CLOSTRIDIUM BOTULINUM Presented by Iniekem Effanga, Ph. D. Student Walden University Environmental Health (PUBH-8165 – 1) Instructor: Dr. Raymond Thron Winter Quarter, 2010 My name is Iniekem Effanga, a Ph. D. student at Walden University. Welcome to this informational presentation on Clostridium botulinum, and thank you for coming. Today, I will be presenting one of the foodborne diseases known as clostridium botulinum to this audience that is comprised of food consumers, food handlers, and representatives from federal, state, and local food safety entities. I hope that at the end of this presentation, that you will learn about what Clostridium botulinum is, its causes, and ways to preventing this foodborne illness. “Foodborne diseases remain responsible for high levels of morbidity and mortality in the general population, but particularly for at-risk groups, such as, infants, young children, the elderly, and the immunocompromised” (WHO, 2010).

Learning Outcomes Increase knowledge base of foodborne botulism in infants, young children, the elderly, and the immunocompromised Help reduce the incidence of foodborne illness caused by Clostridium botulinum http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho... The incidence of the foodborne illness caused by botulism is low, but the mortality rate is high if not treated as an emergency and properly (FDA, 2010). At the end of this presentation, you should have enough information to help increase your awareness and knowledge, and thereby lead to decrease in the incidence of foodborne illness. Knowledge as rightly said, is power.

CLOSTRIDIUM BOTULINUM The above image depicts what clostridium botulinum looks like. According to Schneider, Parish, Goodrich, and Cookingham (2004), “Botulism is caused by the nerve toxins produced by the bacterium Clostridium botulinum, often resulting in a serious paralytic condition that can lead to death”. Image retrieved from http://eatdrinkbetter.com/2009/11/11/toxin-in-a-can

Clostridium botulinums Learning Objectives Name of the Organism: Clostridium botulinums An anaerobic, Gram-positive, spore-forming rod that produces a potent neurotoxin The spores are heat-resistant and can survive in foods that are incorrectly processed In order to reduce the incidence and economic consequences of foodborne diseases, the safety of food from production to final consumption needs to be brought to the attention of the public continually and consistently through public health educational programs and services.

Natural Reservoirs C. botulinum and spores are widespread in the environment occurring predominantly in soils and marine sediments (USDA, 2010). Found in sewage, aerosols, several foods and dust http://fsrio.nal.usda.gov/nal_web/fsrio/fsheet.php?id=233 As seen in the slide above, C. botulinum can be found in soil, sewage, foods, and dust. Also, the pathogen and its spores have several other reservoirs such as, gastrointestinal of fishes, birds, and mammals; bee honey; and other shellfish (USDA, 2010). “Spores are found in freshwater, marine, and terrestrial environments throughout the world…Fish farmers historically referred to botulism caused by C. botulinum neurotoxin type E (BoNT/E) as ‘bankrupt disease’ in response to the significant mortalities and staggering economic loss that it caused” (Yule, Barker, Austin, and Moccia, 2006, p. 479).

C. Botulinum Please take a moment to look at this slide that shows another image of what C. botulinum looks like. Image retrieved from http://google.com/images?hl-&q=clostridium+botulinum&rlz=...

Mode of Botulism Transmission Contaminated foods (particularly home-canned goods) Honey (ingestion) Dust and Aerosols http://fsrio.nal.usda.gov/nal_web/fsrio/fsheet.php?id=233 These are some of the three modes of botulism transmission that the public needs to be aware of to further enhance food safety.

Canned Foods The source of the disease botulinum is most common in low acid foods, and its dangers are lurked in home and commercial processed foods, especially in canned foods (Jyotike, 2009). Image retrieved from http://eatdrinkbetter.com/2009/11/11/toxin-in-a-can

Home Canned Tomatoes According to Jyotike (2009), “What do you do when you have 100 pounds of tomatoes? Do you cook some, give some away, and get canning! To avoid being affected by the botulinum toxin, when making canned foods at home like tomatoes, pickles, jams or jellies, it is advisable to stay away from storing theses food in yoghurt, vinegar or other foods with a high acidic content. Also, the organism is susceptible to heat, so heat sterilizing instruments, and cans used for storage is crucial (Jyotike, 2009). Image retrieved from http://eatdrinkbetter.com/2009/11/11/toxin-in-a-can

Nature of the Disease Four types of botulinum is recognized 1. Foodborne botulinum 2. Infant botulinum 3. Wound botulinum 4. Undetermined botulinum Certain foods have been reported as sources of spores in the cases of infant botulism and the undetermined category; wound botulism is not related to foods. Retrieved from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho...

Foodborne Botulism The consumption of foods containing the neurotoxin produced by C. botulinum is the major cause of foodborne botulinum disease Foodborne botulinum is a severe type of food poisoning that can be fatal if not treated immediately and properly http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho... All persons are susceptible to foodborne illness. Inadequately processed home canned and fermented foods are one of the main implicated sources in foodborne disease outbreaks (FDA, 2010).

Food Poisoning According to the U. S. Department of Agriculture (USDA, 2009), “Americans suffer from about 76 million cases of food poisoning each year, causing over 5,000 deaths, and costing over $7 billion…Food poisoning is often caused by bacteria such as E. coli and Clostridium botulinum”. Retrieved from http://www.ars.usda.gov/main/site_main.htm?modecode=53-25-23-00 Image retrieved from http://google.com/images?hl-&q=clostridium+botulinum&rlz=...

