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Clostridium Botulinum - Public Health Agency of Canada
Clostridium Botulinum - Public Health Agency of Canada
Clostridium Botulinum - Public Health Agency of Canada
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Footnote
Footnote
CLOSTRIDIUM BOTULINUM
C. botulinum (botulinum toxin) is defined as a biothreat level A organism by the Centers for Disease Control
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and Prevention . Category A organisms are considered to pose the greatest threat to national security.
Food-borne botulism: The classic form of botulism is caused by the ingestion of preformed toxin in
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contaminated food . Symptoms include double vision, drooping eyelids (ptosis), slurred speech,
difficulty swallowing and muscle weakness that is symmetric and descends through the body (first
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shoulders are affected, then upper arms, lower arms, thighs, calves, etc.) . Death is usually due to
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respiratory failure and may occur as soon as 24 hours after onset of symptoms .
Wound botulism: Occurs by contamination of a wound with spores from neurotoxin-producing Clostridium
species in the environment and subsequent germination of these spores and production of toxin in the
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anaerobic milieu of an abscess . The toxin is released into the bloodstream and symptoms may
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take up to 2 weeks to appear .
Intestinal (infant) botulism: Results almost exclusively from spore ingestion and subsequent growth and
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toxin production in the intestine , affecting infants under 1 year old . The first clinical sign is
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usually constipation , but this disease has a wide spectrum of clinical severity, ranging from mild illness
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with gradual onset, to sudden infant death due to respiratory failure . With appropriate intensive care,
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almost 100% of infants with botulism make a full recovery . Infants with botulism are lethargic, feed
poorly, have a weakened cry, exhibit ptosis, and floppy neck, and may progress to generalised flaccidity and
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respiratory compromise .
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Adult infectious botulism: Rare . Caused by the intestinal colonization of C. botulinum / other neurotoxin
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producing species, followed by in vivo toxin production in a manner similar to infant botulism .
Patients often have a history of immunocompromise, abdominal surgery, bowel disease, or recent antibiotic
therapy.
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Inhalational botulism: Is not a naturally occurring disease , but has occurred in laboratory workers due to
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inhalation of aerosolized toxin . Inhalational botulism leads to neurological symptoms similar to those of
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food-borne botulism, but with a longer incubation period .
Iatrogenic botulism: Side effects resulting from the therapeutic intramuscular injection of Botox (purified,
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diluted A neurotoxin) . Characterized by clinical weakness and electrophysiological abnormalities .
EPIDEMIOLOGY: Sporadic. Family and general outbreaks occur worldwide in association with food
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products prepared or preserved by means that do not destroy spores and permit the formation of toxin
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.
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HOST RANGE: Humans, and various animals, e.g., fowl, fish, cows, dogs, and minks .
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INFECTIOUS DOSE: Cells/spores are not normally toxic for healthy adults . Botulinum toxin is the most
potent toxin known, with an estimated oral or injected toxic dose (serotype A) of 0.001 μg/kg body weight,
and an estimated lethal dose by inhalation exposure in humans of approximately 0.07 μg/kg body weight
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. Type A toxin is more potent than types B and E and causes the longest lasting disease .
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MODE OF TRANSMISSION: Food borne botulism: Ingestion of contaminated food containing toxin .
Infection is commonly associated with commercially processed foods that had undergone poor processing,
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storage, and improper preservation .
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Wound botulism: Contamination of wounds with spores of neurotoxin producing Clostridium species
and is seen almost exclusively in injection drug users, particularly those who partake in injection of
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black-tar heroin into skin tissue .
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Intestinal (infant) botulism: Ingestion of spores. Sources include honey and infant milk powder .
Adult infectious botulism: Ingestion of clostridial spores, rather than toxin, which then colonize the gut to
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produce their neurotoxin directly in the gut .
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Iatrogenic botulism: Side effect of injection of purified toxin .
Inhalational botulism: Occurs due to absorption of botulinum toxin by the mucous membrane of the nose
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.
INCUBATION PERIOD: The shorter the incubation period, the more severe the disease and the higher the
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case fatality rate .
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Food-borne botulism: Usually 12 to 72 hrs after ingestion of toxin, depending on the dose .
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Wound botulism: The median period is 7 days .
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Adult infectious botulism: Unknown .
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Intestinal botulism: Unknown .
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Inhalational botulism: Not well defined, but it is longer than for food borne botulism , and is estimated
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at 12-80 hours .
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COMMUNICABILITY: No evidence of person-to-person transmission .
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and agricultural products, including honey and vegetables .
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ZOONOSIS: No epidemiological relationship between human and animal botulism has been established .
VECTORS: None.
Adult infectious botulism: Can be diagnosed by demonstration of C. botulinum (or other neurotoxin
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producing species) and/or toxins in a patient's faeces or in autopsy specimens .
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Intestinal (infant) botulism: Since the toxin is rarely found in the sera of infants , faeces should be
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examined . An ELISA has been developed for the detection of A and B toxins in children's faecal samples .
Inhalational botulism: Aerosolized toxin can not usually be identified in serum or faeces, but may be
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detected by ELISA from nasal swabs .
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Iatrogenic botulism: Should be suspected if patient has recently received Botox . An immuno-PCR
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assay capable of detecting neurotoxin type A in the femtogram range has been developed .
Note: All diagnostic methods are not necessarily available in all countries.
FIRST AID/TREATMENT:
Foodborne botulism: Within 1 hour of ingestion of suspected food, the recommended course of action is a
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gastric lavage , or enemas , and the administration of a cathartic (sorbitol) . In some cases
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intravenous administration of AB or ABE botulinum antitoxin is required, and assisted
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ventilation if respiratory failure occurs. Treatment may be required for weeks or months .
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Wound botulism: Antitoxin , wound debridement, drainage and irrigation , and antibiotic
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treatment .
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Infant botulism: Requires meticulous supportive care . Instead of antitoxin which can cause sensitization
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and anaphylaxis , an investigational human-derived botulinal immunoglobulin (BIG) is available for
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the treatment and assisted respiration is given if required .
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Intestinal botulism: Repeated administration of ABE antitoxin and assisted respiration is given, if required
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.
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IMMUNISATION: None .
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PROPHYLAXIS: Individuals known to have eaten contaminated food should be purged with cathartics ,
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given a gastric lavage and high enemas , and may be given equine botulinum AB or ABE antitoxin .
SOURCES/SPECIMENS: Food products, and clinical materials such as serum/blood, stool, vomit, and
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gastric aspirates . For wound botulism: wound exudates, debrided tissue, or swab sample. Other sources
include, nasal swabs from inhalational botulism patients, and environmental samples (soil, surface water)
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.
PRIMARY HAZARDS: Exposure to the toxin. The toxin may be absorbed after ingestion, or following
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contact with the non-intact skin, the eyes, or mucous membranes, including the respiratory tract .
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Inhalation of the toxin has occurred under laboratory conditions .
CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for
work involving infectious or potentially infectious materials, animals, or cultures.
PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is
unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes
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.
OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large
volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other
sharp objects should be strictly limited. Additional precautions should be considered with work involving
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animals or large scale activities .
DISPOSAL: Decontaminate before disposal, using steam sterilisation, incineration, or chemical disinfection
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.
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STORAGE: In locked, leak-proof containers that are appropriately labelled and secured .
Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are
compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or
reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are
frequent and this information may not be completely up to date.
Copyright ©
Public Health Agency of Canada, 2010
Canada
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