What is Botulism Food Poisoning?

Botulism food poisoning is a severe and potentially life-threatening illness caused by the consumption of food contaminated with botulinum neurotoxins (BoNTs). Here are the key points about botulism food poisoning:

1. Neuroparalysis: Botulism food poisoning results in neuroparalysis, a condition characterized by paralysis of the muscles. It is caused by the potent neurotoxins produced by the bacterium Clostridium botulinum.
2. Modes of Infection: Botulism can occur through two main modes of infection. First, by ingesting foods that contain preformed BoNTs. Second, by the production of BoNTs in the intestine when the spores of Clostridium botulinum germinate and multiply in the intestinal tract.
3. Types of Botulinum Toxins: There are seven distinct types of botulinum toxins, labeled as Type A to G. Among these, Type A, B, and E are associated with food-borne botulism in humans.
4. Clinical-Epidemiological Forms: Botulism has different forms based on the clinical and epidemiological characteristics. These include food-borne botulism (from consuming contaminated food), infant botulism (in infants who ingest spores and develop symptoms), and wound botulism (resulting from contamination of wounds by the bacteria).
5. Lethal Dose: Botulinum toxins are incredibly potent, and even a small amount can be fatal. The lethal dose of BoNTs for humans ranges from 0.2µg to 2µg per kilogram of body weight.
6. High Fatality Rate: Botulism has a high fatality rate, particularly if left untreated. Prompt medical intervention is crucial to prevent severe complications and mortality associated with the disease.
7. Hazardous Biological Substance: Botulinum toxin is classified as a hazardous biological substance due to its extreme potency and potential for misuse. Strict safety measures and regulations are in place to handle and store the toxin.

Preventing botulism food poisoning involves proper food handling and storage practices, such as ensuring adequate heat treatment during cooking, avoiding consumption of visibly spoiled or improperly preserved foods, and following guidelines for home canning and preserving. It is important to note that if there is suspicion of botulism, immediate medical attention should be sought, as the administration of antitoxin and supportive care is essential for treatment.

Source of Clostridium botulinum contamination

Clostridium botulinum, an anaerobic, spore-forming, gram-positive bacterium, can be found in various environmental sources, leading to contamination. Here are the key points regarding the sources of Clostridium botulinum contamination:

1. Environmental Distribution: C. botulinum spores are widely distributed in the environment, ranging from soil and sewage to mud, lakes, and sediments of seas and oceans. They can also be found in the intestines of land and aquatic animals.
2. Contamination of Foods: The ability of C. botulinum to grow in diverse environments means that its spores can contaminate a wide range of foods. When present in food, the bacterium can colonize and produce toxins that lead to botulism.
3. Honey and Syrup: C. botulinum spores are a major concern in the contamination of honey and syrup, which can be a significant source of infant botulism. It is important to note that infants under one year of age should not consume honey due to the potential risk of botulism.
4. Canned Foods: Poorly processed or inadequately heat-treated canned foods can be a primary source of C. botulinum contamination. The spores of C. botulinum are capable of surviving and producing toxins even under high heating temperatures during processing.
5. Fish and Meat Products: Various types of lake and sea fishes, particularly those that are smoked, salt-dried, or fermented, have been associated with C. botulinum contamination. Improper handling and processing of these products can contribute to the growth and toxin production of C. botulinum.
6. Soil and Biofertilizers: Certain strains of C. botulinum, particularly Types A and B, are commonly found in soil and can be present in biofertilizers. This increases the risk of contamination in vegetables and fruits that come into contact with the soil or are grown using such fertilizers.
7. Improperly Cooked Vegetables: Vegetables that are not adequately cooked or processed, such as beans, baked potatoes, corn, celery, mushrooms, onions, and olives, can serve as a source of C. botulinum contamination if the spores are present.

To prevent C. botulinum contamination, it is crucial to follow proper food handling, processing, and storage practices. This includes adequate heat treatment, proper canning techniques, avoiding consumption of spoiled or improperly preserved foods, and practicing good hygiene and sanitation in food preparation areas.

