Botulism As a Bioterrorism Agent - Minnesota Department Health

Botu
As a Bioter

ulism
rrorism Agent

Botulism

• Germany (1793) earliest
outbreak

• Organism isolated in 18
• Mortality rate of 5-50%;
• Weaponized by several

U.S., Japan, and Soviet
1930’s
• Iraq (1980’s) produced 1
botulism toxin

• Japan (1990’s) Aum Shi

m History

t recorded human

895
; long recovery period
nations including the
Union, beginning in the

19,000 L of concentrated

inrikyo cult

What Makes B
a Good W

• Botulism toxin is the m
substance known

• High lethality: 1 aeroso
potentially kill 1 million

• Isolated fairly easily fro
• Could be released as a

contaminant in the foo
• Expensive, long-term c

recovery

Botulism Toxin
Weapon?

most poisonous

olized gram could
n people
om soil
an aerosol or as a
od supply
care needed for

Botulism M

• Toxin produced by the bact
Clostridium botulinum

• Anaerobic, gram positive, ro
shaped bacteria

• Bacteria are 0.5 to 2.0 mcm
and 1.6 to 22.0 mcm in lengt

• Create spores that can rema
dormant for 30 years or mor

• Spores extremely resistant
environmental stressors, su
heat and UV light

Microbiology

terium

od-

in width C. botulinum
th

ain
re

to
uch as





Clostridium

• 7 types of botulism A th
antigenic properties of

– toxins A, B, E and F
– toxins C and D cause

mammals
– toxin G

m botulinum

hrough G, based on the
the toxin produced

cause illness in humans
e illness in birds and

Categories o

• Foodborne botulism
– caused by eating food
toxin

• Intestinal botulism (infan
– caused by ingesting s
which germinate and
intestines

• Wound botulism
– C. botulinum spores g

• Inhalation botulism
– Aerosolized toxin is in
– does not occur natura
of bioterrorism

of Botulism

ds that contain botulism
nt and child/adult)
spores of the bacteria
produce toxin in the

germinate in the wound

nhaled
ally and may be indicative

Botulism Pa

• Incubation period
– ingestion: unknown
– foodborne: 6 hours-8 da
– wound: 4-14 days
– inhalation: (estimated) 2

• Toxin enters bloodstream
wound

• Binds to peripheral choline
• Inhibits release of acetylch

from contracting
• Symmetrical, descending p

with cranial nerves and pro

athogenesis

ays
24-36 hours
from mucosal surface or
ergic nerve endings
holine, preventing muscles
paralysis occurs beginning
ogressing downward

Botulism Patho

• Can result from airw
paralysis of respirat

• Secondary complica
prolonged ventilator
intensive care

ogenesis (cont.)

way obstruction or
tory muscles
ations related to
ry support and

Botulism Toxi

in Mechanism

Botulism Clinic

• Classic symptoms of
include:
– blurred/double visi
– muscle weakness
– drooping eyelids
– slurred speech
– difficulty swallowin
– patient is afebrile a

• Infants with botulism
– weak cry
– poor feeding
– constipation
– poor muscle tone,
syndrome

cal Presentation

botulism poisoning
ion

ng
and alert
will present with:

“floppy” baby





Possible Case

• Call MDH imme
612-676-5414 o
5414 if a case o
suspected.

e of Botulism

ediately (24/7) at
or 1-877-676-
of botulism is

Botulism Clini

• Antitoxin administratio

• Supportive Care
– mechanical ventilat
– body positioning
– parenteral nutrition

• Elimination
– Induced vomiting
– High enemas

ical Treatment

on

tion
n





Botulism Tr

• Home-canned goods (fo
– particularly low-acid
beets, and corn

• Honey (ingestion)
– can contain C. botulin
– not recommended for

• Crush injuries, injection

ransmission

oodborne)
foods such as asparagus,

num spores
r infants <12 months old
n drug use (wound)





Botulism Infe

• Botulism cannot be tran

• Standard precautions sh
caring for botulism patie

ection Control

nsmitted person-to-person

hould be taken when
ents

Botulism Labora

• Toxin neutralizatio
– serum, stool, ga
suspect foods

• Isolation of C. botu
– feces, wound, ti

atory Procedures

on mouse bioassay
astric aspirate,

ulinum or toxin
issue

Botulism

• Equine antitoxin
– Trivalent and bivalen
through the CDC
– Licensed trivalent an
A, B, and E botulism
– Effective in the treatm
intestinal, and wound
– Effectiveness for inh
been proven
– Does not reverse cur
limit progression and
if administered early

m Antitoxin

nt antitoxins available

ntitoxin neutralizes type
toxins
ment of foodborne,
d botulism
halation botulism has not

rrent paralysis, but may
d prevent nerve damage

Botulism Ant

• Hypersensitivity to equin
– 9% of people experien

titoxin (cont.)

ne antitoxin
nce some hypersensitivity

Botulism Differe

• Guillain-Barré
syndrome

• Myasthenia gravis
• Stroke
• Tick paralysis
• Lambert-Eaton

syndrome

ential Diagnoses

• Psychiatric illness
• Poliomyelitis
• Diabetic

Complications
• Drug intoxication
• CNS infection
• Overexertion

Botulism

• A toxoid vaccine (antig
E) is available for labor
risk of exposure

• Limited supplies of this

m Vaccine

gen types A, B, C, D, and
ratory workers at high

s vaccine available

Therapeutic Uses

• Focal dystonias - involunta
patterned muscle activity

• Spasticity - velocity-depend
tone

• Nondystonic disorders of i
• Strabismus (disorder of co

nystagmus
• Disorders of localized mus
• Smooth muscle hyperactiv
• Cosmetic use
• Sweating disorders

of Botulism Toxin

ary, sustained, or spasmodic

dent increase in muscle

involuntary muscle activity
onjugate eye movement) and

scle spasms and pain
ve disorders