clostridium botulinum and botulism. introduction about 900's: certain foods caused typical...
TRANSCRIPT
![Page 1: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/1.jpg)
Clostridium botulinum and botulism
![Page 2: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/2.jpg)
Introduction
• About 900's:Certain foods caused
typical poisoning.
Emperor Leo VI of Byzantium forbade the manufacture of blood sausages.
![Page 3: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/3.jpg)
Introduction
• 1793: An outbreak caused by blood sausages was described in Wildbad, Germany
![Page 4: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/4.jpg)
Introduction
• van Ermengem isolated an anaerobic bacterium from cured raw ham that had caused “Kerner’s Disease” in 23 people and killed 3.
1897
![Page 5: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/5.jpg)
Other Findings
killed a number of different experimental animals with the same signs as the disease in humans
Extract from ham & a culture of m.o.
![Page 6: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/6.jpg)
Another outbreak
• Caused by canned white beans
• The signs and symptoms were typical of botulism
• The toxin did not cross-react: type A
• Subsequently more toxin types found
![Page 7: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/7.jpg)
How about the US?
• Between 1918-1922:297 cases and 185 deathsmainly in CaliforniaPrompted the cannery
program that still exists today
![Page 8: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/8.jpg)
Introduction
• 1936: C. botulinum type E was isolated
from smoked fish that caused botulism in the US and Russia
![Page 9: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/9.jpg)
Introduction
• 1951: Wound botulism was described for the first time.
![Page 10: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/10.jpg)
Categories of Human Botulism
1. Foodborne botulism
2. Infant botulism
3. Wound botulism
4. Adult infectious botulism
![Page 11: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/11.jpg)
Categories of Human Botulism
• Infant botulismIt was first recognized in 1976.
This type of poisoning affects infants under the age of 12 month.
It is caused by the ingestion of C. botulinum spores.
![Page 12: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/12.jpg)
Categories of Human Botulism
• Infant botulismThe spores colonize the intestinal tracts of
infants, germinate, multiply, and produce neurotoxin.
The neurotoxin travels through the bloodstream to the central nervous system and causes flaccid paralysis.
![Page 13: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/13.jpg)
Categories of Human Botulism
• Wound botulismThis illness results from the pathogen itself
infecting a wound.Foods are not the vehicle of transmission. The microorganism produces the
neurotoxin which is transmitted to other parts of the body via the blood.
Seen in intravenous drug users
![Page 14: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/14.jpg)
Categories of Human Botulism
• Adult infectious botulismThis type of botulism resembles infant
botulism, however, it affects adults.C. botulinum colonizes the intestinal tract of
adults and produces the toxin in vivo.It has been thought to occur after antibiotic
treatment depleted the indigenous intestinal flora.
![Page 15: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/15.jpg)
Recorded Botulism Cases in California and in the US: 2002-2007
Botulism Type California U.S. (2007 not available)
Food 19 80
Infant 207 435
Wound 132 155
Adult Not Avail. 4
http://ww2.cdph.ca.gov/data/statistics/Pages/CD_Tables.aspx
http://www.cdc.gov/nationalsurveillance/botulism_surveillance.html
![Page 16: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/16.jpg)
Classification of C. botulinum• There are seven types of C. botulinumA, B, C, D, E, F, and Gbased on the serological specificity of the
neurotoxin produced • Types A, B, E, and, very rarely, F are
associated with human botulism (foodborne, wound and infant types).
• Types C and D affect animals.• Type G has not been linked to illness up to
this date.
![Page 17: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/17.jpg)
Characteristics of C. botulinum
• pH values for growthTypes A and proteolytic B pH 4.6-8.5
Minimum pH for E is: 6.2 at 5°C, and 5.4 at 30°C
![Page 18: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/18.jpg)
Implicated Foods in Botulism
Any food that can support the growth of this pathogen or allow the germination of its spores and eventually toxin production can be associated with this illness.
Low acid foods (pH>4.6) Home canned or preserved low acid vegetables Garlic in soybean oil Foil-wrapped baked potato Commercial carrot juice held at ambient temperature
![Page 19: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/19.jpg)
Implicated Foods in Botulism
• North American Indian specialtiesfish and fish eggsseal flippers
• Other implicated foods include luncheon meats, ham, sausage, smoked and salted fish, and lobster.
