Bot Bot is a rare and potentially fatal disease caused by toxins produced by Clostridium botulinum bacteria . Illness begins with weakness, blurred vision, fatigue, and speech impediment. This is then followed by weakness of arms, chest muscles, and legs. Vomiting, abdominal swelling, and diarrhea can also occur. This disease usually does not affect consciousness or cause fever.
Botulism can spread in several different ways. The bacterial spores cause it commonly in soil and water. They produce botulinum toxin when exposed to low oxygen levels and certain temperatures. Food botulism occurs when foods containing toxins are eaten. Baby botulism occurs when bacteria develop in the intestines and release toxins. This usually occurs only in children less than six months, as the protective mechanism develops after that time. Botulism lesions are found most frequently among those who inject drugs. In this situation, the spores enter the wound, and in the absence of oxygen, release the toxin. It is not passed directly among people. The diagnosis is confirmed by finding poison or bacteria in the person concerned.
Prevention is mainly done with proper food preparation. Toxins, though not organisms, are destroyed by heating it more than 85 Â ° C (185 Â ° F) for more than 5 minutes. Honey can contain organisms, and for this reason, honey should not be fed to children under 12 months. Treatment is with antitoxin. In those who lose the ability to breathe on their own, mechanical ventilation may be required for months. Antibiotics can be used for wound botulism. Deaths occur in 5 to 10% of people. Botulism also attacked many other animals. The word comes from Latin, botulus , which means sausage. The initial description of botulism comes from at least since 1793 in Germany.
Video Botulism
Signs and symptoms
Botulism muscle weakness typically begins in muscles given by the cranial nerves - a group of twelve nerves that control eye movement, facial muscles and muscles controlling chewing and swallowing. Double vision, drooping from both eyelids, loss of facial expression and swallowing problems may occur. In addition to affecting the voluntary muscles, it can also cause disruption to the autonomic nervous system. It is experienced as dry mouth and throat (due to decreased saliva production), postural hypotension (decreased blood pressure while standing, with head light produced and risk of blackout), and eventually constipation (due to decreased bowel movement). Some toxins (B and E) also trigger nausea, vomiting, and difficulty speaking. The weakness then spreads to the arm (starting from the shoulders and leading to the forearm) and legs (again from the thighs to the legs).
Severe botulism causes a reduction in respiratory muscle movement, and hence problems with gas exchange. It may be experienced as dyspnea (breathing difficulty), but when severe it can lead to respiratory failure, due to the unexcited accumulation of carbon dioxide and the resulting depressant effect on the brain. It can cause respiratory distress and death if untreated.
Doctors often think of botulism symptoms in terms of the classic trias: bulbar palsy and decreased paralysis, lack of fever, and clear senses and mental states ("clear sensorium").
Baby botulism
Infant botulism (also known as floppy baby syndrome) was first recognized in 1976, and is the most common form of botulism in the United States. Infants are prone to infant botulism in the first year of life, with more than 90% of cases occurring in infants younger than six months. Infant botulism comes from ingestion of C. botulinum spores, and subsequent colonization of the small intestine. Infant intestine may be colonized when the composition of intestinal microflora (normal flora) is not sufficient to inhibit growth of C
Spore growth releases botulinum toxin, which is then absorbed into the bloodstream and taken throughout the body, causing paralysis by blocking the release of acetylcholine at the neuromuscular junction. The typical symptoms of infant botulism include constipation, lethargy, weakness, eating difficulties and crying changes, often progressing to fluctid paralysis decreased perfectly. Although constipation is usually the first symptom of botulism in infants, it is often overlooked.
Honey is a known food of the spore botulinum reservoir and has been associated with infant botulism. For this reason honey is not recommended for infants younger than one year. Most cases of infant botulism, however, are thought to be caused by acquiring spores from the natural environment. Clostridium botulinum is a bacterium that lives everywhere everywhere. Many infant botulism patients have been demonstrated to live near a construction site or disturbance area of ​​the soil.
