Clostridium Botulinum, Research Paper Example

General Overview

The name of the disease ‘botulism’ is derived from a Latin word ‘sausage’ – it was coined by a scientist Justinus Kerner at the beginning of the 19^th century because of the final recognition of the connection between paralysis caused by food poisoning and the bacteria clostridium botulinum (Irwin and Rippe, 2008, p. 1136). Since then it became known that botulism is a serious disease causing the flaccid paralysis of muscles because of the effect of a neurotoxin, i.e. botulinum toxin (Botulism, 2009, p. 1). In more detail the essence and the effect of botulism can be described as follows:

“Clostridium botulinum, the etiologic agent of botulism, is an anaerobic, spore-forming organism that elaborates a neurotoxin that prevents the release of acetylcholine. Illness develops after toxin exposure, and patients present with a symmetric descending paralysis that characteristically begins with dysarthria, diplopia, dysphonia, or dysphagia” (Irwin and Rippe, 2008, p. 1136).

There are generally seven types of botulism toxins affecting different recipients, and the distribution of botulism causes in humans are typical for types A, B and E, while other types are more characteristic for animals, causing similar symptoms and the course of the disease. Investigations on the effect of the neurotoxin have been investigated since the middle of the 18^th century, and it was discovered only in the middle of the 20^th century that the main cause of the paralysis is the toxin BoNT A present in the clostridium botulinum bacteria (Botulism, 2009, p. 1).

As for the distribution of the bacteria, it is known that clostridium botulinum can be widely met in soils and marine sediments. There are no specifics of geographical distribution of bacteria because they can be found throughout the world, and its highest danger is that it can contaminate soil-grown food like vegetables or colonize the gastro-intestinal tract of fishes, birds and mammals (Nantel, 1999, p. 8). At the present moment a major part of research connected with distribution and genetic peculiarities of the bacteria are conducted by modern microbiologists to understand the tendencies of its emergence in nature and to find the ways to block potential epidemics that may occur in animals and human beings. Thus, for example, Boroff and Reilly (1958) have conducted research on pheasants and ducks to investigate their reaction on immunization and to find the right proportions and composition of the immunization to make it more efficient. Another example of modern research is the study of genomic background of different botulism types by Hill et al. (2006) that is potentially vital for understanding of techniques to fight against the bacteria and take preventive measures against its distribution.

At the present moment of time clostridium botulinum is considered one of the most dangerous toxins in the world, thus presenting a high level of danger for the humankind and concealing the potential of being used as a biological weapon in the hands of terrorists. Nonetheless, these facts do not prevent the described bacteria from being used for cosmetic and medical purposes.

Types of Bacteria. Epidemiology

The first type of botulism cases with humans is food-borne botulism. It was usually associated with home-made food because of the improper processing of products, but in the context of the 21^st century there have been a growing number of cases connected with factory-produced products. This tendency occurred because of the improper conditions at the factories that allowed the emergence of bacteria in food. The most common cases were registered in such food types as potato salad, cheese sauces and chopped garlic (Irwin and Rippe, 2008, p. 1136).

Infant botulism also takes the large proportion of all causes of botulism in humans – it occurs with infants under one year of age sue to their extreme vulnerability. Constipation is the main initial symptom, and the bacteria predominantly occur in honey, causing a multitude of symptoms and hospitalization lasting from several weeks up to half a year (Nantel, 1999, p. 6). Wound botulism is commonly associated with the drug usage and intrusion of bacteria through the wounds accompanying long-term drug usage (either through the vein wounds for intravenous drug users, or through nasal wounds for intranasal cocaine users) (Irwin and Rippe, 2008, p. 1136).

Adult infectious botulism occurs due to “intestinal colonization with C. botulinum and in vivo toxin production in a manner similar to that of infant botulism” (Nantel, 1999, p. 6). The distribution of such type of botulism is predetermined – the patients with such cases either used to have abdominal surgery, or achlorhydria, or were treated from the Crohn’s disease (Nantel, 1999, p. 6). Some other types of botulism that were registered with humans include Iatrogenic, or inadvertent botulism occurring because of the improper usage of Botox injections for cosmetic purposes and other intramuscular injections for medical purposes.

Despite the differences in occurrence of all types of botulism it is necessary to remember that all of them are potentially fatal (Botulism, 2009). In case the diagnosis was made too late and there were no first aid measures taken the possibility of death of the patient with botulism is highly credible. For this reason it is highly important to understand all implications of the disease, symptoms according to which it is possible to detect the infection and first aid measures that may be decisive in the flow of the disease and its outcomes.

