Infections botulism

Botulism is a disease caused by ingestion of foods contaminated with Clostridium botulinum (food-borne botulism) or, very rarely, by wound infection (wound botulism) or colonization of the intestinal tract with Clostridium botulinum (infant botulism). The toxins block the release of acetylcholine. Botulism is characterized by generalized muscular weakness, which first affects eye and throat muscles and later extends to all skeletal muscles. Flaccid paralysis can lead to respiratory failure. 

Suggested Alternatives for Differential Diagnosis African horse sickness, anthrax, botulism, pasteurellosis, equine influenza, peracute equine herpesvirus 1 infection, and ingestion of plant or agricultural poisons. 

Botulism is a potent neurotoxin produced from Clostridium botulinum that is an anaerobic, spore-forming bacterium. There are three different types ofbotulism Foodborne botulism occurs when a person ingests a pre-formed toxin that leads to illness within a few hours or days. Foodborne botulism is a public health emergency because the contaminated food may still be available. Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract. Wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin. Approximately 100 cases of the three types of botulism are reported within the United States each year about 5 percent are wound botulism, 25 percent are foodborne botulism, and a full 70 percent are infant botulism. Death can result from respiratory failure, but those who survive may have fatigue and shortness of breath for years. 

Wound botulism occurs where C. botulinum spores germinate in wound infections and develop into vegetative cells. In such cases, neurotoxin is produced which leads to the onset of neurological symptoms. According to the Centers for Disease Control and Prevention, 23 cases of wound botulism (13.6% of all botulism cases) were reported in 2001 in the U.S. Wound botulism has also been diagnosed after intravenous drug injection (Rundervoort et al., 2003). 

Fish and seafood are generally responsible for infections caused by C. botulinum type E (Centers for Disease Control and Prevention, 1998). Many verified cases of botulism type E have been reported in Japan (166 cases and 58 deaths between 1951 and 1960). In 2003, C. botulinum type E was involved in the outbreak in western Alaska linked to consumption of a beached whale (Anonymous, 2003). Many outbreaks were also associated with a Japanese izuschi dish containing fermented raw fish, vegetables, and cooked and malted rice (okji). In Canada, Alaska, or Scandinavia, botulism is caused by consumption of fish and fermented meat dishes, very often prepared as traditional native dishes (Kotev et ah, 1987 Knubley et ah, 1995). 

Weber, J.T., Hibbs, R.G., Darwish, A. and Mishu, B., A massive outbreak of type E botulism associated with traditional salted fish in Cairo, J. Infect. Dis., 167, 451-454, 1993. 

The history of the development of antitoxins in combating bacterial infection dates back to the early beginnings of organized bacteriology. Belrring was tile first to show that animals that were immune to diphtheria contained, in their serum, factors which were capable of neutralizing the poisonous effect of the toxins derived from the diphtheria bacillus. While this work was earned out in 1890, prior to many of the great discoveries of mass immunization, and much later the antibiotics, there yet remains a place for antitoxins in medical treatment or prophylaxis for some diseases, such as tetanus and botulism,... 

Antibiotics, which are produced by other living organisms, inhibit the growth of bacteria or destroy them (bactericidal). There are few known bacterial diseases, the effects of which cannot be mitigated if the proper antibiotic is used early in the course of the disease. Tetanus and botulism are exceptions. These diseases are the manifestation of extremely potent toxins produced by the bacteria, rather than symptoms caused by infections of the microorganisms themselves, See also Antibiotics. 

The data about fields of application of Silics in clinics for treatment for infectious diseases are presented in Table 4. From Table 4 it is evident that the field of application of Silics is rather large and covers both intestinal infections and toxicoses which victimize infants, as well as viral hepatitis, and botulism. It is appropriate to mention here that inclusion of Silics into the complex treatment of patients suffering from salmonellosis, dysentery, and intestinal toxicoses accelerates normalization of clinic manifestations of these diseases by a factor of two and more. In the case of botulism the normalization of symptoms characteristic of lesions of the nervous system is shortened by almost 4 days. If intestinal infections are not severe, Silics can be recommended as a single therapeutic agent. In the case of a considerable diarrheal syndrome it is more expedient to use it together with rehydration substances. Inclusion of Silics into a complex of therapeutic agents for patients suffering from viral hepatitis substantially accelerates recovery rates of patients, so that their normal level of bilirubin and activity of alanine aminotranspherase are recovered within shorter periods of time. 

Neuromuscular disease is a very broad term that encompasses many diseases and ailments which either directly, via intrinsic muscle pathology, or indirectly, via nerve pathology, impair the functioning of the muscles. Diseases of the motor end plate include myasthenia gravis and its related condition Lambert-Eaton myasthenic syndrome. Tetanus and botulism are bacterial infections in which bacterial toxins cause increased or decreased muscle tone, respectively. 

