Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
The botulism neurotoxin is one of the most potent, lethal substances known.
Botulism is a disease caused by this neurotoxin (specifically A, B, E, or F type neurotoxin).
The neurotoxin is produced by bacteria called Clostridium botulinum.
The neurotoxin paralyzes muscles and can be deadly.
There are three major types of botulism that differ in how they are acquired: food-borne, wound, and infant botulism.
Food-borne botulism is usually caused by eating contaminated home-canned foods.
Never taste-test food that may have gone bad.
Wound botulism is due to Clostridium bacteria infecting a wound and releasing the neurotoxin.
In infant botulism, the baby consumes spores of the bacteria which then grow in the baby's intestine and release the neurotoxin.
Honey can contain spores of the bacteria and should not be fed to babies less than 1 year of age.
Early food-borne and wound botulism can be treated with an antitoxin to block the action of the neurotoxin.
Botulism neurotoxin is listed as a potential biological weapon.
Botulism neurotoxin is used in dilute concentration to treat medical and cosmetic conditions.
What is botulism?
Botulism is a serious illness that causes flaccid paralysis of muscles. It is caused by a neurotoxin, generically called botulinum toxin, produced by the bacterium Clostridium botulinum (and rarely by
C. butyricum and C. baratii). There are seven distinct neurotoxins (types A-G) that Clostridium botulinum produces, but types A, B, and E (and rarely F) are the most common that produce the flaccid paralysis in humans. The other types mainly cause disease in animals and birds, which also develop flaccid paralysis. Most
Clostridium species produce only one type of neurotoxin; however, the effects of A, B, E, or F on humans are essentially the same. Botulism is not transmitted
from person to person. Botulism develops if a person ingests the toxin (or rarely, if it is inhaled or injected) or if the
Clostridium spp. organisms grow in the intestines or wounds in the body and toxin is released.
The recorded history of botulism begins in 1735, when the disease was first associated with German sausage (food-borne disease or food poisoning after eating sausage). In 1870, a German physician by the name of Muller derived the name botulism from the Latin word for sausage. Clostridium botulinum bacteria were first isolated in 1895, and a neurotoxin that it produces was isolated in 1944 by Dr. Edward Schantz. From1949 to the 1950s, the toxin (named BoNT A) was shown to block neuromuscular transmissions by blocking the release of acetylcholine from motor nerve endings. Botulism toxin(s) are some of the most toxic substances known to man; while the toxin has been considered for use as a biological weapon, it has also been used to treat many medical conditions. In 1980, Dr. Scott used the toxin to treat strabismus (deviation of the eye), and in December 1989, BoNT-A (BOTOX) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in young patients. The use of BOTOX to treat glabellar lines (wrinkles and frown lines) was approved in 2002 by the FDA for cosmetic improvements; the FDA has approved many additional uses (for example, underarm sweating, and muscle pain disorders) since 2002.
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks or months, plus intensive medical and nursing care. The paralysis slowly improves. Botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. Antitoxin for infants is available from the California Department of Public Health, and antitoxin for older children and adults is available through CDC. If given before paralysis is complete, antitoxin can prevent worsening and shorten recovery time. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria followed by administration of appropriate antibiotics. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.