Clostridium botulinum, botulism, and botox
The bacteria Clostridium Botulinum
Botulism is a rare illness caused by a toxin produced by the bacteria Clostridium botulinum. This etiological agent produces 7 types of toxins under anaerobic (no oxygen) conditions, which are known by the letters A-G. The specific toxins A, B, E, and F cause illness. Botulin toxin is one of the most--if not the most--potent natural toxins on the face of the planet.
Commonly found in soil, C. botulinum is an obligate anaerobe (cannot survive in the presence of oxygen) and is gram positive (meaning it has a thick peptidoglycan cell wall). It is also endospore producing, meaning it can enclose its genetic material and a few necessary enzymes in a thick capsule that can survive under much wider conditions than the bacterium itself--such as in an oxygenated environment, under extreme heat, aridity, and other conditions. When the spores reach an environment suitable for survival of the bacteria, they germinate into bacteria and begin producing their toxins.
How Botulinum Toxin Affects the Host
Exposure to the toxin results in flaccid paralysis, in which the muscles are stuck in an uncontracted state due to the blockage of acetylcholine release at the neuromuscular junction. Death usually results from suffocation because of the diaphragm's inability to contract and enable breathing. There is usually not enough toxin consumed to stimulate an immune response, and because of this botulism can be contracted repeatedly as no immunity can be built.
There are 3 types of botulism:
Foodborne botulism is caused by eating foods containing the botulism toxin, such as home-canned foods and canned foods from dented cans.
Wound botulism occurs when a wound is infected with C. botulinum and the toxin is produced.
Infant botulism is caused by consuming the spores of botulinum bacteria, which then germinate in the intestines and release the toxin. Infants do not have the extensive natural bacteria that live in the adult human gastrointestinal tract and compete with botulinum bacteria in adults, which prevents the spores from germinating in adults.
In the United States, an average of 145 cases are reported each year. Of these, approximately 15% are foodborne, 65% are infant botulism, and 20% are wound.
- Double vision
- Blurred vision
- Drooping eyelids
- Slurred speech
- Difficulty swallowing
- Dry mouth
- Muscle weakness
If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles.
Treatment for botulism generally consists of artificial ventilation combined with intensive medical care. Over time (usually several weeks) the paralysis improves as nerve endings regenerate and the neurotoxin is excreted naturally through normal bodily functions.
If diagnosed early, there are two equine-dervied antitoxins that utilize specific antibodies against the botulism toxin that can be administered. However, the antitoxin cannot access the toxin that is already bound to the nerve endings, and thus recovery can still take weeks and artificial respiration may still be required.
Prevention of botulism infection is simple.
- Avoid home-canned foods
- Avoid eating food from dented cans
- If a can is bulging, throw it away!!
- Boil food for 10 minutes before eating
- Children under 12 months old should not be fed honey
- Avoid needle drugs and keep wounds clean
C. botulinum growth is also prevented by acidic pH and nitrates.
How Botox Works
Botox is an artifically produced Type A botulinum neuromuscular toxin that is approved by the Food and Drug Administration for cosmetic use, treatment of excessive sweating, and other uses. It causes flacid paralysis of the muscles just like the naturally occurring toxins, and through site-specific injection can paralyze targeted muscles. The effect is not permanent, as over time the nerve endings regenerate and the muscle becomes unparalyzed.
There have been concerns over the safety of botox, as the toxin can spread beyond the targeted site and there have been deaths related to treatment of conditions with botulism. The deaths have mainly occurred in children being treated for cerebral palsy and limb spasticity. No deaths have been reported from using botulinum toxin for cosmetic purposes. The general consensus is that botox is safe for use.