Amon, S. (1995). Botulism as an intestinal toxemia. In Infections of the Gastrointestinal Tract (M. Blaser, P. Smith, J. Ravdin, H. Greenberg, R. Guerrant, eds), pp. 257-71. Raven Press, New York. 

Amon, S.S. (1998). Infant botulism. In Textbook of Pediatric Infections of the Gastrointestinal Tract (R.D. Feigen, J.D. Cherry, eds). W.B. Saunders, Philadelphia. 

Chia, J.K., Clark, J.B., Ryan, C.A., Pollack, M. (1986). Botulism in an adult associated with foodhome intestinal infection with Clostridium botulinum. N. Engl. J. Med. 315 239-41. 

Hatheway, C.H., Snyder, J.D., Seals, J.E., Edell, T.A., Lewis, G.E. (1984). Antitoxin levels in botulism patients treated with bivalent equine botulism antitoxin to toxin types A, B, and E. J. Infect. Dis. 150 407-12. 

Weber, J.T., Goodpasture, H.C., Alexander, H., Werner, S.B., Hatheway, C.L., Tauxe, R.V. (1993). Wound botulism in a patient with a tooth abscess case report and review. Clin. Infect. Dis. 16 635-9. 

Differential diagnoses include structural lesions, such as myelopathy and infections including HTV, lyme disease, CMV, rarely paralytic rabies (Sheikh et al., 2005), and, in endemic areas, polio. In children botulism should be considered. Toxic and metabolic conditions such as tick bite and porphyria can also mimic GBS. In the intensive care setting, critical illness neuropathy and quadriplegic myopathy may be clinically indistinguishable from GBS. 

Pathological syndromes may result in muscular spasm, as seen in the exertional myopathies, or weakness, as seen in hyperkalemic periodic paralysis (HYPP). Similarly, infectious diseases may result in muscular rigidity (C. tetani infection (tetanus)) or paralysis (C. botulinum intoxication (botulism)). Overt rhabdomyolysis may result from the ingestion of the coccidiostats monensin, rumensin and lasalocid, or one of a number of plant mycotoxins. Dietary deficiencies of selenium or vitamin E have also been described as having severe deleterious effects on skeletal muscle health. 

Three classified types of botulism (foodborne, intestinal-infant type, and wound) result from infection... 

The treated toxins are sometimes referred to as formol toxoids. Toxoid vaccines are very effective in the prevention of those diseases such as diphtheria, tetanus, botulism and clostridial infections of farm animals, in which the infecting bacteria produce disease through the toxic effects of secreted proteins which enzymically modify essential cellular components. Many of the clostridial toxins are lytic enzymes. Detoxification is also required for the pertussis toxin component of acellular pertussis vaccines. 

Wound botulism, a relatively rare form of the disease, results from the production of toxin by organisms that multiply in a contaminated wound. Wounds associated with botulism may not appear obviously infected (38). Before 1980, wound botulism was most likely associated with complicated wounds, such as extensive crush injuries, compound fractures and other wounds associated with avascular areas. Since 1980, most cases have occurred in illicit drug users, including intravenous drug users with contaminated needle puncture sites or drug users with nasal and sinus wounds secondary to chronic cocaine sniffing (38). In 2001, there were 23 reported cases of wound botulism in the United States, with one death (39). 

The least common form of human botulism, botulism from intestinal colonization, includes cases in patients greater than 1 year of age not associated with ingestion of contaminated food or wound infection with the only possibility being intestinal colonization (38). Stool in these patients will contain toxin and C. botulinum, and the suspected food may contain spores without preformed toxin. Some cases occur in patients with a history of gastrointestinal surgery or inflammatory bowel disease, conditions that could support enteric colonization of B. botulinum (38). In 2001, in the United States, one case of adult colonization botulism occurred in a 45 year old who survived (39). 

No fever (botulism is an intoxication) patients can become afebrile if they develop a secondary infection, such as aspiration pneumonia... 

Although improved supportive care and prompt administration of antitoxin have reduced botulism s case-fatality rate, botulism paralysis can persist for weeks or months, requiring continued fluid and nntritional care, assisted ventilation and treatment of complications such as nosocomial infections, decubitns nlcers and deep venous thrombosis (28,36). Complete resolution of symptoms can take np to a year. 

Although antibiotics are not effective in treating botulism, patients with botulism may develop secondary infections requiring antibiotic treatment. Because aminoglycosides and clindamycin can exacerbate neuromuscular blockage, they are contraindicated for treating secondary infections (36). 

---