The most common way of contracting botulism is through eating food contaminated by the toxin.
For example, homemade preserves (such as hearts of palm), which do not necessarily undergo proper hygiene processes and can create an environment conducive to the sporulation of the bacteria.
Botulism is rare, but often fatal.
This is because the toxin destroys proteins involved in important biological processes of neurotransmitters and this can cause muscle paralysis.
Botulinum toxin binds to nerve ends and damages them. This prevents the nerves from communicating with the muscles, causing paralysis.
In severe cases, paralysis reaches the diaphragm, preventing the person from breathing, which leads to death.
The toxin remains attached to the nerves for a few days, until it is eliminated by the body, but the nerve damage is not reversed with this process. Thus, nerve regeneration can take several months to complete, and it can take up to an entire year for full recovery.
Despite its lethality, the toxin is used in the pharmaceutical industry, to treat muscle spasms , and by the aesthetic industry, as in the application of botox, which is nothing more than the botulinum toxin used in a controlled manner to reduce wrinkles.
The code for botulism in the ICD-10 is A05.1 .
Forms of botulism
The disease caused by intoxication by botulinum toxin is invariably the same and its clinical manifestations as well. However, botulism can be separated into 3 different forms, which vary in the form of transmission.
This disease is not transmissible and is only contracted in specific cases. Are they:
Food botulism
The most common form of botulism is food, which is contracted mainly through canned food made at home.
Although cases in commercial brands are possible and have happened before, industrialized foods usually undergo rigorous inspections and follow hygiene standards that prevent contamination.
However, when someone makes preserves at home, the person does not always follow an adequate hygiene standard. With that, in the time that it preserves it rests, if it is contaminated, the bacteria reproduces and can release botulinum toxin in the food, which is then ingested.
The disease is mandatory to report and anyone who has eaten the same foods as the intoxicated person should be aware of the symptoms.
Intestinal botulism (infant or infant)
Intestinal botulism happens when the bacteria goes to the intestine and reproduces, releasing the toxin already inside the patient’s body. In extremely rare cases it can happen in adults, but it is more common in children under 1 year old.
When you eat a substance with the bacterium Clostridium botulinum , it goes into the intestine. In most cases, the intestinal flora does not allow the environment to be suitable for its reproduction and, therefore, it is eliminated.
However, as the feeding of children under one year of age tends to be exclusively breast milk (which is adequate and healthy), the intestinal environment is shown to be conducive to the proliferation of the bacteria, which then begins to produce the toxin.
Most cases are spontaneous and it is not known where the bacteria came from, as it can be present anywhere. However, it is known that foods with honey are commonly inhabited by the bacteria or their spores, and several cases have been attributed to the baby’s ingestion of the food.
Therefore, it is not recommended to feed children under one year of age with honey.
Wound botulism
Wound botulism happens when the bacterium comes into contact with cuts, scrapes or wounds in general. Generally, there is no oxygenation in wounds and this environment is conducive to the reproduction of Clostridium botulinum .
The result is the production of botulinum toxin, which, in turn, triggers botulism by falling into the blood network.
Causes: what is the bacterium of botulism?
Botulism is caused by the botulinum toxin, produced by the bacterium Clostridium botulinum . This bacterium, by itself, does not harm humans, but when it begins to reproduce in an anaerobic environment (without oxygen), it releases the botulinum toxin.
There are 8 different types of toxin identified, which are A, B, C (which is divided into C1 and C2), D, E, F, G and H.
The toxin denatures (a process that causes biological molecules to lose their properties) after exposure for a few minutes to temperatures above 80º C.
Types A and B are often canned meat or vegetables, while type E is often related to canned fish. These 3 types cause botulism in humans, type A being the most toxic of them.
But it is the H manages to be even more toxic, being known as the most toxic substance in the world due to its very low LD50 .
LD50 of botulinum toxin
LD50 is the median lethal dose of a substance. This is the amount of a substance needed to kill 50% of the population in tests, usually carried out on rats.
For example, the lethal dose of caffeine is 192mg for every kg of body weight.