Botulism

• Botulism is an uncommon but deadly condition caused by a toxin that targets the nerves of the body, resulting in difficulties breathing, paralysis, and even death.
• The microorganisms Clostridium botulinum, Clostridium butyricum, and Clostridium baratii produce this toxin.
• These bacteria can create the poison in newborn intestines, food, and wounds.
• The bacteria that produce botulinum toxin are prevalent in nature, but they rarely cause illness in humans.
• These microorganisms produce spores, which serve as protective coverings. Spores aid bacteria in surviving even under harsh environmental circumstances.
• Even when the spores are ingested, they typically do not cause illness.
• Under specific conditions, however, these spores can produce one of the most dangerous toxins known.
• These circumstances allow spores to thrive and produce toxin:
  • Low-oxygen or oxygen-free (anaerobic) atmosphere.
  • Low in acidity
  • Low sugar.
  • Low salt.
  • A certain range of temperatures.
  • A specific quantity of water.

The Organism

The consumption of food containing the neurotoxin generated by Clostridium botulinum causes botulism. This rod-shaped soil bacterium is anaerobic, saprophytic, spore-forming, and gas-forming. On the basis of the serological specificity of their toxins, seven types are distinguished; the primary (or only) toxin from each type is denoted with the same capital letter.

• Type A: In the western region of the United States, type A botulism is the most frequent. It’s more dangerous than type B.
• Type B: Type B is more prevalent than type A in the majority of the world’s soils and is less harmful to humans.
• Type C: As far as is known, type C causes botulism in poultry, cattle, mink, and other animals but not in humans.
• Type D: Type D is connected with fodder poisoning in the Union of South Africa’s cattle population.
• Type E: Type E, which is hazardous to humans, is primarily derived from fish and fish products.
• Type F: Type F, which is similar to types A and B except for its toxin, has been identified in Denmark and causes human botulism.
• Type G: In Argentina, Type G has been isolated from the soil, but it has not been linked to human botulism.

Not all species produce the same poison. Some type C strains, for instance, produce primarily C1 toxin with minor levels of D and C2 or just C2 toxin. Strains of type D produce primarily D toxin with smaller levels of C1 and C2 toxins. Type A strains and the majority of type B cultures are proteolytic and putrefactive enough to impart an offensive odour to protein-rich foods, whereas type B strains and type E strains are not. Even the first two categories fail to create obvious putrefaction symptoms in low-protein foods like string beans and corn, while producing toxins. The organism ferments carbohydrates with the generation of gas, but this is not always apparent.

Types of Strains

Separating the various strains of C. botulinum based simply on toxin types yields extremely varied groups. C. botulinum strains are typically grouped into three broad categories based on their cultural and physiological characteristics:

• Group I: Group I contains all proteolytic strains of type A, as well as proteolytic strains of types B and F.
• Group II: Group II consists of all nonproteolytic type E strains and nonproteolytic strains of B and F.
• Group Ill: Group Ill consists of kinds C and D, which are nonproteolytic and share a similar metabolic mechanism.

Clostridium botulinum neurotoxin production

Clostridium botulinum, a strict anaerobic bacterium, produces the neurotoxins known as BoNTs (Botulinum Neurotoxins). Here is information about the production of Clostridium botulinum neurotoxins:

1. Neurotoxin Production: BoNTs are extracellular proteins produced by Clostridium botulinum. These neurotoxins have a molecular weight of approximately 150 kDa.
2. Serotypes: BoNTs can be classified into seven distinct serotypes: Type A, B, C, D, E, F, and G. Each serotype has unique characteristics and properties.
3. Grouping Based on Activity: BoNTs are further categorized into four groups based on their proteolytic and non-proteolytic activity: Group I, II, III, and IV.
4. Group I: Group I includes proteolytic BoNTs, specifically Type A, B, and F. These toxins can proliferate and produce neurotoxins within a temperature range of 10 to 20°C.
5. Group II: Group II consists of non-proteolytic BoNTs, namely Type B, E, and F. These neurotoxins are capable of growth and toxin production at lower temperatures, typically around 2.5 to 3°C.
6. Group III and IV: Group III comprises non-proteolytic BoNT Type C and D, while Group IV contains Type G. These serotypes have their distinct characteristics and activities.
7. Spore Formation and Toxin Production: Clostridium botulinum is capable of forming spores that enable survival in harsh conditions. When spores are consumed and reach the intestine, they can germinate and produce BoNTs, leading to botulism intoxication.
8. Strict Anaerobes: Clostridium botulinum is an obligate anaerobic bacterium, meaning it thrives in environments devoid of oxygen. This anaerobic nature is significant in the context of its growth and neurotoxin production.
9. High Temperature Resistance: Clostridium botulinum spores are resistant to high temperatures, allowing them to survive heat treatments. This resilience contributes to their potential to cause botulism when consumed in improperly processed or preserved foods.

