Botulism

The botulism (of the Latin botulus , “roll”) is a rare but serious disease paralytic due to a bacterial neurotoxine, the botulinic Toxine or botuline, produced by different S from Bactérie S Anaérobie the S of the Clostridium , most known being Clostridium botulinum . The human botulism is primarily associated with toxins of the type has, B and E. Their mechanism of action is an inhibition of the release of Acétylcholine on the level of the junctions neuromusculaires, which blocks the transmission between nerve and muscle and conduit with the respiratory and locomotor paralysis.

The botulinic Toxine is most powerful of all the Toxine S known in nature. However, it does not resist heat nor with an exposure prolonged to oxygen, this is why the intoxication generally occurs when one consumes products put out of bottle of glass or metal box with not enough precautions: the typical vectors of the botulism would be thus the preserves manufactured at the house and eaten cold. A not very ordinary case of botulism was observed in Great Britain during the exceptionally hot and dry summer of 1976, when the levels of river fell so low into some places which the swans while feeding accidentally introduced substances coming from the anaerobic layers, which they generally do not reach; they then presented the symptoms of the botulism.

At the human being, one distinguishes three varieties from botulism:

  • the food botulism, caused by the consumption of food contaminated by botulinic toxin: it is thus about a food toxinfection.

  • the botulism by wound, due to toxin produced in a wound infected by Clostridium botulinum .
  • the infantile botulism, caused by the consumption of Spore S of bacteria, which develop then in the intestines where they release toxin.

All the forms of botulism can be mortals and must be treated urgently. The food botulism can become public health problems when a great number of people is poisoned starting from one only contaminated food source.

History

At the beginning of the XIXe century, the medical authorities of the duchy of Wurtemberg were alerted by an increase in the number of cases of fatal poisoning by ingestion of damaged food. The identified cause was a reduction in the precautions of Hygiène in the preparation of the artisanal pork-butcheries in the countryside because of the general poverty caused in the population by the Napoleonean Guerres. In 1802, the government of Stuttgart enacted a public warning statement on “the dangerous consumption of black roll smoked”. The supposed toxic agent was the prussic acid . But they are only 20 years later, in 1822 that the poet and doctor Justinus Kerner identifa correctly the origin of this new poison which he thought of being “the acid of greases” ( Fettsaüre ). It gave a detailed description of the symptoms of the botulism and had moreover the intuition of the potential therapeutic applications of this poison. It is the German doctor Müller which in 1870 gave him its current name, borrowed with the Latin botulus (roll). The responsible bacterium as-with it was identified in 1895 by the Belgian microbiologist Emile-Pierre van Ermengem.

Epidemiology

It is a rare disease enough in France; its annual incidence is about 0,5 cases per million inhabitants. They are sporadic cases, generally of food origin: saltings, pork-butchery and preserves of manufacture family, more rarely artisanal, industrial or by inoculation at the drug addict.

To the the United States one reports on average 110 cases of botulism per annum. 25  % concern the food botulism, 72  % of the infantile botulism, and the remainder of the botulism by wound. The epidemics of food botulism concerning two people or more are usually due to damaged the preserve consumption made at the house. The number of case of food and infantile botulism varied little during these last years, but the botulism by wound increased because of the use of the brown Héroïne ( black tar ), especially in California.

Symptoms in the forms food and by wound

The traditional Symptôme S of the botulism generally occur between 12 and 36 hours after the ingestion of botulinic toxin, but they can be sometimes observed precociously as of the 6th hour or tardily after 10 days. They generally comprise a dryness of the mouth, difficulties with of swallowing, an incomprehensible elocution, a vision doubles, of the vomiting, a important Diarrhée, and especially a generalized muscular weakness. If they are not treated, these symptoms can worsen until the paralysis of the muscles of the members and the trunk (in particular respiratory) what can lead to the death. In all the cases it is the toxin secreted by C. botulinum which causes the disease, and not the bacterium itself.

Infantile botulism

The infantile botulism is in the United States the most widespread form of the disease, the infection occurs by germination of the spores in the intestine of an infant and has as consequences constipation, general weakness, loss of the behavior of the head and difficulty of feeding. To the United States these symptoms gave to the infantile botulism the name of the syndrome of the sloppy baby (“flask baby”).

The origin of the contamination of the infants is the ingestion of sweetened products, such as honey, the corn syrup. Indeed the spores of C. Botulinum are largely widespread in the environment and are moreover among the rare ones to be able to survive in honey. In the infants, the gastric juice is deprived of acidity, which combined with a favorable temperature and an anaerobic environment, creates an ideal medium for the development of the spores of C botulinum in producing bacteria of toxin. Whereas these spores are inoffensive for the adults, because of the acidity of the stomach, they are not destroyed not the insufficiently developed digestive system of an infant. There is at this age an immaturity of the intestinal total colony count and the bacterium microbiota does not reside yet in the digestive tract in sufficient quantity to fight against C. botulinum and to destroy it. Thus, deprived of adversary, C. botulinum can settle there.