A 70kg person needs 13.4g of pure caffeine to die (a cup of coffee is between 95mg and 200mg, so it would take approximately 90 cups to bring a 70kg person to death in an overdose of caffeine).
The lethal dose of botulinum toxin is approximately 2 nanograms per kg. This means that while caffeine needs 13g to kill a 70kg person, botulinum toxin needs 0.00000014 grams to kill the same person. This is 6 zeros after the comma.
Type H of the toxin is even more lethal and only 2 nanograms (not per kg, only 2 nanograms even) injected into the vein can kill an adult.
Fortunately, the production of the toxin by the bacteria is minuscule and contracting the disease is not a concrete death sentence. However, one must not forget that it is extremely lethal.
Transmission of botulism
The transmission of botulism varies according to the form contracted. The disease itself does not change, but the mode of transmission does.
Foods
The most common method of contaminating botulism is through food. Both the dietary and intestinal forms are caused by eating contaminated food.
In the case of food botulism, the patient ingests the toxin itself, commonly found in canned foods that have not undergone proper hygiene procedures, which allows bacteria to reproduce within the canned food.
In the case of intestinal botulism, the victim is usually a baby. The child’s digestive system is not as prepared as that of an adult to deal with contaminations that can be harmful.
Even if there is no toxin, if a baby swallows the bacteria, there is a chance that they will start to reproduce in the child’s gut, which releases the toxin directly into the body.
Wounds
Another way to contract botulism is through contact of the bacteria with wounds. A cut can be the means to enter the body, where the agent begins to reproduce and release botulinum toxin, thus causing the disease through a wound infection.
Risk factors
The disease is rare, but there are people who are more at risk of contamination than others. The main factors are:
Less than a year old
The bacterium is present all over the world. Children under one year of age have less developed intestinal flora and are therefore at risk for the development of infant or intestinal botulism.
Ingestion of poorly preserved food
If the procedure for preserving a food has been done without due care with hygiene, botulinum toxin may be present, thus causing botulism. Remember to always be careful with homemade preserves and to wash your food well.
Exposed wounds
If you have an injury, remember to protect it and keep it clean to prevent the bacteria from contacting it and starting to reproduce, thus causing the production of the toxin and, in turn, botulism.
Symptoms of the disease botulism
All symptoms of botulism are a consequence of the impossibility of neuronal communication that the toxin causes, leading to problems of the nervous system. Are they:
Cold
Constipation is one of the first symptoms, often associated with paralysis of the intestinal muscles.
Descending progressive muscle paralysis
Botulinum toxin poisoning causes paralysis, which is the main symptom.
It is progressive and usually begins with the face, often causing initial lateral paralysis. Then it spreads to other muscles, such as those in the mouth, arms and legs, and finally leads to respiratory paralysis.
Impaired speech and locomotion are characteristic of this disease, but it can also be confused with other conditions with similar symptoms, which can delay proper treatment.
Eyelid ptosis
Eyelid ptosis is paralysis of the eyelid, which can fall. It is one of the first signs of facial paralysis.
Photophobia
Photophobia is characterized by an aversion to light. The eyes become sensitive to light and the person may feel more comfortable in the dark when suffering from botulism.
Double vision
Double vision, also called diplopia, can be a symptom of intoxication by botulinum toxin.
Swallowing difficulty
Paralysis of the throat and mouth muscles can leave the patient with difficulties to swallow solid and liquid foods, which can represent a risk to the patient’s survival.
Speech problems
When the tongue and other muscles of the mouth of the intoxicated patient are affected by botulism, there may be difficulties in articulation, causing the so-called dysarthria , which is the difficulty of speech due to nervous problems.
Respiratory paralysis
The most serious and lethal symptom of botulism is paralysis of the diaphragm, the muscle that controls the entry and exit of air from the lungs. With the diaphragm paralyzed, our body is not able to breathe, which leads to death.
How is botulism diagnosed?
The diagnosis of botulism can be made through toxicological tests, which look for the toxin, or by finding the bacteria reproducing.
After a clinical examination , which consists of a medical analysis that raises the suspicion of the disease, other tests are performed.