Epidemiology of Botulism Food Poisoning

Botulism food poisoning has an interesting epidemiological history. Here is information about the epidemiology of botulism food poisoning:

1. Historical Use as a Biological Agent: During World War II, botulinum toxin was used as a biological agent by the British, American, and Japanese military due to its extreme potency and potential for harm.
2. Large Outbreak in Egypt: In 1991, a significant outbreak of botulism occurred in Egypt. The outbreak was linked to the consumption of a traditional salted fish dish called fesaikh, contaminated with Type E toxin. This outbreak resulted in 91 cases, with 18 fatalities.
3. Improperly Preserved Fish: In the Egyptian outbreak, the fish used for the traditional dish was salted and stored in barrels, creating an environment conducive to the growth of botulinum toxin-producing bacteria.
4. Misuse of Botulinum Toxin: In 2004, an osteopathic physician attempted to use botulinum toxin on himself and his girlfriend as a cosmetic treatment similar to Botox. Both individuals were hospitalized with respiratory failure and required ventilation for several months.
5. Botulism Cases in the United States: The United States reports the majority of botulism cases worldwide, accounting for approximately 90% of cases. Each year, there are typically 9 to 10 outbreaks reported.
6. Home-Preserved Food Products: Many botulism outbreaks are associated with home-preserved food products, particularly those that involve canning, bottling, and preserving food in oil. Improper processing and storage of these products can create an environment favorable for the growth of botulinum toxin-producing bacteria.

The Toxin

• The pure and crystallised protein toxin of C. botulinum is so lethal that only a minute amount is required to cause death.
• It is primarily absorbed in the small intestine and paralyses the body’s involuntary muscles. Its relative thermolability is an essential property.
• The heat treatment required to eliminate a toxin depends on the organism producing the toxin and the heating medium.
• To deactivate type A toxin in the laboratory, heat treatments of 5 to 6 minutes at 80 degrees Celsius and 15 minutes at 90 degrees Celsius are required.
• This should not be interpreted as evidence that thoroughly boiling a highly questionable product is a worthy risk.
• As noted previously, the growth of C. botulinum in certain foods results in a stench so vile and rancid that the item is rejected.
• Meats and protein-rich, low-acid vegetables emit a particularly offensive stench. More acidic foods and those deficient in protein, on the other hand, may become just as poisonous without much putrefaction evidence.
• In addition, the nonproteolytic strains of C. botulinum exhibit less signs of spoiling than the proteolytic variants. In addition, gas generation is not always detectable and is therefore not a reliable indicator of spoiling caused by this bacterium.
• Certainly, it is prudent to discard any raw or canned food that exhibits signs of deterioration, as well as any canned food that exhibits pressure within the container.
• Gamma rays can destroy the toxin in cheese at 7.3 Mrad and in soup at 4.9 Mrad. It is known that the toxin persists in foods for extended durations, especially when stored at low temperatures.
• It is unstable at pH levels greater than 6.8. The nonproteolytic strains create toxins that are not completely activated, and the addition of trypsin will increase their maximum toxicity potential.
• As previously stated, the seven toxins (A to G) are antigenic, resulting in the generation of antitoxin specific to the injected toxin type.
• Some forms of toxoids have been developed for the active vaccination of researchers who may be exposed to the botulinum toxin by mistake.

Toxicity and Bacteriophages

• It is fairly uncommon to isolate nontoxigenic colonies of C. botulinum from a known toxigenic strain.
• Recent research on the relationship between toxigenicity (the ability to produce the toxin) and temperate bacteriophages (intracellular, integrated phage nucleic acid) suggests that the bacterial genome may not be responsible for the production of the toxin, but that the genome of an incorporated temperate bacteriophage may be.
• This might explain why some strains occasionally lose their toxigenicity. Types C and D can be “cured” of their temperate bacteriophage and rendered nontoxigenic by experimentation.
• Even if types A, B, and F have been “cured” of bacteriophages, they remain toxic.
• There are apparently bacteriophages for C. botulinum that induce toxogenesis. Also, a single strain may carry many temperate bacteriophages (multiple infection), which may explain why, as indicated previously, some strains produce more than one type of toxin.