This is why one recommends never not to give to the babies neither honey, nor no other produced sweetened whatever it is until the weaning.

Diagnosis

The clinical history and the antecedents can direct the diagnosis, but other neurologic affections with driving deficits like the Syndrome of Guillain-Barred, the cerebral vascular accidents and the serious Myasthénie can resemble the botulism, and must be isolated by complementary examinations. These tests can comprise a cerebral scanner, an examination of the céphalo-rachidian liquid (LCR), a electroneuromyography (ENMG), and a test with the Tensilon if one suspect a serious Myasthénie. ENMG is the test most useful for the diagnosis, on the condition of thinking of carrying out a high frequency repetitive stimulation which gives an aspect of increment of the driving potential collected on the muscle, specific of a block the terminal neuromusculaire of the presynaptic type, i.e. owing to lack of release of the Acétylcholine in the synapse. This aspect finds only in the Syndrome myasthenic of Lambert-Eaton another rare affection sometimes which can pose problems of differential diagnosis.

The formal diagnosis of the botulism can be confirmed by the presence of the botulinic Toxine in the serum or the saddles of the patient whose injection with the mouse will reproduce the signs of the disease. One can also isolate the bacterium in the saddles from the patients reached of food or infantile botulism, or by a taking away of the wound infected at the time of a botulism by wound.

Treatment

The respiratory insufficiency in the event of serious botulism requires a mechanical ventilation (" breathing artificielle") during several weeks in medium of intensive care. After several weeks, the paralysis improves slowly. Diagnosed rather early, the food botulism or by wound can be treated by an antitoxin blocking the action of the toxin which circulates in blood. That can prevent the state of the patients from worsening, but convalescence will always take many weeks. The antitoxin is not used in the treatment of the infantile botulism.

In the event of food botulism one can try to evacuate the contaminated food which is still in the digestive tract by gastric washings or rectal injections. In the event of botulism by wound, the responsible wound is treated surgically to make disappear the source from the bacteria toxinogenes.

In addition each case of botulism creates an emergency for the public health because it is necessary to identify the source of the infection, and to make sure that all the people who were exposed to toxin were identified and that one made disappear all the contaminated food.

Complications

The botulism can lead to dead by respiratory insufficiency. However, during the fifty last years, the proportion of death among the people reached of botulism fell from approximately 50  % with 8  %. A suffering patient of acute botulism can have need for an respiratory assistance accompanied by medical care and male nurses intensive during several months. The patients who survive an episode of poisoning by botulism can suffer from tiredness and breathlessness during several years, and long-term therapy can be necessary to help them to be restored.

Prevention

The food botulism was often caused by preserves made at the house and low acid content, as the asparaguses, the French beans, the beets and the corn. However, of the epidemics of botulism had less current sources. In July 2002, fourteen Alaska NS ate the meat of a failed whale, and eights of them presented the symptoms of the botulism, two of them had to be treated by mechanical ventilation. Other origins of the infection are the cut garlic mixed with oil, the peppers, the tomatos, the potatoes cooked with the furnace handled without precaution and wrapped aluminum paper, the preserve fish prepared at the house and the fermented fish. The manufacture of domestic preserves should thus obey strict hygienic precautions to avoid the contamination. The garlic or the condiments mixed with oil is to be kept with the refrigerator. The potatoes cooked with the furnace and wrapped aluminum paper must be kept hot until the moment to serve them or preserved at the refrigerator.

As the botulinic Toxine is destroyed at high temperature, it is surer to make boil during ten minutes the preserves prepared at the house before consuming them. The preserves can reveal the presence of C. botulinum by a characteristic external convexity which results from a pressure exerted inside by gases that the bacteria reject like waste, best is to throw purely and simply such preserves. Like honey, and the other sweetened products constitute an ideal medium for the development of the botulism, one should not give some the infants until their weaning, i.e. until the moment when their gastric juices will have become too acid to make it possible the bacteria to develop. The botulism by wound can be prevented by consulting a doctor quickly in the case of infected wounds and while abstaining from injectable drugs.

Legal tendencies

  • In France and Belgium, this disease is on the list of the Infectious illness to obligatory declaration. In France the botulism and the botulinic toxin belong to infectious pathologies and toxins submitted since 2001 to a reinforced surveillance within the framework of the Plan Biotox.

Therapeutic and cosmetic use of botulinic toxin

See also: botulinic Toxin

One warned oneself very early that the power of the botulinic Toxine could be exploited as an advantage, when a muscular Paralysie local proves to be useful or desirable. Already Kerner with the XIXe century had foreseen the potential of use of toxin to the fine therapeutic ones, going until trying out the effects on itself of them. The botulinic Toxine is often effective in the treatment of the neurological diseases comprising a too great muscular activity (abnormal contractions and movements, Crampe S, Spasticité, Dystonie). The botulinic toxin is also employed in Cosmétique, for example to reduce the facial Ride S or the excessive Transpiration.

External bonds

  • the Botulism on the site of the National Sanitary Surveillance Institute
  • Information general public on the botulism
  • Site of information general public (nonup to date)

References

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