Botulism Lawyer

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Los Angeles County officials have detective three new cases of suspected botulism associated with the use of black tar heroin.

Three more cases were discovered in June, the Los Angeles County Department of Public Health said in a prepared statement.

Six cases in one summer is unusual, DPH Health Officer Dr. Muntu Davis said.

“We normally see two to three cases of botulism among heroin users per year, so this is a significant increase,” he said. “We are asking community providers and partners, particularly those serving people that use heroin such as substance use providers, to inform patients and colleagues about the increased risk.”

There are no visible signs that heroin is tainted , health officials said. Heating, or “cooking,” the drugs won’t kill the bacteria.

While the illness cannot be transmitted from person to person, sharing contaminated needles can spread it, according to the health department warning. The risk is greatest when the drug is injected.

Officials warn that botulism is a serious and potentially deadly condition.

Symptoms include drooping eyelids, blurred vision or double vision, difficulty speaking or swallowing and shortness of breath. They may occur within days or weeks of injecting the contaminated heroin, and can be mistaken for a drug overdose.

Health officials are being reminded to consider the possibility of botulism when treating heroin-using patients showing neurological symptoms.

Davis urged anyone trying to kick a heroin addiction to contact the DPH’s Substance Abuse Service Helpline at 844-804-7500.

As a precaution, approximately 7,000 cases of Taco Bell Salsa Con Queso Mild Cheese Dip are being voluntarily recalled because the affected product is showing signs of product separation which can lead to a potential health hazard.

This could create conditions that could allow for the growth of Clostridium botulinum (C. botulinum), a bacterium which can cause life-threatening illness or death. Consumers are warned not to use the product even if it does not look or smell spoiled.

Botulism, a potentially fatal form of food poisoning, can cause the following symptoms: general weakness, dizziness, double vision, and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distension and constipation may also be common symptoms. People experiencing these problems should seek immediate medical attention.

There have been no consumer complaints or reports of illness related to this issue to date.

The following is being recalled:

Product
Size

Name of 
Product

Packaging
Description

Case Unit 
Best When
Used By 
Code Date

Individual Package 
Best When 
Used By 
Code Date

Individual
Package UPC

 Case UPC
15 oz. Taco Bell Salsa Con Queso Mild Cheese Dip Glass Jar 27 DEC 2018
23 JAN 2019		 27 DEC 2018
23 JAN 2019		 021000024490 21000024490
01 NOV 2018
26 DEC 2018
27 DEC 2018
31 OCT 2018 27 DEC 2018
15 oz. Taco Bell Salsa Con Queso Mild Cheese Dip Glass Jar 23 JAN 2019 23 JAN 2019 021000024490 21000066900

Masstown Market is recalling Masstown Market brand Smoked Kippers and Cold Smoked Salmon from the marketplace because they may permit the growth of Clostridium botulinum. Consumers should not consume the recalled products described below.

Recalled products

Brand Name Common Name Size Code(s) on Product UPC
Masstown Market Smoked Kippers Variable weight 18.MR.30 Starts with
0 208172
Masstown Market Cold Smoked Salmon Variable weight 18.MR.27
18.AL.07
18.AL.11		 Starts with
0 208035

Guymon Extracts recalled about 4,202 pounds of pork soup late Tuesday night after a processing problem left the soup vulnerable to spore-forming bacteria, including the one that causes botulism.

“Botulism is a life-threatening disease caused by the ingestion of a potent neurotoxin produced during growth of the C. botulinum bacteria,” the U.S. Department of Agriculture site explains. “This neurotoxin is among the most toxic substances known; even microscopic amounts can cause illness or death.”

That’s why this is a Class 1, High Health Risk recall, which the USDA defines as, “a health hazard situation where there is a reasonable probability that the use of the product will cause serious, adverse health consequences or death.”

Despite that, the recall comes seven days after an investigator found the problem while doing a food safety assessment at the processing facility. The soup, packaged Jan. 3, went to Florida, California, Colorado, Georgia, Illinois, Texas and Washington.
Along with the botulism bacteria, the recall notice mentioned Clostridium perfringens. That bacteria, according to the Centers for Disease Control and Prevention, causes “one million cases of foodborne illness in the United States each year.”

“Pork Soup with Rendered Pork Fat (from bone)” comes in 2.2-pound bags, 10 per case, with a best-by date of Dec. 22, 2019, a lot code 010218-1 and a product code of 61306.

The food recall warning issued on December 9, 2017 has been updated to include additional product information. This additional information was identified during the Canadian Food Inspection Agency’s (CFIA) food safety investigation.

Imperial Caviar & Seafood is recalling Imperial Caviar & Seafood and VIP Caviar Club brand Trout Roe from the marketplace because they may permit the growth of Clostridium botulinum. Consumers should not consume the recalled products described below.

The following products have been sold in Quebec and Ontario.