Botulinum toxin action

Botulinum toxin has a specific mode of action once it enters the body. Here is information about the action of botulinum toxin:

1. Resistance to Stomach Acid: Orally ingested botulinum toxin or toxin produced in the gastrointestinal tract must withstand the acidic environment of the stomach in order to pass through and reach the intestine. This allows the toxin to be absorbed into the bloodstream.
2. Absorption and Colonization: Botulinum toxin is absorbed in the duodenum and jejunum of the small intestine. It then colonizes in these regions, from where it can enter the bloodstream.
3. Entry into the Nervous System: Once in the bloodstream, botulinum toxin is taken up by peripheral nerves through a process called endocytosis. It travels within the bloodstream and reaches the peripheral nervous system.
4. Cleavage and Protease Activity: Inside the neuron, the botulinum toxin undergoes cleavage, where a specific chain of the toxin is separated. This chain acts as a zinc-dependent protease, meaning it requires zinc ions to function properly.
5. Attack on SNARE Proteins: The cleaved botulinum toxin chain targets SNARE proteins (soluble N-ethylmaleimide sensitive fusion protein attachment receptors) within the neuron. It specifically attacks these proteins, which play a crucial role in the release of acetylcholine, a neurotransmitter.
6. Inhibition of Acetylcholine Release: By interfering with SNARE proteins, botulinum toxin prevents the release of acetylcholine at the nerve-muscle junction. Acetylcholine is responsible for transmitting signals from nerves to muscles. The inhibition of acetylcholine release disrupts this transmission, leading to muscle paralysis.
7. Flaccid Paralysis: The overall effect of botulinum toxin action is a flaccid paralysis, characterized by weakened and relaxed muscles. This paralysis occurs because the toxin inhibits the transmission of stimuli from nerves to muscles, resulting in a loss of muscle function.

Heat Resistance of Spores 

• In comparison to the spores of the vast majority of other Clostridium species, the spores of certain putrefactive anaerobes, notably C. botulinum, are rather resistant to heat.
• The heat treatment necessary to eliminate all spores in a food depends on the type of food, the type and strain of C. botulinum, the medium in which the spores were generated, the temperature at which they were formed, their age, and the amount of spores present.
• For a study of the elements that affect the heat resistance of spores, the reader should turn to Chapter 6.
• Esty and Meyer (1922) suggested the following heat treatments to eliminate all C. botulinum spores in food:
• In general, the spores of types C, D, and E organisms are less heat-resistant than those of types A and B, with type E spores inactivated in 15 minutes at 80 degrees Celsius.
• Types A and B spores have D12IC values of 0.21 minutes, whereas type E spores have D100C values between 0.003 and 0.017 minutes.
• Comparing type C spores has revealed that marine strains are more resistant to heat than terrestrial strains (D104C of 0.4 to 0.9 min for the former and D104C of 0.02 to 0.08 for the latter).

Distribution of Spores 

• The soil is assumed to be C. botulinum’s habitat, as spores have been discovered in both cultivated and uncultivated soils around the world.
• Tests indicate that type A spores are more prevalent in the western soils of this country than type B spores.
• After consuming such plants, the soil, intestinal contents, and therefore dung of animals may contaminate plant crops.
• Spores of type E are found in soil, sea and lake mud, and in the intestinal tracts of fish.

Incidence of Botulism 

• Fortunately, botulism is uncommon, but due to its high fatality rate, it always deserves considerable attention.
• The rate of case fatalities has decreased. For example, between 1970 and 1973, the case fatality rate in the United States was approximately 23 percent, whereas between 1899 and 1949, it exceeded 60 percent.
• 23.1 percent of the 688 botulism outbreaks reported between 1899 and 1973 were caused by type A, 6.3% by type B, and 3.2% by type E.
• In 67.3 percent of outbreaks, the kind could not be determined. In recent years, the proportion of outbreaks for which the type is unknown has declined; for example, between 1970 and 1973, just 19.0 percent of outbreaks were untyped.

Conditions Necessary for an Outbreak 

The following conditions are required for a botulism outbreak:

• The presence of spores of C. botulinum types A, B, or E in food that has been canned or otherwise processed.
• Food that allows spores to germinate and clostridia to proliferate and create poison.
• Survival of the organism’s spores, for example, as a result of insufficient heating during canning or inadequate processing otherwise.
• After processing, the environment must be conducive to spore germination, growth, and toxin generation by the organism.
• Insufficient heating of the food to render the poison inactive.
• ingesting the food containing the poison.

