How spreads? & How to avoid?

(Hüseyinden al) (NOTION)

1. colonize in open wounds

2. colonize in intestines (from canned foods), (infants and adults(rare in adults)) → infant
botulism
3. inhalation botulism
4. iatrogenic botulism (injection of BoNT)

The treatment of botulism is antitoxin therapy. Antitoxin therapy is usually given during the first
24 hours after the exhibition of symptoms. Botulinum toxin can be absorbed through mucus
membranes of the eye, mouth, and nose even though they are not transmitted through direct skin
contact. Therefore, proper isolation and PPE (personal protective equipment) are essential.

Bioterrorism (Biosafety)

Neurotoxins of Botulinum has been interested by many bioterrosists for decades. Botulinum’s
toxins are used as bioweapon at least 60 years ago (Smart, 1997). In mid 1990s, there was found
19000 liters of serotype A was found in warheads in Iraq (Cohen & Marshall, 2001). Botulinum’s
toxin is the deadliest poison, moreover, LD50 of BoNT would kill a mouse even 1ng/kg (Gill,
1982). BoNT is favorite toxin for biodefense researches to avoid bioterrorism.

HOW SPREADS? & HOW TO AVOID?

Food-borne botulism (in adequately canned foods)

Wound botulism (wounds by soil, gravel, or improperly treated open fractures, Iatrogenic
botulism)

Infant botulism ( generally from spore contaminated honey, caregivers suggest not to give
honey to infants until reach 1 year old.)
Adult intestinal colonization botulism  (similar to infant but

Inhalation botulism (rare, through BT (release toxins in aerosol))

To avoid these kinds of spreads, consume good canned foods, do not let infants to eat honey, if
you hurt yourself go immediately to hospital, do not take pre-used injections.

Botulism. (2018, January 10). Retrieved March 14, 2021, from

https://www.who.int/news-room/fact-sheets/detail/botulism#:~:text=Foodborne
%20botulism%20is%20a%20serious,of%20botulism%20does%20not%20occur.

Gangarosa EJ, Donadio JA, Armstrong RW, Meyer KF, Brachman PS, Dowell
VR. Botulism in the United States, 1899-1969. Am J Epidemiol. 1971 Feb;93(2):93-101.

HOW TO TREAT? & TREATMENT METHODS?

Botulism needs to be hospitalization generally. Botulism is mainly treated by antitoxins and also
antibiotics. Besides, nursing and physician support, sometimes intensive care unit to support
mechanic ventilation might be needed. Early antitoxin treatment is crucially important as usual.

Harvard Health, P. (2019, April). Botulism. Retrieved March 14, 2021, from
https://www.health.harvard.edu/a_to_z/botulism-a-to-z#:~:text=The%20main
%20treatment%20for%20botulism,as%20needed%20to%20assist%20breathing.

Symptoms? (Hüseyinden al) (NOTION)

Incubation period of wound botulism is longer than other botulisms since spores must be
germinate before releasing the toxins. Most of the wound botulism is caused by drug injections
(Aston & Beeching, n.d.). (SYMPTOMS YAZ)

Food-borne botulism’s symptoms are generally found after 18-36 hours consuming the
contaminated food.

Food-borne botulism typically presents 18e36 hours after ingestion of contaminated food;
symptoms of botulism are often preceded by abdominal symptoms such as nausea, vomiting and
diarrhea, which are absent in wound botulism. Invariably, cases start with symptoms and signs of
cranial nerve palsy. Ocular muscle involvement results in blurred vision and signs of ptosis and
pupillary dysfunction, and facial nerve paresis causes loss of facial expression. Lower cranial
nerve paralysis produces dysphagia, dysphonia, and dysarthria, often associated dry mouth due to
autonomic involvement. A symmetrical descending flaccid paresis follows, associated with loss
of deep tendon reflexes. The autonomic system may be involved, producing constipation, urinary
retention and hemodynamic dysfunction. Cognitive and sensory systems are intact.

Aston S, Beeching N. Botulism. (n.d.). In: Magill A, Ryan ET, Solomon T, Hill D,
eds. Hunters tropical medicine and emerging infectious diseases. 9th edn, vol. 1.
Saunders, 2012; 511e513.