![Page 20: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/20.jpg)
Illness & Causative Agent
• Botulism is a serious paralytic illness.
• It is caused by a nerve toxin that is produced by the bacterium.
• It is a rare illness.
• It is much feared.
![Page 21: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/21.jpg)
Nature of Illness
• Intoxication
• Onset is about 18 – 36 hrs after ingestion of the food containing the neurotoxin.
• Symptoms vary from a mild to severe illness.
![Page 22: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/22.jpg)
Clinical Symptoms
• Symptoms include:neurological signs blurred or double vision difficulty in speaking or swallowing fatigue lack of muscle coordination, and difficulties in breathing
![Page 23: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/23.jpg)
Toxigenic Dose
• Few nanograms of C. botulinum neurotoxin can cause illness.
• The neurotoxin produced is probably the most toxic compound made by a biological system.
• About 1 oz. of this toxin can kill 200 million people.
• Fortunately, the incidence of the illness is low.
![Page 24: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/24.jpg)
Mechanism of Toxin
Neurotoxin binds to neurons
internalized
prevents release of acetyl choline (neurotrasmitter)
![Page 25: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/25.jpg)
C. botulinum Outbreak
• In 1994, in Oklahoma, a 47-year old man was hospitalized for symptoms of progressive dizziness, blurred vision, slurred speech difficulty swallowing, and nausea.
• Twenty-four hours earlier the patient had eaten some home canned green beans and beef and potato stew.
• Green beans tested negative, but stew was positive
![Page 26: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/26.jpg)
C. botulinum Outbreak
• Apparently, the stew was cooked,
covered tight,
left out for four days at room temperature, and
then eaten without reheating
![Page 27: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/27.jpg)
Other recent cases: October 2004
• Refrigerated clam chowder that was stored in the consumer’s home at room temperature
• Consumer tasted it, spit it out because it tasted bad
• She put it out for her chickens
• The next morning the chickens were dead
![Page 28: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/28.jpg)
Other recent cases: June 2006• A truck driver picked up a load of
pasteurized refrigerated carrot juice in the Bakersfield area
• He kept a case of it, and left one bottle in the cab of his truck where he was sleeping
• He subsequently drank it and developed botulism signs and symptoms
• Other bottles from the case that had been refrigerated were negative
![Page 29: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/29.jpg)
Prevention
• Assurance of destruction or inhibition of C. botulinum.
• Keep susceptible foods out of the temperature danger zone (4.4 – 60°C or 40 – 140°F).
• Botulinum toxin is destroyed by heating at 80°C for 30 min or boiling for a few minutes. Thus re-heating foods properly can be a controlling factor.
![Page 30: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/30.jpg)
Antitoxin
• Produced in horses by injecting them with gradually increasing levels of toxin type A
• To make a bivalent antitoxin, the horse is then injected with toxin type B, starting with extremely low levels
• Plasma is subjected to purification steps such as enzyme treatment and ammonium sulfate precipitation
• Time required is a matter of months
![Page 31: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/31.jpg)
Antitoxin
• Distributed by CDC• In California, local health jurisdictions can
contact the DCDC duty officer for release of antitoxin (see flow chart)
• HHS awarded contract to Cangene Corp. of Canada for 200,000 doses of heptavalent botulism antitoxin to be delivered to SNS starting in 2007 as part of Project Bioshield
![Page 32: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/32.jpg)
Detection of Toxin
• Toxin can be detected and typed by mouse inoculation. Number of tests depends on how many mice the lab has available.
• An ELISA method has been developed for detection of toxin. Used by LRN labs
Assumption: Active toxin will kill mouse
![Page 33: Clostridium botulinum and botulism. Introduction About 900's: Certain foods caused typical poisoning. Emperor Leo VI of Byzantium forbade the manufacture](https://reader035.vdocuments.site/reader035/viewer/2022062407/56649dfe5503460f94ae62d7/html5/thumbnails/33.jpg)
Detection of Toxin
• Department of Defense, USDA, and Food and Drug Lab Branch use ECL (electrochemiluminescence) with which they can do 400-500 samples per day
• CDC has developed a TRF (Time-resolved fluorescence) test that is also high capacity (based on 96-well plate).