Topic: Health & MedicineSurgery

Last updated: May 8, 2019

One of the deadliest substances on the face of the Earth is the botulinum toxin (“Botulism” World).

Every year there are about 110 botulism cases in the United States (Franz and Odle). While the botulinum toxin, the cause of botulism, is rare, it can be fatal without treatment. Therefore, people living in secluded areas are at risk of not receiving treatment for botulism. Also attributing to its danger, botulism has had the potential of being used in a terrorist attack.

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Botulism, while uncommon, is a lethal disease which has serious implications of being used as a bioweapon. Botulism has been around for a long time, but has not been understood until recent years. Since the ancient times of Greece and Rome, there have been medical description of what is thought to be botulism (Franz and Odle). Still, a true understanding of the disease has not been developed until as of late. First, in 1793, Justinus Kerner, a German physician, discovered that a certain substance in sausages that had become rancid caused botulism. Justinus Kerner named the material in the sausages wurstgift, which is “sausage poison” in German (Franz and Odle). Eventually in 1895 Belgian professor Emile Von Ermengem was able to deduce that Clostridium botulinum was the source of the poison, by isolating it (Franz and Odle). This discovery would lead to much of what is known about botulism today.

In terms of the word botulism, it is derived from the Latin term for sausage, which is botulus. While botulism has a rich history, it also has some unique characteristics. Clostridium botulinum has fascinating attributes and means of survival. The bacterium itself is gram positive, rod-shaped (bacilli), and is able to make spores (Nantel 8). It is also an obligate anaerobe and can be found in soil and sediment in water and land across the globe (Nantel 8). Since the bacteria thrives in soil in can infiltrate vegetables in the soil as well as some mammals, fish,and birds (Nantel 8).The bacteria are unable to grow in acidic areas (“Botulism” World) and need an anaerobic environment, which is an environment that has no oxygen (“Botulism” Salem 317). If the bacteria does not find itself in conditions like these then it will turn into a spore and remain dormant (Franz and Odle).

Eventually, once the conditions are right, the spores will germinate (“Botulism” Human 252) and develop into the rod-shaped bacterium that can produce toxins (“Botulism” Salem 317). The toxins are produced, however, only once the bacteria have died and broken apart (“Botulism” Salem 317). Even though botulism is not contagious between humans (“Botulism” World), the bacteria have many different forms. Botulism can appear in many different ways. Seven different types of the botulinum toxin exist and they are lettered A through G, but only four can make humans ill (“Botulism”Human 252). The four strains are A, B, E, and F which translate to infant botulism, food-borne botulism, wound botulism, and inhalation botulism (“Botulism” Human 252).

However, inhalation botulism is the only form which does not naturally occur (“Botulism” World). While there are many different forms of botulism they primarily affect the host in a similar manner. Botulism has a systematic approach in how it enters and affects the host.

People can ingest botulinum toxin by consuming contaminated food or water (Franz and Odle). Botulinum spores can also infiltrate the host by being ingested or by contaminating a wound (“Botulism” Salem 317). Therefore, humans can get ill by ingesting the botulinum toxin, bacteria, or spore. Once the toxin is either ingested or released within the host it can resist stomach acid and get absorbed by the blood stream (“Botulism Salem 317). Then, the botulinum prevents the organisms motor nerves from releasing acetylcholine, which is a neurotransmitter that sends signals from the nervous system to muscles (Franz and Odle).

A neurotransmitter is simply a chemical in nerve cells, which can be released to send signals to other cells (Franz and Odle). Often when acetylcholine is blocked, flaccid paralysis can occur and the muscles that control breathing can fail (Franz and Odle). While all forms of botulism end with the same result, they all have minor differences in how they enter the body. All natural forms of botulism have variation in how they invade the host.

Food-borne botulism can be attributed to foods that are improperly canned in households and are low in acidity such as fish, fruit, or vegetables (Mayo Clinic Staff). In order to grow on food C. botulinum spores need low-oxygen levels, warm temperatures, and for there to be no preservatives in the food (“Botulism” World). Food-borne botulism is also the form in which the toxin itself is ingested (“Botulism Human 253). Infant botulism is the form of botulism in which the spores are swallowed and release toxin inside the intestine (“Botulism” Human 253). Unlike adults, infants lack sufficient stomach acid, antibodies, and intestinal bacteria to combat the botulinum spores (“Botulism” Human 253). Infant botulism is also most likely due to infants being exposed to soil with botulinum as well as honey, as the spores can be found in honey (Mayo Clinic Staff). Finally, wound botulism is the rarest form and occurs only when a wound gets infected by botulinum bacteria or spores which then multiply (“Botulism” Human 253).

