1. Clostridium botulinum and Botulism A Caitlin, Farida, Nino, Natalie and Simon Presentation

2. OUTLINE ► Introduction to C. Botulinum ► Introduction to Botulism ► Infant Botulism ► Food-Borne Botulism ► Wound Botulism ► Bioterrorism

3. Clostridium botulinum ► Gram positive rods ► Spore forming ► Anaerobic bacteria ► Produces toxin that causes botulism ► Seven neurotoxic subtypes, labeled A-G ► First recognized and isolated in 1896 by Van Ermengem

4. Botulism ► Botulism is a neuroparalytic disease ► It is caused by the potent protein toxin released from C. botulinum ► Once released into the bloodstream it irreversibly binds to the acetylcholine receptors in the neuromuscular junction ► It alters the mechanism for acetylcholine release, making the neuron unresponsive to action potentials ► Three major types: Infant, food-borne, and wound ► Potential bio-weapon due to its potency

7. Infant Botulism ► Most common form ► 2 per 100,000 live births in US ► Afflicts babies from 1 week – 1 year ► Antigenic variations types A/B ► Caused by:  Ingesting contaminated foodstuff  Lack of breast milk  Untreated natural honey and corn syrup  Household dust containing C. botulinum spores

8. Infant Botulism Signs and Symptoms ► Poor feeding (weak sucking) ► Weak gag ► Weak cry ► Decreased movement ► Appearing lethargic ► Flat, blunted facial expression ► Trouble swallowing ► Excessive drooling ► Muscle weakness ► Breathing problems ► Ptosis (Drooping eyelids) ► Poor head control ► Decreased anal sphincter tone ► Decreased deep tendon reflexes Treatment and Recovery ► New drug: BabyBIG®, Botulism Immune Globulin Intravenous (Human) (BIG-IV) ► Drastically reduces lethargy, IV feeding and overall hospital stay ► With early detection, proper treatment, no long term effects observed

9. Food-borne Botulism ► Second most common form ► Caused by eating food containing the toxin produced by C. botulinum ► Antigenic variations types A/E ► Non-commercially canned food is at a higher risk for being contaminated ► Dangerous because most contaminated foods cannot be detected until too late

10. Food-borne Botulism Signs and Symptoms ► 12 – 36 hrs after ► Muscle weakness, ► Diarrhea ► Blurred vision ► Vomiting ► Eventual Paralysis Treatment and Recovery Treatment and Recovery ► Equine Botulinum Antitoxin ► Lingering symptoms are fatigue and respiratory difficulty ► With early detection, proper treatment, no long term effects observed Prevention ► Inspect canned food for  Bulging  Loose lids  Mold  Odor ► Proper home canning procedures:  Hygiene  Time schedule,  Proper processing method  Equipment ► Avoiding home canning or cheaply produced commercial food

11. Wound Botulism ► Least common, but on the rise ► Occurs when spores inoculate a wound and anaerobic conditions allow germination and subsequent production of the toxin ► Associated with IV drug use (rise in black tar heroine use), and medical equipment ex. catheters ► Often misdiagnosed as other neurological syndromes

12. Bioterrorism ► C. botulinum is one pathogenic microorganism that has been researched and developed into a biological weapon. ► Many countries, and now terrorists, have developed and used botulinum toxin as a biological weapon.  From 1990 to 1995, aerosols were dispersed at multiple sites in downtown Tokyo and at US military installations in Japan on at least 3 occasions by Japanese terrorists.  In 1995, Iraq revealed that it had deployed more than 11,000 L of botulinum toxin into specially designed SCUD missiles.

13. Bioterrorism ► Smallpox and anthrax may be getting the most attention, but bio-defense researchers have long been concerned about botulinum toxin, the deadliest of all potential toxic threats gram for gram. ► A biological attack with the botulinum toxin would more likely be dispersed in an aerosolized form. ► Currently, the US military possesses limited quantities of an investigational heptavalent antitoxin, which might be available in the event of a terrorist attack

14. QUESTIONS