Infant botulism has been reported in 49 of the 50 US states, and cases have been recognized in 26 countries on five continents.
Complications
Infant botulism has no long-term side effects, but can be complicated by hospital-acquired infections.
Botulism can cause death from respiratory failure. However, in the last 50 years, the proportion of patients with deceased botulism has dropped from about 50% to 7% due to increased supportive care. A patient with severe botulism may require mechanical ventilation (respiratory support via ventilator) as well as intensive medical and nursing care, sometimes for several months. The person may need rehabilitation therapy after leaving the hospital.
Maps Botulism
Cause
Clostridium botulinum is anaerobic, Gram positive, spore-forming rod. Botulinum toxin is one of the most powerful known toxins: about one microgram is lethal to humans when inhaled. It acts by blocking nerve function (neuromuscular blockade) by inhibiting the release of excitatory neurotransmitter acetylcholine from the presynaptic membrane of the neuromuscular junction in the somatic nervous system. This causes paralysis. Advanced botulism can cause respiratory failure by paralyzing the chest muscles; this can progress to breathing. Furthermore, the release of acetylcholine from the presynaptic membrane of muscarinic nerve synapses is blocked. This may cause the autonomous signs and symptoms described above.
In all cases, the disease is caused by the botulinum toxin produced by bacteria C. botulinum in anaerobic conditions and not by the bacteria itself. The pattern of damage occurs because the toxin affects the illuminated nerve (depolarization) at a higher frequency first.
The mechanisms of entry into the human body for botulinum toxin are described below.
Colonization of the intestines
The most common form in Western countries is infant botulism. This occurs in infants who are colonized with bacteria in the small intestine during the early stages of their lives. The bacteria then produce toxins, which are absorbed into the bloodstream. Consumption of honey during the first year of life has been identified as a risk factor for infant botulism; it is a factor in one-fifth of all cases. The adult form of infant botulism is called adult intestinal toxemia , and is very rare.
Food
The toxin produced by bacteria in an incorrectly preserved food container is the most common cause of food-borne botulism. Acaciazed fish without salinity or acidity of salt water containing acetic acid and high sodium levels, and smoked fish kept at too high a temperature, poses a risk, just like canned food that is not true.
The food-borne botulism is produced from contaminated food in which botulinum C. spores have been allowed to germinate under low-oxygen conditions. This usually occurs on the substance of home-cooked food and fermented raw dishes. Given that many people often consume food from the same source, usually more than one person is affected simultaneously. Symptoms usually appear 12-36 hours after eating, but may also appear within 2 hours to 10 days.
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Botulism wounds result from wound contamination with bacteria, which then secrete toxins into the bloodstream. It has become more common in injecting drug users since the 1990s, especially those who use black tar heroin and those who inject heroin into the skin rather than the artery. Wound botulism account for 29% of cases.
Inhale
The isolated case of botulism has been described after inhalation by laboratory workers.
Injection
Botulism has occurred after the cosmetic use of unsuitable Botox strength.
Mechanism
Toxin is a botulinum protein toxin produced under anaerobic conditions (where there is no oxygen) by Clostridium botulinum bacteria .
Clostridium botulinum is a large anaerobic Gram-positive bacillus that forms the subterminal endospores.
There are eight varieties of bacteria serological denoted by letters A through H. The toxin of all of these measures in the same manner and produce the same symptoms: motor nerve endings prevented from releasing acetylcholine, causing flaccid paralysis and symptoms of blurred vision, ptosis, nausea, vomiting , diarrhea or constipation, cramping, and difficulty breathing.
Botulinum toxin is broken down into 8 neurotoxins (labeled as types A, B, C [C1, C2], D, E, F, and G), which are antigenically and serologically distinct but have structural similarities. Human botulism is mainly caused by types A, B, E, and (rarely) F. Types C and D cause toxicity only in other animals.
