A frantic mother calls your office stating that her sister had
just told her that feeding honey to children causes botulism. She
had given a quarter teaspoon of a locally grown honey to her infant daughter
three days earlier and was now in a panic. The mother states that
the child appears normal and has shown no evidence of illness over
the past three days, specifically no constipation, lethargy, or
swallowing difficulty. You ask her to bring the child to your office
where you examine her. The child appears healthy and in no respiratory
distress. She is breathing normally and is not pooling secretions.
The girl readily drinks a baby bottle of water without any difficulty.
Her eyes are wide open with no proptosis, and her pupils are normal
and react swiftly to a penlight. No cranial nerve findings or muscle
hypotonia are present. You tell the mother that although botulism has
been associated with honey in infants, none of the disease’s
features of descending paralysis, or odynophagia, are present and
reassure her that her child does not have the disease. The mother asks
whether there is “a test” to prove it definitively
and whether there is an antidote for botulism. What do you tell
Botulinum is the first of the eight biotoxins in this book to
be discussed. It is the only biotoxin included among the Category
A agents, largely because of the ubiquity of the bacteria that produce
it, its toxicity, the relative ease of production and dissemination,
as well as the precedence of its use in warfare. Botulism is a neurologic
syndrome caused by a toxic proteolytic enzyme produced by the bacteria Clostridia botulinum. Botulism derives
its name from the Latin word for sausage because contaminated sausage
was the source for several of the earliest described outbreaks of
the disease. C. botulinum is a spore-forming,
obligate anaerobe found most commonly in soil. The neurotoxin produced
by the bacterium is responsible for the clinical disease known as
botulism. Botulinum toxin includes seven different proteins (identified
as A through G) that are secreted by four distinct but closely related
types of Clostridia bacteria.
Botulinum toxin (botulinum) is the most potent toxin in existence:
If dispersed ideally, 1 g could kill over a million people. Botulinum
is colorless, odorless, and said to be without taste. Botulism is
a medical emergency since proper treatment must be implemented quickly,
including antitoxin and life support systems, to prevent death.
Botulinum toxin as a weapon of bioterrorism possesses several distinctive
features compared to other Category A agents, the most obvious being
that it is the product of the microbe and not the microbe itself
that causes the disease.
There are three naturally occurring forms of botulism: foodborne,
wound, and intestinal. An additional form, resulting from the weaponization
of botulism, is inhalational. Historically, many of the deaths associated
with botulism resulted from exposure to improperly prepared and
canned foods. It has found ...