Recalled products

Brand

Product

Size

UPC

Codes

Imperial Caviar & Seafood

Trout Roe

100g

1 86866 51017 1

All Best Before dates up to and including December 13, 2018

Imperial Caviar & Seafood

Trout Roe

50g

1 86866 51016 4

All Best Before dates up to and including December 13, 2018

VIP Caviar Club

Trout Roe

50g

1 86866 51016 4

All Best Before dates up to and including December 13, 2018

The Canadian Food Inspection Agency says a variety of fish products from two grocery stores in the Toronto area are being recalled due to a risk of botulism.

The agency says the affected products were sold at Yummy Market stores in northern Toronto and Maple, Ont., and include the store’s brand of smoked herring, lesch, mackerel, rainbow trout, salmon and sturgeon.

The CFIA says the recall was issued last week after a consumer complaint and was recently expanded after a food safety investigation.

It says there have been no other illnesses reported that have been linked to the recalled fish products.

The CFIA advises people to throw out the recalled products or return them to the store where they were purchased.

The Canadian Food Inspection Agency says a brand of caviar is being recalled because it may contain a dangerous toxin.

The agency says the International House of Caviar is recalling its brand of rainbow trout caviar due to a risk of botulism.

It says the caviar has been distributed in Alberta, British Columbia, Manitoba, Ontario and Saskatchewan.

The recalled item is sold in 100-gram jars with a best before the date of Aug. 30, 2018.

The CFIA says there have been no reported illnesses linked to the caviar.

Food contaminated with Clostridium botulinum toxin may not look or smell spoiled, but can still make you sick.

Symptoms in adults can include facial paralysis or loss of facial expression, unreactive or fixed pupils, difficulty swallowing, drooping eyelids, blurred or double vision and difficulty speaking.

Symptoms in children can include difficulty swallowing, slurred speech, generalized weakness and paralysis.

Death Wish Coffee Co. (“Death Wish”), the Round Lake, N.Y.-based Coffee producer known for producing the ‘World’s Strongest Coffee’, has initiated a recall its 11-oz Death Wish Nitro Cold Brew cans.

Death Wish in conjunction with an outside Process Authority has determined that the current process could lead to the growth and production of the deadly toxin, botulin, in low acid foods commercialized in reduced oxygen packaging.

Botulism, a potentially fatal form of food poisoning, can cause the following symptoms: general weakness, dizziness, double-vision and trouble with speaking or swallowing. Difficulty in breathing, weakness of other muscles, abdominal distention and constipation may also be common symptoms. People experiencing these problems should seek immediate medical attention.

“Our customers’ safety is of paramount importance and Death Wish Coffee is taking this significant, proactive step to ensure that the highest quality, safest, and of course, strongest Coffee products we produce are of industry-exceeding standards – thus we are taking this measure of recalling all Death Wish Nitro cans from shelves,” founder/owner of Death Wish Coffee Co., Mike Brown says. “We have also gone a step further, to make sure that everyone who purchased the product on deathwishcoffee.com will receive a full refund within 60 days. We apologize for the inconvenience this may cause our customers and our retail partners, but we believe this is the right precautionary measure to take.”

Death Wish is halting production of Nitro Cold Brew until an additional step in the manufacturing process is implemented.

Death Wish Nitro cans have been removed from the company’s online store, in addition to it has been pulled from shelves at Price Chopper/Market 32, Healthy Living Market & Café, and independent retailers at the behest of Death Wish Coffee.

BOTULISM—A Rare, But Deadly Disease

Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum.[1]  Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.[2]  These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions.[3]  Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity.[4]  And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.[5] C. botulinum bacteria and spores are widely distributed in nature, because they are indigenous to soils and waters.[6] 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.[7]

The incidence of foodborne botulism is extremely low.[8]  Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.”[9] This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly.[10] Most of the botulism events[11] that are reported annually in the United States are associated with home-canned foods that have not been safely processed.[12]  Occasionally, though, commercially-processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.[13]

Symptoms of Botulism

After their ingestion, botulinum neurotoxins are absorbed primarily in the duodenum and jejunum, pass into the bloodstream, and travel to synapses in the nervous system.[14] There, the neurotoxins cause flaccid paralysis by preventing the release of acetylcholine, a neurotransmitter, at neuromuscular junctions, thereby preventing motor-fiber stimulation.[15] The flaccid paralysis progresses symmetrically downward, usually beginning with the eyes and face before moving to the throat, chest, and extremities.[16] When the diaphragm and chest muscles become fully involved, respiration is inhibited and, unless the patient is ventilated, death from asphyxia results.[17]

Classic symptoms of botulism include nausea, vomiting, fatigue, dizziness, double vision, drooping eyelids, slurred speech, difficulty swallowing, dryness of skin, mouth, and throat, lack of fever, muscle weakness, and paralysis.[18]  Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone.[19] Throughout all such symptoms, the victims are fully alert and the results of sensory examination are normal.[20]