In October 2013, scientists released news of the discovery of type H, the first new botulism neurotoxin found in forty years. However, further studies show type H as a chimeric toxin consisting of parts of type F and A (FA).
Some species produce a typical putrefactive odor and digest meat (type A and some B and F); this is said to be proteolytic; type E and some types B, C, D and F nonproteolytic and can not be detected because there is no sharp odor associated with it.
When bacteria are under pressure, they develop spores, which are inert. Their natural habitat is located on the ground, in mud that consists of the sediments of riverbeds, lakes and coastal and marine waters, while some species are natural inhabitants of mammalian intestinal tracts (eg horses, cattle, humans), and present in their excreta. Spores can survive in their inert form for years.
Toxins are produced by bacteria when environmental conditions support spores to replicate and grow, but genes that encode toxin proteins are actually carried by viruses or phages that infect bacteria. Unfortunately, little is known about the natural factors that control phag infection and replication in bacteria.
Spores require warm temperatures, protein sources, anaerobic environments, and moisture to be active and produce toxins. In the wild, decaying vegetation and invertebrates combined with warm temperatures can provide ideal conditions for botulism bacteria to activate and produce toxins that can affect feeding birds and other animals. Spores are not killed by boiling, but botulism is rare due to special conditions, rarely obtained necessary for the production of botulinum toxin from C. botulinum spores, including anaerobic, low-salt, low-acid, low-sugar environments at room temperature.
Botulinum inhibits release in the acetylcholine nervous system, neurotransmitters, responsible for communication between motor neurons and muscle cells. All forms of botulism cause paralysis that usually begins with the facial muscles and then spreads to the limbs. In severe form, botulism causes paralysis of the respiratory muscles and causes respiratory failure. Given these life-threatening complications, all botulism-suspected cases are treated as medical emergencies, and public health officials are usually involved to identify sources and take steps to prevent further cases from happening.
Botulinum toxins A, C, and E split SNAP-25, which eventually cause paralysis.
Diagnosis
For infant botulism, a diagnosis should be performed on signs and symptoms. Confirmation of diagnosis is done by testing a stool specimen or an enema with a bioassay mouse.
Doctors may consider a botulism diagnosis if the patient's history and physical examination show botulism. However, these instructions are often not sufficient to allow for diagnosis. Other diseases such as Guillain-Barrà © Å © syndrome, stroke, and myasthenia gravis may appear similar to botulism, and special tests may be required to exclude other conditions. These tests may include brain scans, cerebrospinal fluid examination, neural conduction (electromyography, or EMG) tests, and edrophonium chloride (Tensilon) tests for myasthenia gravis. A definite diagnosis can be made if the botulinum toxin is identified in food, stomach or intestinal contents, vomit or feces. Toxins are sometimes found in the blood in cases of peracute. Botulinum toxin can be detected by various techniques, including enzyme-linked immunosorbent tests (ELISAs), electrochemyluminescent (ECL) tests and rat inoculation or feeding experiments. Toxins can be typed with neutralization tests in mice. In contagious toxic botulism, organisms can be cultured from the tissues. In the yolk medium, toxic colonies typically display surface color that extends beyond the colony.
Prevention
Although the vegetative form of the bacteria is destroyed by boiling, the spores themselves are not killed by the temperature reached by normal sea level pressure, allowing it to grow and again produce toxins when conditions are right.
The recommended precautions for infant botulism are to avoid giving honey to babies less than 12 months, since botulinum spores are common. In older children and adults normal bowel bacteria suppress the development of C. botulinum .
While commercial tin goods are required to undergo "botulinum cooking" in a pressure cooker at 121 ° C (250 ° F) for 3 minutes, and thus rarely causing botulism, there are important exceptions. Two are the Alaskan salmon outbreak of 1978 and the outbreak of Castleberry 2007. Foodborne botulism is the rarest form, accounting for only about 15% of cases (USA) and more often from low-acid home foods such as carrot juice, asparagus, nuts green, beetroot, and corn. However, outbreaks of botulism have been generated from a more unusual source. In July 2002, fourteen Alaskans ate whale meat from beach whales, and eight of them developed botulism symptoms, two of which required mechanical ventilation.
