Botulism Types, Dangers, and Benefits of Botulinum Toxin

Introduction to Botulism

Botulism is a rare disease caused by extremely potent toxins found in foods that humans consume, according to the Journal of Environmental Health. These toxins are produced by Clostridium botulinum, a bacterium. While certain types of botulism are dangerous to humans, the disease is not transmitted from person to person and therefore cannot spread the way many other infectious diseases do. This paper covers the seven types of botulism and includes information about the benefits that can be derived from botulinum toxin.

The Seven Types of Botulism

The Journal of Environmental Health (2003, p. 51) explains that of the seven specific types of botulism, four — Types A, B, E, and, on rare occasions, F — cause botulism in humans. The other three (Types C, D, and G) are linked to disease in fish, birds, and mammals. It is important to understand that the symptoms of botulism are produced by the toxin inside the organism, and it generally takes between 12 and 36 hours for a person to become ill. The Journal of Environmental Health reports that only five to ten percent of botulism cases result in death. A typical botulism attack initially produces fatigue, weakness, blurred vision, vertigo, and difficulty speaking and swallowing. Sufferers may also experience vomiting, diarrhea, constipation, and abdominal swelling (Journal of Environmental Health, p. 51).

The Centers for Disease Control and Prevention explains that in foodborne botulism, the muscle weakness a person experiences begins with the shoulders, then moves to the upper arms, then the lower arms, followed by the thighs and calves (CDC, 2006).

One of the most commonly experienced types is foodborne botulism. This kind of botulism occurs, in most cases, when food has not been cooked sufficiently. The organism Clostridium botulinum grows in certain foods when oxygen is absent and storage temperatures are not properly controlled (Journal of Environmental Health, p. 51). Foods that commonly become contaminated include: lightly preserved products such as fermented, salted, or smoked fish or meat; inadequately processed home-canned or home-bottled low-acid foods such as vegetables; preserved green beans, mushrooms, beets, and spinach; fish products such as canned tuna and smoked or fermented fish like smoked salmon; and certain canned meat products such as sausages, chicken, and ham (Journal of Environmental Health, p. 51).

There are a number of conditions under which Clostridium botulinum can thrive, but in most cases the toxin can be eliminated through normal cooking — using temperatures of around 85 degrees Celsius for at least five minutes, or a hard boil for three to four minutes (Journal of Environmental Health, p. 51).

The second type is inhalation botulism, which occurs when the toxin is inhaled in aerosol form. Its symptoms are very similar to those of foodborne botulism, except that the incubation period is generally longer (Journal of Environmental Health, p. 51). Waterborne botulism, the third type, occurs when an individual drinks water containing the toxin, though this form is uncommon. In rare instances, patients have contracted botulism through cosmetics or medical applications, which constitutes the fourth type (Journal of Environmental Health, p. 52).

Infant botulism is very rare but occurs when infants ingest spores that germinate and produce bacteria, which grow in the child's intestinal tract and release toxins into the body (Journal of Environmental Health, p. 52). The effects are generally not severe; they can include loss of appetite, an unusual cry, constipation, and in some cases a striking loss of head control (Journal of Environmental Health, p. 52). The Centers for Disease Control and Prevention reports that infant botulism occurs only in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract (CDC, 2006).

The sixth type, botulism of undetermined origin, does not result from food or wounds and may follow surgery or antibiotic use when the normal gut flora has been altered (Journal of Environmental Health, p. 52). The seventh type, wound botulism, is quite rare and occurs when spores enter an open wound. Symptoms may take nearly two weeks to appear and are similar to those of foodborne botulism (Journal of Environmental Health, p. 52).

The best way to prevent botulism is to practice sound food preservation methods, since foodborne contamination is the most common route. Pasteurizing products should be sufficient to prevent botulism, though the Journal of Environmental Health notes that some Clostridium botulinum spores can survive even after sterilization.

