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Botulism. Overview. Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control . Organism. Clostridium botulinum Gram positive Obligate anaerobic bacillus Spores Ubiquitous Resistant to heat, light, drying and radiation

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Botulism

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Botulism


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Overview

  • Organism

  • History

  • Epidemiology

  • Transmission

  • Disease in Humans

  • Disease in Animals

  • Prevention and Control

Center for Food Security and Public Health Iowa State University 2004


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Organism

  • Clostridium botulinum

    • Gram positive

    • Obligate anaerobic bacillus

    • Spores

      • Ubiquitous

      • Resistant to heat, light, drying and radiation

      • Specific conditions for germination

        • Anaerobic conditions

        • Warmth (10-50oC)

        • Mild alkalinity

Center for Food Security and Public Health Iowa State University 2004


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Neurotoxins

  • Seven different types: A through G

    • Different types affect different species

    • All cause flaccid paralysis

    • Only a few nanograms can cause illness

    • Binds neuromuscular junctions

  • Toxin: Destroyed by boiling

  • Spores: Higher temperatures to be inactivated

Center for Food Security and Public Health Iowa State University 2004


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Neurotoxins

Center for Food Security and Public Health Iowa State University 2004


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History


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History

  • 1793, Justinius Kerner

    • “Wurstgift”

  • “Botulus” = Latin for sausage

  • 1895, Emile von Ermengem

    • Isolated organism during Belgium outbreak

  • U.S. outbreaks led to improved industry processing

Center for Food Security and Public Health Iowa State University 2004


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Transmission


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Transmission

  • Ingestion

    • Organism

    • Spores

    • Neurotoxin

  • Wound contamination

  • Inhalation

  • Person-to-person not documented

Center for Food Security and Public Health Iowa State University 2004


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Epidemiology


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Epidemiology

  • In U.S., average 110 cases each year

    • Approximately 25% food-borne

    • Approximately 72% infant form

    • Remainder wound form

  • Case-fatality rate

    • 5-10%

  • Infective dose- few nanograms

Center for Food Security and Public Health Iowa State University 2004


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Epidemiology

  • 1977, Largest botulism outbreak

    • Michigan - 59 people

    • Poorly preserved jalapeno peppers

  • Alaska

    • 27% of U.S. foodborne botulism cases

    • 1950-2000

      • 226 cases from 114 outbreaks

Center for Food Security and Public Health Iowa State University 2004


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Disease in Humans


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Human Disease

  • Three forms

    • Foodborne

    • Wound

    • Infant

  • All forms fatal and a medical emergency

  • Incubation period: 12-36 hours

Center for Food Security and Public Health Iowa State University 2004


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Foodborne Botulism

  • Preformed toxin ingested from contaminated food

  • Most common from home-canned foods

    • Asparagus, green beans, beets, corn, baked potatoes, garlic, chile peppers, tomatoes; type A

    • Improperly fermented fish (Alaska); type E

Center for Food Security and Public Health Iowa State University 2004


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110

100

90

80

70

60

50

40

30

20

10

0

Reported Cases

1982 1987 1992 1997 2002

Year

MMWR

Center for Food Security and Public Health Iowa State University 2004


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Infant Botulism

  • Most common form in U.S.