The doctor responsible for this diagnosis can be the general practitioner , the infectologist and the toxicologist .
Some ways to achieve these results are:
Differential diagnosis
The differential diagnosis is made to differentiate one disease from another with similar symptoms, so that the appropriate treatment is carried out.
In the case of botulism, this is extremely important since, due to the lethality of the disease, rapid diagnosis is urgent and there are other diseases with similar symptoms.
Botulism can be confused with Guillain-Barré syndrome, myasthenia gravis, amyotrophic lateral sclerosis and others.
Therefore, the differential diagnosis is made by elimination, seeking to find exclusive details of each disease.
Blood test
By examining the blood serum, it is possible to find the botulinum toxin. Her identification confirms the diagnosis.
Stool examination
Stool examination can find both the toxin and the bacteria, if it is in the patient’s intestine.
Wound sample culture
When a case of wound botulism is suspected, a sample of the wound can be taken and the bacteriological culture performed. If it is confirmed that the bacterium Clostridium botulinum exists in the wound , the diagnosis can be made.
Does botulism have a cure?
Despite the high level of lethality of botulism, the disease can be cured. The toxin that binds to the nerves remains connected to them for several days, maintaining symptoms and creating risks, but after some time the nerves regenerate.
The treatment aims to keep the patient alive until regeneration occurs, in addition to eliminating the toxin that is circulating in the body of the intoxicated person.
What is the treatment for botulism?
The treatment for botulism is carried out with specific antitoxins – if the exact type can be identified – or polyvalent, which work in more than one type of botulinum toxin.
This treatment seeks to eliminate toxin from the body, but it is not able to remove that which has already connected to the nerves.
From this point on, the goal is to keep the patient alive until recovery occurs.
Antitoxin
Antitoxin is a drug made with human immunoglobulin for botulism. The substance eliminates the toxin from the body, preventing the symptoms from spreading.
In some cases, especially when there has been a long time since the onset of the disease, it may not be effective, which can cause sequelae or even death.
It is important that treatment with antitoxin is started as soon as possible, so if there is a suspicion of botulism, the drug should be introduced even before laboratory confirmation, as the results can take a few days and this can be very dangerous.
Gastric lavage
Stomach washing is performed to eliminate foods that may be contaminated with the toxin and that have not yet been digested. This way, more toxin is prevented from entering the bloodstream.
To perform this procedure, a probe is inserted in the patient’s stomach, which irrigates and aspirates the contents.
Enemas
An enema is the insertion of water into the anus for the purpose of washing. It can be performed for the elimination of the toxin that may be present in the patient’s intestines.
Hospitalization
Hospitalization is performed to ensure that the patient survives. In case of diaphragm paralysis, breathing must be performed through hospital equipment so that the patient is stable.
Antibiotics
In the case of wound botulism, antibiotics can be used to eliminate the bacteria, but the same does not apply to the intestinal version.
In the vast majority of cases of intestinal botulism, the patient is a baby, which means that his body is small and fragile.
The death of the bacteria by antibiotics can cause a momentary increase in the availability of botulinum toxin. When the bacteria is in a wound in an adult, this is not usually a problem, but in babies this increase can be dangerous.
That is why, in the case of intestinal botulism, antibiotics are not usually used, since the body itself is usually able to eliminate the bacteria.
Medicines for botulism
The treatment for botulism uses some medications. The main one is the antitoxin that serves to prevent further damage to the nerves. Antibiotics, in turn, cannot be used in all cases, but they can eliminate the bacteria in situations where this is necessary.
Medicines for botulism are:
Antitoxin
The substance used to eliminate botulinum toxin from the human body is human anti-botulinum immunoglobulin .
This substance neutralizes the toxin in the affected organism. It is not able to eliminate the poison when it has already connected to the nerves, nor to reverse the damage, so the symptoms continue, but its progression slows down or even stops.
There is also equine heptavalent antitoxin, which is produced with the blood serum of horses and, like human immunoglobulin, can neutralize toxins that have not yet bound to nerves.
These drugs, when used too late, may not have the expected effect.