Other sources of rare infections (around every decade in the US) include garlic or spices stored in oil without acidification, chili, properly handled baked potatoes wrapped in aluminum foil, tomatoes and canned or fermented fish.
When canning or preserving food at home, attention should be paid to cleanliness, pressure, temperature, cooling and storage. When making home preserves, only acid fruits such as apples, pears, fruit stones and berries should be packed in bottles. Tropical fruits and tomatoes have a low acidity level and should have acidity levels before being bottled.
Oil infused with fresh garlic or spices should be pickled and cooled. Baked potatoes wrapped in aluminum foil should remain hot until served or cooled. Because botulism toxins are destroyed by high temperatures, home food is best boiled for 10 minutes before eating. Metals containing foods in which bacteria, possibly botulinum, grow can stand out because of gas production from bacterial growth; Such cans should be thrown away.
Any heat-treated food container is then considered airtight which shows no such signals, for example, metal cans with pinprick pins of rust or mechanical damage, should be discarded. Contamination of canned foods only with C. botulinum should not cause visual defects (eg, bulging). Only enough heat treatment during production should be used as a food safety control.
Vaccines
There is a vaccine but its usefulness is unclear because it is associated with significant adverse effects. In 2013 there are efforts being made to develop better vaccines.
Treatment
Botulism is generally treated with botulism antitoxin and supportive care.
Supportive care for botulism includes monitoring of respiratory function. Respiratory failure due to paralysis may require mechanical ventilation for 2 to 8 weeks, plus medical care and intensive care. After this time, paralysis generally increases as new neuromuscular connections are formed.
In some cases of the stomach, the doctor may try to remove contaminated food still in the digestive tract by inducing vomiting or using enemas. Wounds should be treated, usually by surgery, to remove sources from poison-producing bacteria.
Antitoxin
In adults, botulism can be treated with passive immunization with antitoxin derived from the horse, which blocks the action of toxins circulating in the blood. Trivalent antitoxins containing antibodies raised against botulinum toxins A, B, and E are most commonly used, but heptavalent botulism antitoxin has also been developed and approved by the US FDA in 2013. In infants, horse-derived antitoxin is sometimes avoided. for fear of having sickness or long lasting hypersensitivity to the protein from the horse. To avoid this, human-derived antitoxins have been developed and approved by the US FDA in 2003 for the treatment of infant botulism. This human-derived antitoxin proves to be safe and effective for the treatment of infant botulism. However, the dangers of antitoxin originating from horses to infants are unclear, and one study showed antitoxin derived from horses to be safe and effective for the treatment of infant botulism.
Trivalent (A, B, E) botulinum antitoxin is derived from a horse source that uses intact antibodies (Fab and Fc parts). In the United States, these antitoxins are available from the local health department through the CDC. The second antitoxin, heptavalent (A, B, C, D, E, F, G) botulinum antitoxin, derives from the "desiccated" equine IgG antibody that has caused the Fc part to break up from part F (ab ') 2. This less immunogenic antitoxin effective against all known botulism types in which it is not contraindicated.
Prognosis
Botulism-induced paralysis can last for 2 to 8 weeks, where supportive care and ventilation may be necessary to keep the person alive. Botulism is fatal in 5% to 10% of people affected. However, if left untreated, fatal botulism in 40% to 50% of cases.
Botulism in infants usually has no long-term side effects but can be complicated by treatment-related side-effects. The case mortality rate is less than 1% for hospitalized infants.
Epidemiology
Globally, botulism is fairly rare, with about 1,000 cases each year.