Wound botulism is predominantly caused by injecting heroin which can carry the botulinum spore (Mayo Clinic Staff). Even though inhalation botulism does not naturally occur, it provides the biggest danger of any form of botulism. Inhalation botulism has the potential risk of being used as bioweapon. The process of making small particles of the botulinum toxin, which can spread through the air, has been attempted by some terrorists but has failed (“Botulism” Human 253). Even though inhalation botulism has been successfully produced by terrorists there is still the potential of it becoming a biological weapon (“Botulism” Human 253). In fact “The Iraqi government admitted in 1995 that it had loaded 11,200 liters of botulinum into SCUD missiles during the Gulf War” (Franz and Odle). Even though there has never been an inhalation botulism outbreak the imminent threat still exists as it will be used successfully at some point.

However, the lethal dose of aerosolized botulinum in humans is 2 ng per kg, which is three times greater than in foodborne cases (“Botulism” World). Since more botulinum is required in inhalation botulism, developing a successful sample has been difficult. While nobody has experienced inhalation botulism, people have gone through the symptoms of the the other forms of botulism.

The symptoms of botulism can vary greatly in severity. Wound botulism symptoms tend to appear after 10 days and consist of droopy eyelids, difficulty breathing, slurred speech, trouble seeing and swallowing, weakness in facial tissue, and paralysis (Mayo Clinic Staff). Food-borne botulism has the same symptoms as wound botulism as well as nausea and a dry mouth (Mayo Clinic Staff). Food-borne botulism symptoms tend to appear between 12 and 36 hours (Mayo Clinic Staff), but do have a range of six hours to eight days (Nantel 5). Infant botulism symptoms usually occur between 18 and 36 hours after ingestion of spores and symptoms include floppy muscles, drooling, constipation, trouble eating, fatigue, weak cries, droopy eyelids, and paralysis (Mayo Clinic Staff). People who do die of botulism tend to die from infection, breathing failure, or from being in a state of paralysis for an extended period of time (“Botulism: Diagnosis”). However, paralysis caused by botulism will often get better with time and proper medical treatment (“Botulism: Diagnosis”). Based on symptoms, doctors will try to use the best treatment possible.

In different forms of botulism treatment will vary from case to case. In order to first diagnose botulism doctors conduct tests such as a scan of the brain, a muscle and nerve function test, and inspection of the spinal fluid (“Botulism: Diagnosis”). In all most all cases of botulism the antitoxin drug will be administered to the patient.

(“Botulism: Diagnosis”) Antitoxin cannot heal the damage that the botulinum toxin has done, but can prevent it from causing any more damage (“Botulism: Diagnosis”). In severe cases of botulism the process of intubation, sticking a plastic tube down into the trachea, and artificial ventilation are important in keeping patients alive (“Botulism” Salem 318). In food-borne botulism flushing of the GI (gastrointestinal) tract is often necessary (Franz and Odle). Also in cases of wound botulism surgery may be required to remove the area with toxins along with the prescription of antibiotics (“Botulism: Diagnosis”).

Even though treatment usually works it is often better to prevent the disease altogether. Preventing botulism is a fairly easy task as the steps are not that difficult. In order to prevent food-borne botulism food should be stored in a safe container and should be heated to above 80 degrees celcius before eaten (Nantel 25).

In order to prevent wound botulism a person should receive immediate medical attention for an infected wound and avoid injecting street drugs (“Botulism” Human). To prevent infant botulism infants should not be given honey until the age of 1 as honey can contain botulinum spores (Nantel 25). Breastfeeding an infant can also help protect them from botulinum spores (“Botulism” Human).

While there is a vaccine for botulism it is almost never used as it can have negative side effects and its effectiveness is not truly known (“Botulism” World). While the botulinum toxin is very dangerous, in controlled settings it can help some patients. The botulinum toxin can help certain patients because of its nerve-blocking qualities. Mark stillman, a neurologist at the Cleveland Clinic, states “The FDA approved botulinum toxin for the treatment of chronic migraines on October 15, 2010 after receiving and reviewing two large multicenter trials”(Brain and Spine Team). The botulinum toxin can also help sporadic movements in people with multiple sclerosis and cerebral palsy as well as people with eye twitching, teeth grinding, excessive sweating, and an overactive bladder (Brain and Spine Team). Even while being potentially fatal, the botulinum toxin is able to be used for good in many patients.

The botulinum toxin is hazardous, but also has benefits in the field of medicine. With the toxins abilities many people are given help for their conditions. However, the danger of botulinum being used as biological weapon is still looming. Hopefully, botulinum will continue to be used to treat ailments and will never be utilized to purposely infect people.


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