The antitoxin for botulism can be found here:
- Antibotulinic Serum AB – Instituto Butantan .
Antibiotics
In cases where the disease is contracted through wounds, antibiotic medications may be needed to eliminate the bacteria and stop it from producing the toxin.
Remembering that they are not suitable for children under 1 year of age.
Antibiotics against the bacterium Clostridium botulinum are:
- Metronidazole ( Flagyl );
- Amoxicillin ( Amoxil ).
Attention!
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Living together
Botulism must be closely monitored by a medical team and, therefore, during treatment, it is important that the patient is hospitalized.
This ensures that if the disease progresses to respiratory paralysis, doctors can act quickly to save the person’s life.
Nasogastric feeding (through a tube that enters the nose and goes to the stomach) may be necessary if swallowing is impossible due to the disease. This type of food is preferable to parenteral (via the vein) as the nasogastric intestine continues to function.
After recovery, physical therapy may be necessary for the patient who has been paralyzed for a long time.
Prognosis
The patient who contracts botulism needs to be treated quickly, to prevent the disease from advancing and causing the person to die. Lethality is high and diagnosis is often difficult. However, with medical care and quick start of treatment, a cure is possible.
Complications
The damage caused by the toxin to the nerves is not undone when it is eliminated from the body.
Recovery depends on nerve regeneration, which can take up to 12 months. Depending on which nerves are affected, this can mean months in the hospital. The main complications are:
Respiratory paralysis
The major cause of death due to botulism is paralysis of the diaphragm, which is the muscle that performs the breathing movements. When this happens, respiration by machines becomes necessary.
Muscle paralysis
The paralysis of several muscles can cause serious problems, from difficulties in locomotion to muscle atrophy due to lack of prolonged movement. Physical therapy may be required after recovery is complete, which can take months.
Hospital infections
Due to the long period that the patient may have to be hospitalized, nosocomial infections are a concern.
Is botulism preventable?
There are a few ways to reduce the chances of getting botulism. Are they:
Avoid poorly preserved foods
If you are going to eat canned or canned food, be sure to check the validity and analyze the can to ensure that it is not crushed or tampered with. If the preserves were made at home, boil for five minutes in water to denature the toxin.
It is also important to know the methods of preparing the preserves to make sure that the hygiene used was adequate.
Clean wounds
When there are injuries, remember to treat and sanitize them properly to prevent bacteria such as botulism from entering the wounds.
Other bacteria can also cause infections, so cleaning wounds prevents not only botulism, but several other diseases.
Do not give honey to children under 1 year
It is estimated that 8% of the honey produced has the bacterium Clostridium botulinum . For an adult, this is not a problem, as the digestive system and intestinal flora can eliminate the agent before it starts producing the toxin.
However, a baby’s system may not be as prepared.
Therefore, avoid giving honey to young children to reduce the chances of them coming into contact with the bacteria.
Bovine botulism
Botulism in livestock is a major concern of the livestock industry, as in the same way as in humans, the disease has a high lethality rate. The infection, in this case, is usually related to the lack of phosphorus in the animals’ diet.
Phosphorus deficiency causes cattle to seek the substance elsewhere, often through osteophagy , which is the ingestion of bones from other animals found in pasture.
Unfortunately, animal carcasses are ideal environments for the bacterium Clostridium botulinum to reproduce, releasing botulinum toxin in it. When the ox or cow eats the bone from the carcass to supply its need for phosphorus, intoxication can occur.
As in humans, paralysis can occur and lead the animal to death.
Prevention is the best way to prevent bovine contamination by botulism.
Supplementing livestock’s diet with phosphorus can prevent animals from eating bones. Incinerating animal carcasses is also an appropriate method to avoid contamination.
Can I develop botulism with botox application?
It is possible, but the chances are slim. The amount normally used is low and the toxin is usually contained at the application site.
What botox does is to paralyze a region on purpose, preventing muscle contraction that wrinkles the skin.
However, it is important to know that there are risks. If the dose applied is very large or in a place where the toxin can go to other parts of the body, there may be a danger of developing botulism. Be sure to carry out the application in trusted locations.