The 2006 Thailand Botulism Outbreak

In Thailand and other Asian countries, bamboo shoots are a dietary staple. The young, tender shoots of bamboo have been a traditional forest vegetable in China for more than 2,500 years and are valued not only for their flavor but also for their rich nutritional content, including proteins, carbohydrates, minerals, and fiber (Chongtham et al., 2011, p. 153). Most bamboo shoots are free from residual toxicity and require no fertilizers to grow. Their consumption is associated with several health benefits, including improved appetite and digestion, weight loss, and potential protective effects against cardiovascular disease and cancer. The shoots are also known to have anticancer, antibacterial, and antiviral properties (Chongtham, p. 153). Bamboo shoot fiber is used in cookies, breakfast cereals, sauces, shredded cheeses, and some meat products (Chongtham, p. 153).

However, when bamboo shoots are preserved through home canning, the correct heat levels must be maintained for the required duration, or botulism can result. In March 2006, an annual religious ceremony was held in a small village in Thailand, and bamboo shoots were served unheated in small plastic bags for lunch (Aldis et al., 2007, p. 238). The consequences were serious: 209 of the villagers who attended the ceremony experienced the onset of symptoms consistent with botulism (Aldis, p. 238).

Sixty-four percent of those 209 individuals — 134 villagers — were hospitalized with paralysis ranging from minor bulbar palsies to quadriparesis (Aldis, p. 238). No deaths occurred, but 42 villagers (20%) required mechanical ventilation for respiratory depression. A public health emergency was declared the following day, March 16, by provincial authorities, and once botulism poisoning was confirmed, a search began for botulinum antitoxin.

Over the next three days, nineteen patients were placed on ventilators; by six days after the outbreak, 39 patients required ventilatory support. Obtaining the antitoxin proved difficult, as Aldis reported (p. 238). Public health agencies in the UK, the United States, Geneva, Japan, and Bangkok were contacted. The antitoxin was ultimately supplied by the Centers for Disease Control and Prevention in Atlanta, the National Laboratory in London, and the NIID in Tokyo. These three sources sent 93 vials, and a commercial source in Canada provided an additional 10 vials (Aldis, p. 239).

The time required to secure the antitoxin meant that the most severe cases in Thailand were not treated until five days after patients became seriously ill. By the ninth day after exposure, 70 more patients had been treated.

Conclusion

The incident in Thailand, caused by botulism in bamboo shoots, is ample evidence that nations around the world need to be more fully prepared for outbreaks that could affect large numbers of people. Citizens should also be educated about how to safely preserve foods and how to identify commercially prepared foods that may pose a risk of botulism. This paper has also demonstrated that there are legitimate positive health applications for botulinum toxin. While it may not be clear that the benefits of botulinum toxin outweigh its potentially deadly risks, an understanding of both outcomes is essential for health agencies and citizens throughout the world.

Works Cited

Aldis, W., Braden, C.R., Chunsuttiwat, S., Olsen, S.J., Ueno, K., and Ungchusak, K. (2007). The need for global planned mobilization of essential medicine: lessons from a massive Thai botulism outbreak. Bulletin of the World Health Organization, 85(3), 238–241.

Centers for Disease Control and Prevention. (2006). There are three main kinds of botulism. Retrieved July 4, 2012, from http://emergency.cdc.gov/agent/botulism/factsheet.asp.

Chongtham, Nirmala, Bisht, Madho Singh, and Haorongbam, Sheena. (2011). Nutritional properties of bamboo shoots: Potential and prospects for utilization as a health food. Comprehensive Reviews in Food Science and Food Safety, Vol. 10, 153–169.

Henshaw, Ashley. (2012). Dangers and benefits of botulinum toxin. Symptom Find. Retrieved July 4, 2012, from http://www.symptomfind.com/health/botulinum-toxin.

Journal of Environmental Health. (2003). Botulism — information from the World Health Organization. Journal of Environmental Health, 65(9), 51–52.