Prevention of Outbreaks 

• Among the procedures and precautions for preventing botulism listed in the preceding section is the use of approved heat processes for canning goods.
• All canned goods that are gassy or otherwise deteriorated must be rejected.
• unwillingness even to taste a questionable food.
• Avoiding foods that have been cooked, stored, and improperly reheated.
• At least 15 minutes of boiling a suspected food product is required. Avoiding uncooked or precooked items that have been frozen, thawed, and stored at room temperature could be included to this list.
• To prevent botulism from smoked fish, it has been suggested that (1) good sanitation be maintained throughout production and handling, (2) the fish be heated to at least 82 degrees Celsius for 30 minutes in the coldest part during smoking or after smoking, (3) the fish be frozen immediately after packaging and kept frozen, and (4) all packages be labelled “Perishable-Keep Frozen.”

Types of Botulism

The five most common types of botulism are:

• Infant botulism: Infant botulism can occur if the bacteria’s spores enter an infant’s intestines. The spores multiply and generate the disease-causing toxin.
• Wound botulism: Botulism of the wound can occur when spores of the bacteria enter a wound and produce a toxin. People who inject narcotics are more likely to contract wound botulism. Botulism has also occurred in patients with traumatic wounds, such as those sustained in a motorbike accident or during surgery.
• Foodborne botulism: Consuming foods infected with botulinum toxin can cause botulism that is transmitted via the food chain. Homemade foods that have been inadequately canned, preserved, or fermented are common botulinum vectors. Although rare, botulinum toxin contamination of store-bought goods is also possible.
• Iatrogenic botulism: Iatrogenic botulism can occur when excessive botulinum toxin is injected for aesthetic or medicinal purposes, such as to treat wrinkles or migraine headaches.
• Adult intestinal toxaemia: Adult intestinal toxaemia (also known as adult intestinal colonisation) botulism is a relatively rare form of botulism that occurs when spores of the bacterium enter the intestines of an adult, multiply, and generate the toxin (similar to infant botulism). Although we don’t know why people acquire this sort of botulism, persons who have major health disorders that damage the stomach may be more likely to get sick.

Symptoms of Botulism

Among the possible signs and symptoms is 

• difficulty swallowing.
• musculoskeletal weakness
• Double vision.
• Drooping eyelids.
• fuzzy vision
• Fluctuating speech
• Breathing difficulties
• It is difficult to move the eyes.
• Vomiting.
• Nausea.
• Stomachache.
• Diarrhea.

Signs and symptoms in an infant might include:

• Constipation.
• Poor feeding.
• Drooping eyelids.
• Slowly responding pupils to light.
• Face expressing less emotion than usual.
• A weak cry that sounds distinct from the norm.
• Breathing difficulties

All of the symptoms originate from the toxin-induced paralysis of the muscles. If left untreated, the condition may advance and symptoms may deteriorate to the point where some muscles, particularly those required for breathing and those in the arms, legs, and trunk, become completely paralysed (part of the body from the neck to the pelvis area, also called the torso).

Symptoms of foodborne botulism often appear between 18 and 36 hours after consuming a contaminated product.

Detection of Botulism Food Poisoning

1. Bioassay

• By injecting the poison into a mouse and measuring its toxicity, the bioassay is the most sensitive and extensively used method.
• Injected mice show symptoms within four hours.
• The botulinum toxin is characterised by abdominal tremors, an abdomen in the shape of a wasp, paralysis of the limbs, and breathing difficulties.

2. Immunoassay

• ELISA is the most sensitive immunoassay used to detect botulinum toxin.
• ELISA binds the antigen (toxin) present on the solid surface to the antibody (antitoxin).
• The amount of toxin can then be measured by an enzymatic response after a second enzyme-labeled antibody attaches to the antigen.
• The quality of the antiserum employed determines the specificity and sensitivity of ELISA.

3. Endopeptidase assay

• Endopeptidase assay is an in-vitro assay used to determine the therapeutic potential of a toxin. (Botox, Dysport, Xeomin, etc.)
• Bioluminescence, fluorescence resonance energy transfer (FRET), and mass spectrometry are used to measure it.
• As it identifies only active botulinum toxins, the endopeptidase test is more reliable than immunoassays.