Symptoms and First Aid Measures

Despite the fact that there are many types of clostridium botulinum bacteria, the symptoms that may be evident with the patient who got infected are commonly similar:

“The classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Constipation may occur. The doctor’s examination may reveal that the gag reflex and the deep tendon reflexes like the knee-jerk reflex are decreased or absent” (Botulism, 2009, p. 4).

In addition to the described symptoms, Irwin and Rippe () identify some more symptoms such as descending paralysis and symmetry in symptoms. Infant botulism is accompanied with feeding difficulties and constipation as well (Irwin and Rippe, 2008, p. 1137). Taking into consideration the fact that the incubatory period of botulism takes from 12 to 36 hours, timely diagnosis is vital because first aid measures will prevent the patient from experiencing aggravating symptoms such as disappearance of deep tendon reflexes and lower extremity weakness (Irwin and Rippe, 2008, p. 1137). One more factor that has to be taken into consideration is the dose of toxins that has been taken by the patient because the amount of clostridium botulinum is almost always the decisive point in the course of the illness and its result.

First aid measures to be taken in case botulism has been detected depend on the origin of the disease. For this reason it is important for the clinician to find out the recent history of the patient (regarding home-made food, treatment he or she underwent or drug usage, if present) – this will help identify the range of measures that will help the patient. Having stipulated the cause of botulism, it is already possible to take first aid measures.

Help with food-borne botulism may be conducted by emptying the stomach with the syrup of ipecac, administering activated charcoal and a cathartic, maintaining airway and assisting ventilation. In cases of wound and adult infectious botulism it is possible to conduct repetitive trivalent administration due to the slow recovery period. When it comes to infant botulism, regarding the vulnerability of the infant organism only immune globulin application is possible (Nantel, 1999, p. 7).

Treatment and Applications in Medicine

Treatment logically also depends on the kind of botulism the patient has. In cases of infant botulism, a new governmental program of treatment titled BabyBIG IV has been created (BIG is the abbreviation of Botulism Immune Globulin of type IV) – this medicine “is comprised of immune globulins that can be given intravenously to infants who have been diagnosed with infant botulism” (Botulism, 2009). As for adults and older children, it is possible to note such kinds of treatment as passive immunization with equine antitoxin, trivalent antitoxin and immune globulin is common (Irwin and Rippe, 2008, p. 1137). What is necessary to be remembered in the course of treatment is that the antitoxins that have been named are only means to stop the destructive effect of the toxin and they cannot restore the initial functions of muscles and eliminate all symptoms at once. Thus, blocking the activity of the toxin is the main purpose of treatment, while restoration of all functions of the body requires a long-term hospitalization period and comprehensive treatment.

As a concluding part of the report it is also necessary to name some medical application of the dangerous toxin called clostridium botulinum. The matter is that despite its fatal danger and threat that it represents for the human and animal organism, many applications have been found for the bacterium in medicine and cosmetics. As for other medical applications, clostridium botulinum bacteria can treat such diseases as:

• Spastic muscular conditions (torticollis)
• Cervical and upper limb dystonia
• Childhood strabismus
• Apraxia or eye-lid opening
• Hemifacial spasm
• Writer’s cramp
• Spasticity in cerebral palsy in children
• Hyperhidrosis (Nantel, 1999, p. 10).

However, despite such a wide application of clostridium botulinum has been found in the sphere of cosmetics. The most widely spread application is the usage of Botox for conservation of beauty and youth of women’s skin – injections in proper groups of muscles can reduce wrinkles (Nantel, 1999, p. 10).

References

Boroff, D.A., & Reilly, J.R. (1958). Studies of the Toxin of Clostridium Botulinum. Journal of Bacteriology, vol. 77 (2), pp. 142 – 146.

Botulism (2009). Retrieved February 15, 2010, from http://www.medicinenet.com/ botulism/page7.htm

Hill, K.K. et al. (2006). Genetic Diversity among Botulinum Neurotoxin-Producing Clostridial Strains. Journal of Bacteriology, vol. 189(3), pp. 818-832.

Irwin, R.S., & Rippe, J.M. (2008). Irwin and Rippe’s intensive care medicine (6^th edn.). Lippincott Williams & Wilkins.

Nantel, A.J. (1999). Clostridium Botulism. Centre de Toxicologie du Québec. Retrieved February 15, 2010, from http://www.who.int/csr/delibepidemics/clost ridiumbotulism.pdf