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(food-borne botulism and infant botulism)
What is botulism?
Botulism is a severe type of poisoning caused by toxins (poisons) that are made by bacteria called Clostridium botulinum.
There are three main types of botulism: infant botulism, foodborne botulism, and wound botulism. Infant botulism is the most common form of botulism reported in the USA. It mainly affects infants under the age of 1 year.
Infant botulism results from an infection of the gut with C. botulinum. As the bacteria grow in the the infants's gut, they produce a toxin that has its principle effect on the nervous system. In contrast, foodborne botulism results from eating the preformed toxin (toxin made by the bacteria in contaminated food). The bacteria are most commonly found in inadequately preserved, often home-canned or home-bottled food items. The third type of botulism, wound botulism, is rare and results when the botulism bacteria infects a wound and produces the toxin. Botulism is not spread from person-to-person.
What are the symptoms of botulism?
Infant botulism produces a wide range of symptoms including breathing difficulty, visual difficulty, poor feeding, and poor reflexes. The symptoms of foodborne botulism include blurred or double vision, general weakness, poor reflexes, and difficulty in swallowing. Untreated botulism may result in paralysis and death.
When do symptoms start?
The symptoms of wound and foodborne botulism usually start 12 to 36 hours after exposure to the botulinum bacteria. However, the symptoms may take as few as 2 hours or as many as 8 days to appear. Generally speaking, the shorter the incubation time, the more severe the disease. The length of time for symptoms to appear in infants is unknown, in part, because it is difficult to accurately determine when an infant was exposed to the bacterial toxin.
What is the treatment for botulism?
Hospital care is usually necessary to prevent respiratory failure. Antitoxin medications are given in some cases.
How can you keep from getting it?
Carefully and thoroughly cook (pasteurize) all home-canned and preserved foods before bottling or canning.
Canned or bottled foods that have bulging lids or sides should be discarded or returned unopened to the store where they were purchased.
Do not feed raw honey to infants. Also be sure that all milk and juices (i.e., apple juice) and food products that are fed to infants are pasteurized or cooked thoroughly.
Foods that do not smell right should not be eaten or tasted.
1. Name of the organism:
Currently, there are four recognized classes of enterovirulent E. coli (collectively referred to as the EEC group) that cause gastroenteritis in humans. Among these is the enterohemorrhagic (EHEC) strain designated E. coli O157:H7. E. coli is a normal inhabitant of the intestines of all animals, including humans. When aerobic culture methods are used, E. coli is the dominant species found in feces. Normally E. coli serves a useful function in the body by suppressing the growth of harmful bacterial species and by synthesizing appreciable amounts of vitamins. A minority of E. coli strains are capable of causing human illness by several different mechanisms. E. coli serotype O157:H7 is a rare variety of E. coli that produces large quantities of one or more related, potent toxins that cause severe damage to the lining of the intestine. These toxins [verotoxin (VT), shiga-like toxin] are closely related or identical to the toxin produced by Shigella dysenteriae.
2. Name of Acute Disease:
Hemorrhagic colitis is the name of the acute disease caused by E. coli O157:H7.
3. Nature of Disease:
The illness is characterized by severe cramping (abdominal pain) and diarrhea which is initially watery but becomes grossly bloody. Occasionally vomiting occurs. Fever is either low-grade or absent. The illness is usually self-limited and lasts for an average of 8 days. Some individuals exhibit watery diarrhea only.
Infective dose - Unknown, but from a compilation of outbreak data, including the organism's ability to be passed person-to-person in the day-care setting and nursing homes, the dose may be similar to that of Shigella spp. (10 organisms).
4. Diagnosis of Human Illness:
Hemorrhagic colitis is diagnosed by isolation of E. coli of serotype O157:H7 or other verotoxin-producing E. coli from diarrheal stools. Alternatively, the stools can be tested directly for the presence of verotoxin. Confirmation can be obtained by isolation of E. coli of the same serotype from the incriminated food.
5. Associated Foods:
Undercooked or raw hamburger (ground beef) has been implicated in nearly all documented outbreaks and in other sporadic cases. Raw milk was the vehicle in a school outbreak in Canada. These are the only two demonstrated food causes of disease, but other meats may contain E. coli O157:H7.
6. Relative Frequency of Disease:
Hemorrhagic colitis infections are not too common, but this is probably not reflective of the true frequency. In the Pacific Northwest, E. coli O157:H7 is thought to be second only to Salmonella as a cause of bacterial diarrhea. Because of the unmistakable symptoms of profuse, visible blood in severe cases, those victims probably seek medical attention, but less severe cases are probably more numerous.
7. Usual Course of Disease and Some Complications:
Some victims, particularly the very young, have developed the hemolytic uremic syndrome (HUS), characterized by renal failure and hemolytic anemia. From 0 to 15% of hemorrhagic colitis victims may develop HUS. The disease can lead to permanent loss of kidney function.
In the elderly, HUS, plus two other symptoms, fever and neurologic symptoms, constitutes thrombotic thrombocytopenic purpura (TTP). This illness can have a mortality rate in the elderly as high as 50%.
8. Target Populations:
All people are believed to be susceptible to hemorrhagic colitis, but larger outbreaks have occurred in institutional settings.
9. Analysis of Foods:
E. coli 0157:H7 will form colonies on agar media that are selective for E. coli. However, the high temperature growth procedure normally performed to eliminate background organisms before plating cannot be used because of the inability of these organisms to grow at temperatures of 44.0 - 45.5oC that support the growth of most E. coli. The use of DNA probes to detect genes encoding for the production of verotoxins (VT1 and VT2) is the most sensitive method devised.
10. History of Recent Outbreaks:
Three outbreaks occurred in 1982. Two of them, one in Michigan and one in Oregon, involved hamburgers from a national fast-food chain. The third occurred in a home for the aged in Ottawa, Ontario; club sandwiches were implicated, and 19 people died. More recently, several outbreaks in nursing homes and a day-care center have been investigated. Two large outbreaks occurred in 1984, one in 1985, three in 1986. Larger outbreaks have occurred in the Northwest U.S. and Canada.
In October-November, 1986, an outbreak of hemorrhagic colitis caused by E. coli O157:H7 occurred in Walla Walla, WA. Thirty-seven people, aged 11 months to 78 years developed diarrhea caused by the organism. All isolates from patients (14) had a unique plasmid profile and produced Shiga-like toxin II. In addition to diarrhea, 36 persons reported grossly bloody stools and 36 of the 37 reported abdominal cramps. Seventeen patients were hospitalized. One patient developed HUS (4 years old) and three developed TTP (70, 78, and 78 years old). Two patients with TTP died. Ground beef was the implicated food vehicle.
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TO BE GOOD FOR BIO-ATTACKS:
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