  • Spore ingestion

    • Germinate then toxin released and colonize large intestine

  • Infants < 1 year old

    • 94% < 6 months old

  • Spores from varied sources

    • Honey, food, dust, corn syrup

Center for Food Security and Public Health Iowa State University 2004


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110

100

90

80

70

60

50

40

30

20

10

0

Reported Cases

1982 1987 1992 1997 2002

Year

MMWR

Center for Food Security and Public Health Iowa State University 2004


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Wound Botulism

  • Organism enters wound

    • Develops under anaerobic conditions

    • From ground-in dirt or gravel

    • It does not penetrate intact skin

    • Associated with addicts of black-tar heroin

Center for Food Security and Public Health Iowa State University 2004


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Adult Clinical Signs

  • Nausea, vomiting, diarrhea

  • Double vision

  • Difficulty speaking or swallowing

  • Descending weakness or paralysis

    • Shoulders to arms to thighs to calves

  • Symmetrical flaccid paralysis

  • Respiratory muscle paralysis

Center for Food Security and Public Health Iowa State University 2004


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Infant Clinical Signs

  • Constipation

  • Lethargy

  • Poor feeding

  • Weak cry

  • Bulbar palsies

  • Failure to thrive

Center for Food Security and Public Health Iowa State University 2004


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Diagnosis

  • Clinical signs

  • Toxin in serum, stool, gastric aspirate, suspected food

  • Culture of stool or gastric aspirate

    • Takes 5-7 days

  • Electromyography also diagnostic

  • Mouse neutralization test

    • Results in 48 hours

Center for Food Security and Public Health Iowa State University 2004


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Treatment

  • Intensive care immediately

    • Ventilator for respiratory failure

  • Botulinum antitoxin

    • Derived from equine source

    • CDC distributes

    • Used on a case-by-case basis

  • Botulism immune globulin

    • Infant cases of types A and G

Center for Food Security and Public Health Iowa State University 2004


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Animals andBotulism


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Animals

  • Cattle and sheep

  • Horses

  • Birds and poultry

  • Mink and ferrets

  • Uncommon in dogs and pigs

    • Fairly resistant

  • No natural cases documented in cats

Center for Food Security and Public Health Iowa State University 2004


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Cattle and Sheep

  • Ingestion of toxin

  • Incubation

    • 24 hours to 7 days

  • Sources

    • Spoiled stored silage or grain

    • Silage using poultry litter or products

    • Phosphorus deficiency in cattle

    • Carcasses: Baled or chopped into hay

Center for Food Security and Public Health Iowa State University 2004


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Ruminants: Clinical Signs

  • Progressive ascending ataxia

  • Recumbent

  • Head turned into flanks

  • Cranial nerve dysfunction

  • Rumen stasis; bloat

  • Atonic bladder - loss of urination

Center for Food Security and Public Health Iowa State University 2004


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Cattle and Sheep: Diagnosis

  • History

  • Bloodwork and CSF tap: Normal

  • ELISA test available for type C & D

  • Definitive diagnosis

    • Demonstration of toxin in serum, gut contents or organs

  • Electromyography (EMG)

Center for Food Security and Public Health Iowa State University 2004


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Cattle and Sheep: Treatment

  • Symptomatic and supportive

  • Nutritional

  • Ventilatory support, if needed

  • Metronidazole

  • Antitoxin, in early stages

    • Ineffective by the time clinical signs are present

    • Can block further uptake of toxin

Center for Food Security and Public Health Iowa State University 2004


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Horses

  • Horses, especially foals, are highly sensitive to botulism toxin

  • Type B & C toxins

  • Incubation period

    • 24 hours to 7 days

  • Sources

    • Contaminated feed

    • Wound infections

Center for Food Security and Public Health Iowa State University 2004


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Adult Horses

  • “Forage poisoning”

    • Ingest preformed toxin

  • Clinical Signs

    • Dyspnea

    • Flaccid tail

    • Muscle tremors

    • Severe paresis to rapid recumbency

    • Unable to retract tongue, drooling

Center for Food Security and Public Health Iowa State University 2004


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Foals

  • “Shaker Foal” syndrome

    • Most 2 weeks to 8 months old

    • On a high nutrition plane

  • Spores in contaminated feed

  • Usually type B

    • Most common in KY and eastern seaboard

Center for Food Security and Public Health Iowa State University 2004


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Foals: Clinical Signs

  • Clinical signs

    • Paresis, recumbent

    • Muscle tremors

    • Dysphagia

    • Ptosis, mydriasis, decreased PLR

    • Ileus, constipation, urine retention

    • Death due to respiratory paralysis

  • Mortality greater than 90%

Center for Food Security and Public Health Iowa State University 2004


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Birds and Poultry

  • “Limber neck”

  • Types C and E

  • Good sentinel species

  • Sources:

    • Decomposed vegetation or invertebrates

    • Ingest toxin or invertebrates with toxin

    • Contaminated feed or water of chickens

Center for Food Security and Public Health Iowa State University 2004


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Birds and Poultry:Clinical Signs

  • Occurs 12-48 hours after ingestion

  • Droopy head

  • Drowsy

  • Wing and leg paralysis

    • Unable to hold their head up

    • Unable to use their wings or legs

  • Eyelid paralysis

Center for Food Security and Public Health Iowa State University 2004


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Mink and Ferrets

  • Type C

    • Occasionally A and E

  • Sources

    • Chopped raw meat or fish

    • Improper storage of meat by-products

  • Vaccine available for type C

Center for Food Security and Public Health Iowa State University 2004


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Dogs

  • Rare

  • Type C; few cases type D

  • Source

    • Ingestion of carrion

    • Wetland areas with avian botulism epizootics

  • Incubation period

    • Few hours to 6 days

Center for Food Security and Public Health Iowa State University 2004


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Dogs

  • Progressive symmetric ascending weakness

    • Rear limbs to forelimbs

  • Cranial nerve deficits

  • Respiratory paralysis

  • Lose ability to urinate and defecate

Center for Food Security and Public Health Iowa State University 2004


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Dogs

  • Diagnosis

    • Bloodwork and CSF: Normal

    • Electromyography (EMG)

    • Toxin in serum, vomitus, feces, or suspect food/carrion

    • Mouse neutralization test preferred

  • Treatment

    • Supportive

    • Antitoxin

Center for Food Security and Public Health Iowa State University 2004


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Prevention and Control


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Human: Prevention

  • Do not feed honey to children <1 yr of age

  • Proper food preservation methods

    • Proper time, temperature and pressure

      • 80oC for 30 min or 100oC for 10 min

  • Prompt refrigeration of foods

  • Boil foods for > 10 minutes

  • Decontamination

    • Boil suspected food before discarding

    • Boil or chlorine disinfect utensils used

  • Center for Food Security and Public Health Iowa State University 2004


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    Ruminants: Prevention

    • Good husbandry practices

    • Rodent and vermin control

    • Prompt disposal of carcasses

    • Avoid spoiled feedstuff or poor quality silage

    • Vaccination in endemic areas

    Center for Food Security and Public Health Iowa State University 2004


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    Equine: Prevention

    • Good husbandry

    • Rodent and vermin control

    • Avoid spoiled feed

    • Prophylactic vaccine for pregnant mares

      • Currently only type B botulinum toxoid available for horses

    Center for Food Security and Public Health Iowa State University 2004


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    Potential Bioterrorism Threat

    • Aum Shinriky cult

    • Extremely potent and lethal

    • Easily produced and transported

    • Signs of deliberate aerosol or foodborne release of toxin

      • No common source

      • Large number of acute cases clustered

      • Uncommon toxin type (C, D, F, G)

    Center for Food Security and Public Health Iowa State University 2004


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    Potential Bioterrorism Threat

    • Point source aerosol release

      • Incapacitate or kill 10% of persons within 0.5 km downwind

    • CDC surveillance system

      • Prompt detection of botulism related events

    Center for Food Security and Public Health Iowa State University 2004


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    Additional Resources

    • CDC – Division of Bacterial and Mycotic Diseases

      • http://www.cdc.gov/ncidod/dbmd/ diseaseinfo/botulism_g.htm

    • Center for Civilian Biodefense Strategies

      • http://www.hopkins-biodefense.org/pages/agents/ agentbotox.html

    Center for Food Security and Public Health Iowa State University 2004


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    Acknowledgments

    Development of this presentation was funded by a grant from the Centers for Disease Control and Prevention to the Center for Food Security and Public Health at Iowa State University.

    Center for Food Security and Public Health Iowa State University 2004


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    Acknowledgments

    Author:

    Co-author:

    Reviewers:

    Glenda Dvorak, DVM, MS, MPH

    Radford Davis, DVM, MPH

    Danelle Bickett-Weddle, DVM, MPH

    Jean Gladon, BS

    Center for Food Security and Public Health Iowa State University 2004


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