Botulism Symptoms Symptoms usually appears 12-36 hours after eating contaminated food In rare cases, symptoms may not develop for several days http://www.dhs.wisconsin.gov/communicable/factsheets/BotulismFoodborne_42031_0504... Symptoms are symmetric and often include blurred or double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, and muscle weakness (WDHS, 2010).

Treatment with Botulism Antitoxin Equine antitoxin Effective for treatment of wound botulism, intestinal, and foodborne Available through CDC are the trivalent and bivalent antitoxin Equine antitoxin does not reverse the present paralysis caused by botulism. It may limit the progression, and prevent nerve damage if administered early (WHO, 2010).

Botulism Infection Control Botulism is not transmitted from person-to-person Foodborne botulism is not contagious Use universal precaution when taking care of botulism patients http://www.dhs.wisconsin.gov/communicable/factsheets/BotulismFoodborne_42031_0504... Botulism illness is not contagious, but good health care practice calls for using universal precaution when dealing with patients.

Infant Botulism Affects infants under 12 months of age C. botulinum spores produces toxin in the intestinal tracts of infants Soil, cistern water, dust and foods; honey is a dietary reservoir of C. botulinum http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho... “The number of confirmed infant botulism cases has increased significantly as a result of greater awareness by health officials since its recognition in 1976” (FDA, 2010).

Infant Botulism Infants with botulism presents with: Poor feeding Constipation Weak cry Poor muscle tone known as “floppy” baby syndrome Above is botulism’s clinical presentation in infant with the foodborne illness. According to Francisco and Arnon (2007), “Botulinum toxin blocks the release of acetylcholine at the neuromuscular junction and other peripheral cholinergic synapses, which results in constipation, lethargy, poor feeding, generalized weakness, decreased head control, hypotonia, diminished deep-tendon reflexes, hypoventilation, and cranial nerve palsies” (p. 826).

Wound Botulism “The illness results when C. Botulinum by itself or with other microorganisms infest a wound and produces toxins which reach other parts of the body via the blood stream” (FDA, 2010). This is the rarest form of botulism According to the FDA (2010) report, foods are not involved in this type of botulism.

Undetermined Category of botulism “This involves adults cases in which a specified food or wound source cannot be identified” (FDA, 2010). Might result in intestinal colonization in adults, with in vivo production of toxin (FDA, 2010). http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho... “In these cases, the patient had surgical alterations of the gastrointestinal tract and/or antibiotic therapy” (FDA, 2010).

Detection methods Critical for early and accurate serotype determination (USDA, 2010) Administration of an appropriate antitoxin treatment http://fsrio.nal.usda.gov/nal_web/fsrio/fsheet.php?id=233 As seen in this slide, there are methods available to detect and treat Clostridium botulism foodborne illness.

Botulism Prevention All canned and preserved foods must be properly processed and prepared Home canned foods should be boiled for 10 minutes before eating Bulging containers should not be opened http://www.dhs.wisconsin.gov/communicable/factsheets/BotulismFoodborne_42031_0504... Prevention is better than cure, as the treatment for botulism foodborne illness can be expensive and may take months for infected individuals to recover.

References: FDA. (2010). Bad Bug Book: Foodborne pathogen microorganisms and natural toxins handbook. Retrieved from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePatho... Francisco, A. M. O., & Arnon, S. S. (2007). Clinical mimics of infant botulism. Journal of the American Academy of Pediatrics, 119(4), 826-828. doi: 10.1542/peds.2006-0645 Jyotike, J. (2009). Toxinin a can: Eat drink better. Retrieved from http://eatdrinkbetter.com/2009/11/11/toxin-in-a-can Schneider, Parish, Goodrich, and Cookingham (2004). Preventing foodborne illness: Clostridium botulinum. Retrieved from http://edis.ifas.ufl.edu USDA. (2009). Pathogen and Contaminants: A focus on Clostridium botulism. Retrieved from http://fsrio.nal.usda.gov/nal_web/fsrio/fsheet.php?id=233 References.

References: WDHS. (2010). Botulism foodborne fact sheet: Botulism, Foodborne. Retrieved from http://www.dhs.wisconsin.gov/communicable/factsheets/BotulismFoodborne_42031_0504... WHO. (2010). Clostridium botulinum: International Programme on chemical safety poisons information monograph 858 bacteria. Retrieved from www.who.int/en/ Yule, A. M., Barker, I. K., Austin, J. W., & Moccia, R. D. (2006). Toxicity of clostridium botulinum type E neurotoxin to great lakes fish: Implications for avian botulism. Journal of Wildlife Diseases, 42(3), 479-493. References.

Useful Resources www.foodsafety.gov www.fda.gov www.cdc.gov www.who.int http://fsrio.nal.usda.gov www.ncbi.nlm.gov Please find these useful resources to further investigate Clostridium botulinum and other foodborne diseases.

Appreciation Thank you for attending. I hope that you have learned from this presentation about the foodborne illness/disease, and are better informed about the causes and ways to prevent Clostridium botulism Knowledge is power Please pass on these useful information to your families and friends in the community, who might not be aware of this type of foodborne illness/disease. Thanks again for coming.

Questions are welcomed Please feel free to ask any questions regarding this presentation If you have concerns and/or need clarification on the subject matter, I’ll be glad to provide you with more information At this time, you are free to ask questions. I hope I have addressed your questions and concerns to the best of my ability, and that you have benefited from this session. Please depart safely to your respective destination. Keep the good news going. It might benefit someone else greatly. Thanks and goodbye.