United States
In the United States, an average of 145 cases are reported annually. Of these, about 65% are infant botulism, 20% are wound botulism, and 15% are congenital. Botulism in infants is largely sporadic and unrelated to epidemics, but great geographic variability exists. From 1974 to 1996, for example, 47% of all cases of infant botulism reported in the US occurred in California.
Between 1990 and 2000, the Centers for Disease Control and Prevention reported 263 cases of food intake from 160 botulism events in the United States with mortality rates of 4%. Thirty-nine percent (103 cases and 58 events) occurred in Alaska, all of which were attributed to Aboriginal Alaskan traditional foods. In the lower 49 states, home-canned food is involved in 70 (91%) events with asparagus cans being the most common cause. Two restaurant-related outbreaks affect 25 people. The average number of cases per year is 23 (range 17-43), the average number of events per year is 14 (range 9-24). The highest incidence rates occur in Alaska, Idaho, Washington, and Oregon. All other states have an incidence rate of 1 case per ten million people or less.
The number of food and baby botulism cases has changed slightly in recent years, but wound botulism has increased due to the use of black tar heroin, especially in California.
All data on the release of antitoxin botulism and laboratory confirmation of cases in the US are recorded annually by the Centers for Disease Control and Prevention and published on their website.
- 1971 Bon Vivant botulism case On July 2, 1971, the US Food and Drug Administration (FDA) issued a public warning after learning that a New York man had died and his wife had fallen ill from botulism after eating a can of vichyssoise soup Bon Vivant.
- Between March 31 and April 6, 1977, 59 individuals developed Type B botulism. All sick people had eaten at the same Mexican restaurant in Pontiac, Michigan and all had consumed spicy sauce made with unrefined jalapeà ± o peppers , either by adding it to their food, or by eating nachos that have a spicy sauce used in its preparation. Complete clinical spectrum (mild symptomatology with neurological finds via life-threatening ventilatory palsy) type B botulism is documented.
- In April 1994, the largest outbreak of botulism in the United States since 1978 occurred in El Paso, Texas. Thirty people were affected; 4 necessary mechanical ventilation. All ate food from Greek restaurant. The rate of attack among people who ate potato-based sauces was 86% (19/22) compared with 6% (11/176) among people who did not eat dip (relative risk [RR] ÃÆ'... 13, 8, 95% confidence interval [CI], 7.6-25.1). The rate of attack among people who ate eggplant-based dips was 67% (6/9) compared with 13% (24/189) among people who did not (RR ÃÆ'... 5.2; 95% CI, 2.9- 9.5). Type A botulism toxin is detected from the patient and in both dips. The formation of toxins is produced from holding a baked aluminum wrapped potatoes at room temperature, apparently for several days, before they are used in dips. The food handler must be informed of the potential hazards caused by holding the potatoes wrapped in foil at room temperature after cooking.
- In 2002, fourteen Alaskans ate malinguk (whales fur) from whales stranded on shore, resulting in eight of them developing botulism, with two of those affected requiring mechanical ventilation.
- Beginning in late June 2007, eight people suffered from poisoning botulism by eating canned food products produced by the Castleberry Food Company at the Augusta, Georgia plant. Later it became known that the Castleberry factory had a serious production problem on a special retort path that had processed fewer cans of food. These problems include broken cooking alarms, water leaking valves and inaccurate temperature devices, all resulting from poor management of the company. All the victims were hospitalized and placed in mechanical ventilation. The Outbreak of the Castleberry Food Company is the first example of botulism in commercial canned foods in the United States in more than 30 years. One person died, 21 confirmed cases, and 10 others were suspected in Lancaster, Ohio when the botulism outbreak occurred after the church was flattened in April 2015. Suspected sources were salads made from potato cans.
- The botulism outbreak occurred in Northern California in May 2017 after 10 people ate a nacho cheese dip served at a gas station in Sacramento County. One person died of the plague.
