

• The container is bloated or leaking, the lid “clicks” when pushed down.
• The container appears to be damaged, it has cracks or looks strange.
• Liquid or foam splashes out of the container when opened.
• The food is discoloured, mouldy or develops a foul smell.

If it is suspected that a can is contaminated, it should not be opened because this can spread the bacteria. Also, one should not taste the content.
If one of the contaminated food falls and stains a surface, the area should be cleaned with a bleach solution. To do this, dilute 1/4 cup of bleach in 2 cups of water.

What is the prognosis for people with botulism?

Untreated botulism has a mortality rate (death rate) of about 50%.
With treated botulism, the mortality rate is still about 3-5%. Some patients may have varying degrees of paralysis for many months.

As a rule, the prognosis is better with early diagnosis and treatment.
If the function of a nerve is affected, recovery may be possible as the nerve regenerates.

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