Foodborne Botulism: Clinical Diagnosis and Medical Treatment

Abstract

Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.

Botulinum Toxin in Movement Disorders: An Update

“…Clostridium botulinum , an anaerobic, rod-shaped bacterium, produces a neurotoxin called botulinum toxin (BoNT) during sporulation [ 1 , 2 , 3 ]. BoNT is the most potent biological toxin, as it causes botulism manifested by paralysis of muscles and eventual fatal respiratory failure [ 4 , 5 ]. When an action potential arrives at the cholinergic presynaptic nerve terminal, there is an influx of calcium into the presynaptic terminal, which then facilitates acetylcholine vesicle fusion with the presynaptic membrane; this fusion is facilitated by a group of proteins referred to as SNARE (soluble N-ethylmaleimide-sensitive factor attachment receptor) proteins, which include SNAP 25 (25 kD synaptosomal-associated protein) and Syntaxin [ 6 , 7 ].…”

Novel Lytic Enzyme of Prophage Origin from Clostridium botulinum E3 Strain Alaska E43 with Bactericidal Activity against Clostridial Cells

“…Four distinct phenotypic groups (I-IV) of C. botulinum are recognized. C. botulinum Groups I and II are primarily responsible for human botulism, the most frequent form of botulism in the European Union [5]. C. botulinum Group I has minimum and optimum growth temperatures of 12 • C and 37 • C, respectively.…”

Toxemia in Human Naturally Acquired Botulism

“…It probably shows a similar pattern than in experimental animals, notably supporting the long persistence of BoNT in the serum of certain patients. BoNT detection in serum is the most direct way to confirm a diagnosis of botulism [ 41 , 42 , 191 ]. However, the presence of BoNT in the blood circulation depends on the time between serum sampling and the symptom onset, the initial amount of toxin involved in the disease, which has been ingested or produced locally, and probably of individual host factors related to toxin absorption and/or elimination which remain to be defined.…”

“…BoNT amino acid sequences deduced from bont gene sequencing revealed that each toxinotype is subdivided into an increasing number of subtypes defined as >2.6% amino acid variation. Thus, 41 BoNT subtypes and multiple variants have been reported [5][6][7]. More recently, genome comparison showed the presence of bont related sequences in a few non-clostridial strains such as bont/Wo or bont/I from Weisenella oryzae, a bacterium of fermented rice, bont/J (ebont/F or bont/En) from an Enterococcus faecalis strain in a cow, and Cp1 from Chryseobacterium piperi from sediment [1,[8][9][10][11][12].…”

“…Botulism cases are suspected on the basis of clinical symptoms and epidemiological aspects. Botulism confirmation is supported by laboratory tests that are required for botulism typing [ 41 , 42 ]. Initially, food-borne botulism was confirmed by BoNT detection in suspected food samples using experimental animals [ 40 ].…”