United Kingdom
The largest plague of foodborne botulism in Britain occurred in June 1989. A total of 27 patients were exposed; one patient died. Twenty-five patients ate one brand of hazelnut yogurt a week before the onset of symptoms. Control measures include the cessation of all yogurt production by the involved producers, the company's yogurt withdrawal from sales, cans recall from the hull preserve, and advice to the general public to avoid consumption of all hazelnut yogurt.
China
From 1958-1983 there were 986 botulism outbreaks in China involving 4,377 people with 548 deaths.
Canada
From 1985-2015 there were outbreaks of 91 confirmed cases of food botulism in Canada, 85% of whom were in the Inuit community, notably Nunavik and First Nations on the coast of British Columbia from eating traditionally prepared marine mammals and fish products.
Ukraine
In 2017, there are 70 cases of botulism with 8 deaths in Ukraine. The previous year there were 115 cases with 12 deaths.
Other species
Botulism can occur in many vertebrates and invertebrates. Botulism has been reported in mice, rats, chickens, frogs, frogs, goldfish, aplysia, squid, crayfish, drosophila, leeches, etc.
Botulism deaths often occur in waterfowl; an estimated 10,000 to 100,000 birds die from botulism every year. This disease is called "limberneck". In some major outbreaks, a million or more birds can die. Ducks seem to be most often exposed. The form of duck botulism enzymes in the western United States and Canada is known as "western duck disease". Botulism also attacks commercial poultry. In chickens, mortality rates vary from some birds to 40% of the herd.
Botulism seems relatively rare in domestic mammals; However, in some parts of the world, epidemics with deaths of up to 65% are seen in cattle. The prognosis is poor in large, supine animals.
In cows, the symptoms may include salivation, anxiety, uncoordination, urinary retention, dysphagia, and sternal recurrence. The supine animal is usually very close to death. In sheep, the symptoms may include saliva, sharp nasal secretions, stiffness, and lack of coordination. Abdominal respiration may be observed and the tail may alternate sideways. As the disease develops, the limb can become paralyzed and death can occur. Phosphorous livestock, especially in southern Africa, tends to swallow bones and carcasses that contain clostridial toxins and consequently suffer from lethargy or lamsiekte.
A recent study has shown an effective vaccine against cow botulism associated with Clostridium botulinum C and D serotypes.
Clinical signs on horses are similar to cows. Muscular paralysis is progressive; usually starting at the back and gradually moving to the forelegs, neck, and head. Death generally occurs 24 to 72 hours after the initial symptoms and results from respiratory paralysis. Some foals are found dead without other clinical signs.
Clostridium botulinum Type C toxins have been suspected of causing grass diseases, conditions in horses that occur in hot, rainy summers in Northern Europe. The main symptom is pharyngeal paralysis.
Domestic dogs may develop systemic toxemia after consuming C. botulinum type C exotoxins or spores in bird carcasses or other infected meat but generally resistant to heavier effects of Clostridium botulinum type C. Symptoms include flaccid muscle paralysis; dogs with difficulty breathing will require more intensive care monitoring. Muscle paralysis can cause death from heart attack and breathing.
Pigs are relatively resistant to botulism. Reported symptoms include anorexia, rejection to drinking, vomiting, pupil dilatation, and muscle paralysis.
In birds and wild birds, soft paralysis is usually seen in the legs, wings, neck and eyelids. Toxic chicken with poisonous form may also experience diarrhea with excess uric acid.
See also
- List of foodborne disease outbreaks
References
External links
- BOTULISM in the United States, 1889-1996. A Handbook for Epidemiologists, Doctors and Laboratory Technicians. Centers for Disease Control and Prevention. National Center for Infectious Diseases, Division of Mycotic Bacteria and Disease 1998.
- The NHS option
- CDC Botulism: Review of Control Measures for Doctors
- University of California, Santa Cruz Environmental toxicology - Botulism
- CDot Botulism FAQ
- FDA Clostridium botulinum Bad Bug Book
- USGS Avian Botulism
Source of the article : Wikipedia
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