4. PCR-based assays

• Using a primer with a high annealing temperature and agarose gel electrophoresis, traditional multiplex PCR detects the toxin gene. It can identify types A, B, E, and F toxins.
• Real-time PCR is able to identify BoNT A, B, and E.
• Within 1 to 2 hours, fluorescence-based PCR amplifies gene fragments and detects the toxin with excellent sensitivity.

Treatment of Botulism

• Botulism is caused by a toxin that targets the nerves of the body, resulting in difficulties breathing, paralysis, and even death.
• Antitoxins are used to treat botulism, as they prevent the toxin from causing further damage.
• Antitoxin does not repair the damage already caused by the toxin. Depending on the severity of your symptoms, you may need to spend weeks or even months in the hospital before you are healthy enough to return home.
• If your illness is severe, you may experience breathing difficulties. If the poison paralyses the muscles responsible for breathing, you may potentially experience respiratory failure.
• If this occurs, your doctor may place you on a ventilator until you can breathe on your own.
• Toxin-induced paralysis typically improves slowly. The purpose of the medical and nursing care you get in the hospital is to facilitate your recovery.
• Botulism of the wound may necessitate surgery to remove the source of the germs, as well as the administration of medications.

As a result of the discovery of antitoxin and modern medical care, the mortality rate among botulism patients is far lower than it was in the past, when approximately 50 out of every 100 patients died. Today, less than 5 out of every 100 botulism patients die.

Even with antitoxin and intense medical and nursing care, some botulism patients succumb to respiratory failure. Others perish from infections or other complications resulting from weeks or months of paralysis.

Patients who survive botulism may experience chronic weariness and shortness of breath for years and may require long-term therapy to recover.

Prevention of Botulism

Foodborne botulism

Many cases of foodborne botulism have resulted from the consumption of tainted home-canned, preserved, or fermented foods. The food could have become infected if it had not been properly canned (processed).

Low-acid foods are the most common source of botulism cases associated to home canning. Examples of foods low in acid include:

• Asparagus
• Green beans
• Beets
• Corn
• Potatoes

The identification of new sources of foodborne botulism continues. When food is incorrectly handled during its preparation, storage, or consumption, it might get contaminated. The following foods are examples of contaminated foods:

• Garlic minced with oil.
• Cheese sauce from a can
• Tomatoes in cans
• Carrot juice.
• Potatoes baked and wrapped in foil.

If you preserve, can, or ferment your own foods, you can limit the risk of botulism by taking the following precautions:

• In the USDA Complete Guide to Home Canning, the U.S. Department of Agriculture recommends safe home canning procedures.
• Following all washing, cleaning, and sterilising instructions for canning equipment.
• Utilizing pressure canners for low-acid items such as potatoes, the vast majority of other vegetables, and meats.

Everyone can lower their risk of contracting botulism by:

• Keeping handmade oils infused with garlic or herbs refrigerated and discarding any unused oils after four days.
• Keeping baked potatoes wrapped in aluminium foil hot (at temperatures above 140°F) until they are served, or refrigerating them with the foil loosened.
• After opening canned or pickled items, refrigerate them.

Wound Botulism

Keep wounds clean to prevent wound botulism. If wounds appear infected, seek immediate medical attention. If a wound meets the following criteria, it may be infected:

• Red
• Swollen
• Painful
• Warm to the touch
• Full of pus or other drainage
• Accompanied by fever

Not all botulism-infected wounds exhibit these common signs of a wound infection. If you have a wound and develop botulism symptoms, seek medical attention immediately.

Botulism is more prevalent among those who inject illicit drugs, such as black tar heroin, than among those who do not inject drugs. Individuals who contract botulism from injecting illegal narcotics may not have a visibly diseased injection site. Learn more about how to prevent drug-induced wound botulism.

Botulism can occur after traumatic injuries, including motorcycle accidents and surgery. Be vigilant for symptoms of infection.

Infant botulism

• The bacteria that cause baby botulism cannot be prevented in the majority of instances because they are found in soil and dust.
• Even after cleaning, the bacteria can be found on floors, carpet, and worktops.
• Ingestion of botulinum spores is not dangerous and will not cause botulism in almost all healthy children and adults (the toxin is dangerous).
• Some infants develop botulism for unknown causes when spores enter their digestive tracts, proliferate, and create the toxin.
• Honey may contain the bacteria that causes infant botulism; therefore, children younger than 12 months should not consume honey. Honey is safe for those 1 years and older.

