Botulism Blog : Botulism Lawyer & Attorney : Marler Clark Law Firm : Botulism Blog

We are very fortunate that while botulism is deadly it is also rare.

Today’s issue of Morbidity & Mortality Weekly Report (MMWR) published by the Centers for Disease Control & Prevention (CDC) carries an article that dissects all the food-borne disease outbreaks that occurred in 2006.

In “Surveillance for Foodborne Disease Outbreaks --- United States, 2006;” CDC looks at all 1,270 Food-borne Disease Outbreak (FBDOs) that were reported during that year, resulting in 27,634 confirmed illnesses and 11 deaths.

Only one of the 11 deaths was from Clostridium botulinum or botulism. That fatality was attributed to the C. botulinum toxin being transmitted by carrot juice.

Writing on his personal blog last December, Seattle food safety attorney Bill Marler told us what happened:

"For those that do not recall, in September 2006, three people living in Georgia developed food-borne botulism that was eventually traced to commercial carrot juice from a single bottle. Soon thereafter an additional case in Florida and two in Ontario, Canada surfaced. One of the 6 botulism patients died 90 days after illness onset. One year later, two others were still on ventilators. The remaining three were taken off ventilator support after 54, 90, and 129 days. Two survivors were at home, two were in rehabilitation facilities, and one was still hospitalized. All the patients had consumed carrot juice from the same manufacturer.

"Now, here is the interesting part, according to Dr. Anandi N. Sheth at the Centers for Disease Control in Atlanta, Georgia and colleagues, an investigation eventually determined that inadequate refrigeration probably led to botulinum toxin production. As the investigators pointed out, the pasteurized carrot juice had no protection against the bacterium Clostridium botulinum other than refrigeration. "This investigation demonstrates that carrot juice and other processed foods with no natural barriers to C. botulinum germination require additional chemical or thermal barriers," the investigators wrote in the medical journal Clinical Infectious Diseases. Accordingly, they report, "In June 2007, the FDA modified its guidance for refrigerated low-acid juices to recommend adding a validated juice-treatment method, such as acidification or appropriate thermal treatment, to decrease the risk of C. botulinum contamination, should any breaches in refrigeration occur."

Its comforting to know FDA may have addressed the problem and implemented the fix for the 2006 carrot juice outbreak.  However, it also shows that botulism from food products remains a concern.

 

• Email This
• Print
• Comments
• Trackbacks
• Share Link

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. Clostridium botulinum is the name of a group of bacteria commonly found in soil. The bacteria are anaerobic, gram-positive, spore-forming rods that produce a potent neurotoxin. These rod-shaped organisms grow best in low oxygen conditions. The bacteria form spores that allow them to survive in a dormant state until exposed to conditions that can support their growth. The organism and its spores are widely distributed in nature. They occur in both cultivated and forest soils, bottom sediment of streams, lakes, and coastal waters, in the intestinal tracts of fish and mammals, and in the gills and viscera of crabs and other shellfish.

Foodborne botulism is a severe type of food poisoning caused by the ingestion of foods containing the potent neurotoxin formed during growth of the organism. The incidence of the disease is low, but the disease is of considerable concern because of its high mortality rate if not treated immediately and properly. Most of the 10 to 30 outbreaks that are reported annually in the United States are associated with inadequately processed, home-canned foods, but occasionally commercially produced foods are implicated as the source of outbreaks. Sausages, meat products, canned vegetables, and seafood products have been the most frequent vehicles for foodborne botulism.

Symptoms of Botulism

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk, and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after consuming contaminated food, but they can occur as early as 6 hours or as late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, then moving to the throat, chest, and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and unless the patient receives treatment in time, death from asphyxia results.

Detection and Treatment of Botulism

Although botulism can be diagnosed by clinical symptoms alone, differentiation from other diseases may be difficult. The most direct and effective way to confirm the clinical diagnosis of botulism in the laboratory is to demonstrate the presence of toxin in the serum or feces of the patient or in the food the patient consumed. Currently, the most sensitive and widely used method for detecting toxin is the mouse neutralization test, which involves injecting serum or stool into mice and looking for signs of botulism. This test typically takes 48 hours. Culturing of specimens takes 5-7 days. Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or using enemas.

While botulism has been known to cause death due to respiratory failure, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves.

Preventing Botulism

The types of foods implicated in botulism outbreaks vary according to food preservation and eating habits in different regions. Any food that is conducive to outgrowth and toxin production, that when processed allows spore survival, and is not subsequently heated before consumption, can be associated with botulism. Almost any type of food that is not very acidic (pH above 4.6) can support growth and toxin production by C. botulinum. Botulinal toxin has been demonstrated in a considerable variety of foods, such as canned corn, peppers, green beans, soups, beets, asparagus, mushrooms, ripe olives, spinach, tuna fish, chicken and chicken livers and liver pate, and luncheon meats, ham, sausage, stuffed eggplant, lobster, and smoked and salted fish.

Botulinum toxin is heat-labile, or unstable if heated to a certain temperature, and can be destroyed if heated and held at 80 degrees Centigrade (176 degrees Fahrenheit) for ten minutes or longer.

• Email This
• Print
• Comments (1)
• Trackbacks
• Share Link