In foodborne botulism cases, symptoms usually begin anywhere between 12 and 72 hours after the ingestion of toxin-containing food.[21]  Longer incubation periods—up to 10 days—are not unknown, however.  The duration of the illness is from 1 to 10 (or more) days, depending on host-resistance, the amount of toxin ingested, and other factors.[22]  Full recovery often takes from weeks to months.[23] And, as earlier indicated, mortality rate can be from 30% to 65%, with rates generally lower in European countries than in the United States.[24]

Detection and Treatment  of Botulism

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition.[25] Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient.[26]  The food consumed by the patient can also be tested for the presence of toxins.[27]  Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism.[28]  This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days.[29] Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.[30]

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood.[31] This can prevent patients from worsening, but recovery still takes many weeks.[32] The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.[33]

Long-Term and Permanent Injury

Although a minority of botulism patients eventually recover their pre-infection health, the majority do not. For those who fully recover, the greatest improvement in muscle strength occurs in the first three months after the acute phase of illness.[34]  The outside limit for such improvement appears, however, to be one year.[35]  Consequently, physical limitations that still exist beyond the one-year mark are more probably than not permanent.  Recovery from acute botulism symptoms may also be followed by persistent psychological dysfunction that may require intervention.[36]

According to a recently-published study that tracked the long-term outcomes of 217 cases of botulism, a large majority of patients reported “significant health, functional, and psychosocial limitations that are likely the consequences of the illness.”[37]  These limitations included: fatigue, weakness, dizziness, dry mouth, and difficulty lifting things.  The victims also reported difficulty breathing caused by moderate exertions, such as walking or lifting heavy items.  They were also more likely to have limitations in vigorous activities, like running or playing sports, climbing up three flights of stairs, or carrying groceries. Summarizing its finding, the study concluded that:

Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing caused by moderate exertion….In addition, patients…reported worse overall psycho-social status than did control subjects, with patients being significantly less likely to report feeling happy, calm and peaceful, or full of pep.[38]

There is, as a result, no question that the damaging effects of botulism are life-long.

[1]           See J. Sobel, et al., Foodborne Botulism in the United States, 1990-2000, Emerging Infectious Diseases, Vol. 10, No. 9, at 1606 (Sept. 2004).

[2]           James M. Jay, MODERN FOOD MICROBIOLOGY, 466 (6th Ed. 2000)

[3]           Id. at 469-71; see also Sobel, supra note 2, at 1606.

[4]           Sobel, supra note 2, at 1606.

[5]           Id.

[6]           Jay, supra note 3, at 467-69.  See also, generally H. Houschild, Clostridium Botulinum, in FOODBORNE BACTERIAL PATHOGENS, at 112-89  (M. Doyle Ed. 1989)

[7]           Jay, supra note 3, at 467-69.

[8]           Sobel, supra note 2, at 1607-09; Jay, supra note 3, at 472-76.

[9]           Sobel, supra note 2, at 1606-07 (also noting that the CDC maintains a 24-hour clinical consultation and emergency antitoxin release service).

[10]          Jay, supra note 3, at 474.

[11]          With botulism, the broader term “event” is used to encompass both outbreaks—i.e., two or more cases of botulism caused by a common-source, as well as individual (or sporadic) cases.

[12]          Sobel, supra note 2, at 1610; Jay, supra note 3, at 474.

[13]          Id.

[14]          Thomas P. Bleck, Clostridium botulinum (Botulism), in MANDELL, DOUGLAS AND BENNETT’S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASE 2543, 2544 (5th ed. 2000).

[15]          Id.; Sobel, supra note 2, at 1606.

[16]          Bleck, supra note 15, at 2545; see also BOTULISM FACT SHEET, National Agricultural Bio-Security Center, Kansas State University, online at http://nabc.ksu.edu/content/factsheets/category/Botulism#f26

[17]          Bleck, supra note 15, at 2545; Sobel, supra note 2, at 1606.

[18]          Sobel, supra note 2, at 1606; Jay, supra note 3, at 474.

[19]          Jay, supra note 3, at 476-77.

[20]          Sobel, supra note 2, at 1606.

[21]          Jay, supra note 3, at 474.

[22]          Id.

[23]          R. Shapiro, et al., Botulism in the United States: A Clinical and Epidemiologic Review, Ann. Intern. Med. 1998; 129:221-28.

[24]          Jay, supra note 3, at 474.

[25]          Bleck, supra note 15, at 2546 (noting that “botulism has a limited differential diagnosis”).

[26]          Sobel, supra note 2, at 1607; see also FDA/CFSAN Bad Bug Book, Clostridium Botulinum, available at http://vm.cfsan.fda.gov/~mow/chap2.html

[27]          Id.