Iatrogenic botulism

You can prevent iatrogenic (an illness induced by medical examination or treatment) botulism by having injections of botulinum toxin exclusively by qualified practitioners:

• If you require a botulinum toxin injection for a medical issue, your physician will select the safest dose.
• Botulinum toxin injections for cosmetic purposes should only be administered by licenced professionals.

Adult intestinal colonization

• Adult intestinal colonisation, commonly known as adult intestinal toxaemia, is an extremely uncommon form of botulism.
• People with health disorders that alter the structure or function of their intestines (gut) may be at increased risk.
• Few patients have been diagnosed with adult intestinal toxaemia, and experts do not fully comprehend how this form of botulism develops. It may be comparable to newborn botulism, which is incurable.

Injection Drug Use and Wound Botulism

Botulism, a potentially fatal condition, poses a concern to individuals who inject illegal substances. If you inject illicit narcotics, especially black tar heroin, under your skin (“skin popping”) or into your muscle (“muscle popping” or “muscling”), your risk of developing wound botulism increases.

Botulism of the wound is an uncommon but deadly sickness that occurs when the bacterium Clostridium botulinum enters a wound and produces a toxin. This toxin assaults your body’s nerves, causing difficulty breathing, muscle weakness, and even death. If you develop wound botulism, you will require antitoxin. The antitoxin can prevent the toxin from inflicting further injury, but it cannot reverse the damage that has already occurred. Even after getting antitoxin, you may have to remain hospitalised for weeks or even months before you can return home.

What to Watch For

Botulism of the wound typically manifests several days following injection of contaminated medications, as opposed to immediately. It takes several days or even a couple of weeks for the germs to multiply and produce the toxin within the body.

Some of the possible symptoms include 

• double vision.
• Vision impaired
• Drooping eyelids.
• Fluctuating speech
• Swallowing difficulties
• A tongue with a sensation of thickness.
• The mouth is dry.
• musculoskeletal weakness

As the condition worsens, you may acquire additional symptoms, such as: 

• breathing difficulties.
• Paralysis.

Botulism can occur even if the injection site does not appear infected.

Some symptoms of wound botulism resemble those of opioid overdose, including slurred speech or inability to speak, weakness, and difficulty breathing. Opioids include heroin and painkillers such as oxycodone (“OxyContin”), oxymorphone (“Opana”), hydrocodone (as in Vicodin), and hydromorphone (“Dilaudid”).

If administered in time, Naloxone, widely known as Narcan®, can reverse the consequences of an opioid overdose, but it cannot reverse the symptoms of botulism. Immediately visit a doctor or the emergency department if you or someone you know receives Naloxone treatment for botulism but continues to exhibit symptoms.

When seeking medical care, be straightforward and honest with your providers. Describe the medications you have taken within the past two weeks and how you utilised them. It is easy to confuse wound botulism with other, more prevalent infections. Your doctor must know if you inject drugs in order to rapidly and accurately diagnose and treat you.

How injecting heroin can give you botulism?

In the United States, around twenty persons are diagnosed with wound botulism each year. Most obtain heroin by skin popping or muscle popping. We do not know how black tar heroin becomes infected with the botulism-causing bacterium. Due to the fact that the bacterium resides in soil, it is possible for it to contaminate heroin during production, transportation, cutting, mixing, preparation for use, or other processes. The drug-use equipment (“works”) used to prepare or inject contaminated medicines may also transmit the botulism germs to anyone uses it.

Key facts:

• The botulism-causing microbe is invisible. There is no visual distinction between tainted and non-contaminated medications. The only way to determine if your medications are infected with the botulism-causing bacterium is through laboratory testing.
• The botulism bacterium is not eliminated by heating (or “cooking”) heroin. It takes specific conditions to eradicate this pathogen.
• You cannot contract botulism from another individual. It’s not infectious. But if you and another person share contaminated heroin or equipment (“works”), you could both contract botulism.

FAQ

References

1. Notermans, S. H. W., Stam, C. N., & Behar, A. E. (2014). CLOSTRIDIUM | Detection of Neurotoxins of Clostridium botulinum. Encyclopedia of Food Microbiology, 481–484
2. McLauchlin, J., & Grant, K. A. (n.d.). Clostridium botulinum and Clostridium perfringens. Foodborne Diseases, 41–78.
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