Botulism is an uncommon disorder that is caused by the toxin of the
Clostridium botulinum bacteria. It can be classified as either being
foodborne, from contaminated food products,
infant, usually in children under six months of age,
wound, after trauma or a wound becomes contaminated, or
unclassified, for children over 12 months with no obvious wound or food source.
C. botulinum is a bacteria that can form spores, which are dormant cells that are very tough and resistant to being destroyed (surviving boiling for several hours). These spores are very commonly found in the soil and in the sediment of rivers and lakes, and make their way into the intestines of many animals and fish and they may also be found on the surfaces of fruits and vegetables.
If the spores are so commonly found, then why is botulism such an uncommon disorder? It is because the spores usually only germinate and produce the botulinum toxin, which is extremely poisonous and causes the symptoms, in foods that are improperly prepared and/or stored. Therefore, proper food handling and safety precautions can easily prevent botulism. The most common ways to kill the spores or toxin is by heating foods to a very high temperature and not leaving foods at room temperature.
Foodborne (classic) botulism is a type of food poisoning that occurs after ingestion of a food that has been contaminated with the toxin of C. botulinum. The contaminated food has usually been stored or preserved improperly so that the spores can germinate, grow and multiply and produce toxin. Foods that are commonly associated with botulism include home-canned foods, especially vegetables, that are not prepared properly, foods preserved in oil, foods left out of the refrigerator at room temperature for long periods of time, and fish that aren't properly prepared and cooked.
Infants, usually between three weeks and six months of age, can develop botulism by ingesting the spores themselves, which can germinate in their intestines and produce toxin. A baby may ingest the spores from contaminated honey, and this is the reason that honey shouldn't be given to young children, or by inhaling spores from contaminated dust or soil. Light and dark corn syrups that are not sterilized may also be contaminated with spores, although this is controversial and the American Academy of Pediatrics reports that 'light and dark corn syrups are not potential sources' of botulism. In most cases, the source of the spores is not discovered. Symptoms of infant botulism usually include constipation, poor feeding, lethargy or decreased activity, a weak cry, generalized muscle weakness and poor muscle tone leading to poor head control, drooling, apnea, decreased reflexes, dilated pupils that do not react quickly to light, and finally paralysis, which may include the eye muscles. In most cases, the symptoms last for 2-6 weeks and the infant has a complete recovery (although a relapse is possible in about 5% of cases).
C. botulinum can also infect a wound, usually 4-14 days after a crush injury, multiply and produce toxin leading to symptoms.
Symptoms usually develop within 12-36 hours of eating contaminated food, but may develop as quickly as a few hours or as slowly as several days. The symptoms may begin with nausea, diarrhea and/or vomiting and will include symmetric paralysis (occuring on both sides of the body) that initially affects the muscles of the head and face (causing the eyelids to droop, paralysis of one or more muscles of the eyes, double vision, difficulty speaking or swallowing, and a dry mouth), and then advances down the body, affecting the muscles of the arms and legs. Weakness and fatigability will usually worsen with activity. Other symptoms can include dizziness and constipation, but fever is usually absent. Without treatment, the paralysis can also affect the muscles that help a person to breathe, causing difficulty breathing and sometimes death, but symptoms may also be much more mild, with a full recovery over 2-3 months.
Diagnosis is by testing for the bacteria and/or toxin in the blood and stool of person's thought to be infected. Contaminated food can also be tested. Other tests may include a spinal tap to evaluate the cerebrospinal fluid, which can help differeniate this disorder from Guillain-Barre syndrome, which has similar symptoms, and an EMG (electromyography). An edrophonium test may be needed to rule out myasthenia gravis, which also has similar symptoms.
In addition to supportive treatments, such as putting a child who is not able to breathe on his own on a ventilator or using tube feedings for children who can't eat, children suspected of having botulism can be treated with an antitoxin.
Preventative measures to prevent contamination of food can include using a pressure cooker to heat foods to a temperature high enough (250 degrees F) to kill the spores before canning, boiling foods for at least 10 minutes (especially home canned foods) before eating (this doesn't kill the spores, but it can inactivate the toxin), promptly refrigerating leftovers and not leaving foods at room temperature for more than a few hours and avoiding canned foods that seem to bulge, which can be an indication that C. botulinum is growing and producing gas.
Other ways to protect your child from germs that cause food poisoning,include the following food safety techniques, which include not giving your child undercooked or poorly refrigerated poultry, meat, fish or eggs; washing your hands, utensils and kitchen surfaces after handling uncooked poultry and meat; thoroughly washing fruits and vegetables; not giving your child unpasteurized dairy products or fruit juices; avoiding fish and shellfish from noncommercial sources; not serving hamburgers rare; defrosting foods in the refrigerator; and keeping your refrigerator set to at least 40 degrees Fahrenheit and your freezer to 0 degrees.
Botulinum toxin (Botox) is used as a treatment for children with cerebral palsy. When injected into a muscle that is spastic or stiff, it can help to decrease the muscle tone for about 4-6 months.