[28]          Bleck, supra note 15, at 2546.  See also, e.g. MMWWR, supra note 1, at 2 (“CDC detected botulinum toxin Type A by mouse bioassay in the man’s serum sample”).

[29]          Bad Bug Book, supra note at 25.

[30]          Sobel, supra note 2, at 1606; Shapiro, supra note 23, at 223.

[31]          Jay, supra note 3, at 474; Sobel, supra note 2, at 1606.

[32]          Id.; Bleck, supra note 15, at 2546-67.

[33]          Sobel, supra note 2, at 1606.

[34]          Bleck, supra note 15, at 2547. See also P. Wilcox, et al., Recovery of Ventilatory and Upper Airway Muscles and Exercise Performance After Type-A Botulism, Chest, 98:620-26 (1990); J. Mann, et al., Patient Recovery From Type-A Botulism: Morbidity Assessment Following a Large Outbreak, Am. J. Public Health, 71 (3):266-69 (Mar. 1981).

[35]          Id.

[36]          Bleck, supra note 15, at 2547. See also F. Cohen, et al., Physical and Psychosocial Health Status 3 Years After Catastrophic Illness—Botulism, Issues Mental Health Nurs., 9:387098 (1988)

[37]          S. Gottlieb, et al., Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia, Clin. Infectious Disease, 45: 174-80, at 180 (220&).

[38]          Id. at 179.

thThe California Department of Public Health (CDPH) tested and confirmed that nacho cheese sauce that was sold at a gas station in Sacramento County has tested positive for the toxin that causes botulism. The toxin found in the cheese sauce is the same type identified in patients for whom CDPH has results. https://emdinspections.saccounty.net/document.aspx?id={8AB316AD-53B0-4F16-9C25-26209CA87B1F}&type=application/pdf 

CDPH has received reports of 10 cases of botulism linked to this outbreak, and has learned that one patient has died. The nacho cheese sauce was removed from sale on May 5. CDPH believes there is no continuing risk to the public.

“While there are still unanswered questions about this outbreak, these tragic illnesses are important reminders to be vigilant about food safety,” said CDPH Director and State Public Health Officer Dr. Karen Smith. “As we head into the summer barbecue season, both indoor and outdoor chefs need to be on guard against all foodborne illnesses.”

Botulism cases are reported to CDPH so that appropriate action can be taken to protect public health. For botulism and other foodborne diseases, CDPH and local public health departments receive case reports, conduct investigations to determine possible sources of exposure, test laboratory specimens to identify and link foodborne illnesses, take action to ensure food items that pose a risk to public health are no longer available, provide information to the public about how to prevent disease, and publish data about overall disease trends and risks.

For foodborne diseases, CDPH does not track patient conditions or outcomes. To protect patient privacy, CDPH is not sharing information about the patients affected in this botulism outbreak, their conditions or the four counties that have reported cases.

CDPH and local health departments have notified health care providers to be aware of the symptoms of botulism, including:

·             Double or blurred vision

·             Drooping eyelids

·             Slurred speech

·             Difficulty swallowing

·             Dry mouth

·             Muscle weakness

People experiencing these symptoms should contact their health care provider immediately.

Foodborne botulism is a rare but serious paralytic illness caused by a nerve toxin produced by the bacterium Clostridium botulinum. Botulism can be treated with antitoxin and supportive care, often in an intensive care unit. Botulism is fatal in about 5 percent of cases. The toxin that causes botulism can be found in foods that are not properly processed or stored. It is odorless and colorless, so it is not possible to tell if a product is contaminated just by looking at it.

In the kitchen or at your backyard grill, simple steps can prevent many types of foodborne illnesses, including:

·             Cook – Make sure foods are cooked to the right temperature.

·             Clean – Wash hands and surfaces often.

·             Chill – Refrigerate foods properly.

·             Separate – Separate raw meats from other foods.

According to recent news reports, the outbreak of foodborne botulism originating from the Valley Oak Food and Fuel gas station in Walnut Grove has left 10 people hospitalized, the state Department of Health reported Friday, and an Antioch resident, Martin Galindo, may have died as a result.

The botulism outbreak was reported to have come from nacho cheese sauce sold at the Valley Oak Food and Fuel gas station in Walnut Grove.

37-year-old Martin Galindo from Antioch also died in a hospital in San Francisco on Thursday night after contracting what his family said is a rare case of botulism. ABC7 News reported on Friday that Martin Galindo contracted botulism from nacho cheese bought at the gas station and was being treated in San Francisco.

Inspection reports for the Valley Oaks Food and Fuel station show that on May 6 and 7, officers impounded bags of Montecito nacho cheese tortilla chips and closed the facility. On May 8, health officers from the state Department of Health impounded four bags of Gehls cheese sauce and reopened the store to sell prepackaged food items only.