What is botulism?
Botulism is a serious illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. The illness is rare, but its effects on the body are often paralytic in nature. The three main kinds of botulism are foodborne, wound, and intestinal (adult and infant). Foodborne botulism occurs when foods that contain the botulism toxin are ingested. Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Infants and adults develop a type of botulism by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin. Foodborne botulism can be especially dangerous because many people can be poisoned by eating a contaminated food, but all forms of botulism can be fatal. Although, death can occur due to respiratory failure in botulism cases, this percentage has dropped from 50% to 8% in 50 years, due to medical advances.

Botulism Facts
The rod-shaped botulism bacterium is most often found in soil. They require an oxygen rich environment, and therefore, lie dormant in soil in the form of spores until they are exposed to conditions that are ideal for their growth. There are seven types of botulism – A through G – but humans only develop illness when exposed to types A, B, E, and F. There are about 110 case of illness due to botulism reported in the United States each year. About 25% are foodborne, 72% are infant botulism, and the remaining is due to botulism infecting wounds. The cases of wound botulism have increased in recent years due to the use of black-tar heroin. Foodborne botulism cases are usually contracted by eating contaminated home canned foods. The number of these cases has remained relatively the same through the years.

Symptoms and Diagnosis
The symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. In infants the illness manifests itself as lethargy, poor food intake, constipation, a weak cry, and poor muscle tone. All of these symptoms are the early signs of the muscle paralysis that affects the arms, legs, trunk, and respiratory muscles, and should be treated immediately. These symptoms usually begin to manifest themselves 18 to 36 hours after contamination, but they can start as early as six hours after or as late as 10 days.

Although symptoms are classic, when diagnosing botulism, physicians need to rule out other paralyzing illnesses including myasthenia gravis, stroke, and Guillain-Barre. Tests that can be done to rule these things out include a brain scan, tension test for myasthenia gravis, spinal fluid examination, and a nerve conduction test (EMG - electromyography). The most definitive test to diagnose botulism is a test to detect the botulinum toxin within the body by taking a person’s blood or stool and injecting it into a mouse to see if botulism develops. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism. These tests are performed at the CDC and at some state health departments.

Treatment
Treatment for botulism can become quite complex, especially if respiratory paralysis (which leads to respiratory failure) occurs, in severe cases. Patients may need to be on a ventilator (breathing machine) to aid in breathing for several weeks until paralysis improves. When there is a positive diagnosis, patients are started on anti-toxin to block the toxin in their body. This will stop the illness from progressing, but recovery could take many weeks. If the botulism is foodborne, doctors may attempt to remove the remainder of the food from the stomach by inducing vomiting and administering enemas. If the botulism is wound based, wounds need to be surgically treated to remove the source of the bacteria. Currently, the antitoxin is not given to treat infant botulism. Recovery is long, and people may experience shortness of breath, weakness, and fatigue for many years. Long term therapy may be necessary.

Prevention
Foodborne botulism is often found in home canned foods with low acid content, such as asparagus, corn, and green beans, and other foods, such as chile peppers, tomatoes, improperly handled baked potatoes, and fermented fish. To prevent foodborne botulism , use proper hand washing technique when canning foods. Keep oils that contain garlic or herbs refrigerated. Keep potatoes baked in foil warm until served or refrigerated. To destroy any possible botulism in home canned foods, consider boiling the food for ten minutes. Beware of honey, which can contain spores, and has been pinpointed to many infant cases of botulism. It is advised that any children under the age of 12 months not be given honey. However, honey is safe for individuals over 12 months of age. To prevent wound botulism, promptly and thoroughly clean and dress new wounds . Also avoid injectable street drugs.

Public Health Agencies and Botulism Prevention and Control
Public education about botulism prevention is an ongoing activity. Information about safe canning is widely available for consumers through the Department of Agriculture. State health departments and CDC have persons knowledgeable about botulism are available to consult with physicians 24 hours a day. If antitoxin is needed to treat a patient, it can be quickly delivered to a physician anywhere in the country. Suspected outbreaks of botulism are quickly investigated, and if they involve a commercial product, the appropriate control measures are coordinated among public health and regulatory agencies. Physicians should report suspected cases of botulism to a state health department.

                                    Source: CDC (Center for Disease Control and Prevention)