Botulism: Difference between revisions

Browse history interactively

← Previous edit Next edit →

Content deleted Content added

VisualWikitext

Inline

Revision as of 19:16, 19 February 2013

{{Infobox disease | yolo

@@ Line 1: / Line 1: @@
 {{Infobox disease
+| yolo
-| Name           = Botulism
-| Image = Botulism1and2.JPG
-| Caption = A 14-year-old with botulism. Note the bilateral total [[ophthalmoplegia]] with [[ptosis (eyelid)|ptosis]] in the left image and the dilated, fixed pupils in the right image. This child was fully [[conscious]].
-| DiseasesDB = 2811
-| ICD10 = {{ICD10|A|05|1|a|00}}
-| ICD9 = {{ICD9|005.1}},{{ICD9|040.41}},{{ICD9|040.42}}
-| ICDO =
-| OMIM =
-| MedlinePlus = 000598
-| eMedicineSubj =article
-| eMedicineTopic =213311
-| MeshID =
-|}}
-'''Botulism''' ([[Latin]], ''botulus'', "sausage") (pronounced {{IPAc-en|'|b|ɒ|tʃ|ʉ||l|I|s|əm|}}) also known as '''botulinus intoxication''' is a rare but sometimes fatal [[paralytic]] illness caused by [[botulinum toxin]] which is a protein produced under anaerobic conditions by the bacterium ''[[Clostridium botulinum]]'', and affecting a wide range of mammals, birds and fish.<ref name=whodestroy>http://www.who.int/mediacentre/factsheets/fs270/en/</ref>
-got to eat pie to cure it
-The toxins enters the [[human body]] in one of three ways: by colonization of the digestive tract by the bacterium in children (infant botulism){{Citation needed|date=February 2012}} or adults (adult intestinal toxemia), by ingestion of toxin from foods (foodborne botulism) or by contamination of a wound by the bacterium (wound botulism).<ref name=Sobel>{{cite journal |author=Sobel J |title=Botulism |journal=Clin. Infect. Dis. |volume=41 |issue=8 |pages=1167–73 |year=2005 |month=October |pmid=16163636 |doi=10.1086/444507}}</ref> Person to person transmission of botulism does not occur.
-All forms lead to [[paralysis]] that typically starts with the muscles of the face and then spreads towards the limbs.<ref name=Sobel/> In severe forms, it leads to paralysis of the breathing muscles and causes [[respiratory failure]]. In light of this life-threatening complication, all suspected cases of botulism are treated as [[medical emergency|medical emergencies]], and [[public health]] officials are usually involved to prevent further cases from the same source.<ref name=Sobel/>
-Foodborne botulism can be prevented by use of [[pressure cooking]] or autoclaving at {{convert|121|°C|°F}} for 30 minutes when [[canning]] to kill the spores, or by providing conditions that prevent the spores from growing. Additional precautions for infants include not feeding them [[honey]].<ref name="honey-risk">{{cite journal |title=Honey and other environmental risk factors for infant botulism |journal=[[The Journal of Pediatrics]] |date=February 1979 |author=Stephen S. Arnon ''et al.'' |volume=94 |issue=2 |pages=331–336 |pmid=368301 |doi=10.1016/S0022-3476(79)80863-X}}</ref>
-==Signs and symptoms==
-The muscle weakness of botulism characteristically starts in the muscles supplied by the [[cranial nerves]]. A group of twelve nerves controls [[eye movement (sensory)|eye movements]], the [[facial muscles]] and the muscles controlling [[chewing]] and [[swallowing]]. [[Diplopia|Double vision]], [[Ptosis (eyelid)|drooping of both eyelids]], loss of facial expression and swallowing problems may therefore occur, as well as [[dysarthria|difficulty with talking]]. The weakness then spreads to the arms (starting in the shoulders and proceeding to the forearms) and legs (again from the thighs down to the feet).<ref name=Sobel/>
-Severe botulism leads to reduced movement of the [[muscles of respiration]], and hence problems with [[gas exchange]]. This may be experienced as [[dyspnea]] (difficulty breathing), but when severe can lead to [[respiratory failure]], due to the buildup of unexhaled [[carbon dioxide]] and its resultant depressant effect on the brain. This may lead to [[coma]] and eventually death if untreated.<ref name=Sobel/>
-In addition to affecting the [[Somatic nervous system|voluntary muscles]], it can also cause [[Dysautonomia|disruptions in the autonomic nervous system]]. This is experienced as [[xerostomia|a dry mouth and throat]] (due to decreased production of saliva), [[postural hypotension]] (decreased blood pressure on standing, with resultant lightheadedness and risk of blackouts), and eventually [[constipation]] (due to decreased [[peristalsis]]).<ref name=Sobel/> Some of the toxins (B and E) also precipitate [[nausea]] and [[vomiting]].<ref name=Sobel/>
-Clinicians frequently think of the symptoms of botulism in terms of a classic triad: [[bulbar palsy]] and descending paralysis, lack of fever, and clear senses and mental status ("clear sensorium").<ref name=outreakid>http://www.outbreakid.com/bioterrorism.htm</ref>{{Self-published inline|date=July 2011}}
-===Infant botulism===
-Infant botulism was first recognized in 1976, and is the most common form of botulism in the United States. There are 80 to 100 diagnosed cases of infant botulism in the United States each year.  Infants are susceptible to infant botulism in the first year of life, with more than 90% of cases occurring in infants younger than six months.<ref name="SSAIBchap">Arnon SS [http://www.infantbotulism.org/readings/ibchap.pdf Infant Botulism] In Feigin RD, CherryJD, Demmler GJ, Kaplan SL., eds. ''Textbook of Pediatric Infectious Diseases.'' 5th edition Philadelphia, PA: WB Saunders; 2004:1758–1766</ref>  Infant botulism results from the ingestion of the [[Clostridium botulinum|''C. botulinum'']] spores, and subsequent colonization of the small intestine.  The infant gut may be colonized when the composition of the [[gut flora|intestinal microflora]] (normal flora) is insufficient to competitively inhibit the growth of [[Clostridium botulinum|''C. botulinum'']] and levels of bile acids (which normally inhibit clostridial growth) are lower than later in life.<ref name=Caya2004>{{cite journal |author=Caya JG, Agni R, Miller JE |title=Clostridium botulinum and the clinical laboratorian: a detailed review of botulism, including biological warfare ramifications of botulinum toxin |journal=Arch. Pathol. Lab. Med. |volume=128 |issue=6 |pages=653–62 |year=2004 |month=June |pmid=15163234 |doi=10.1043/1543-2165(2004)128<653:CBATCL>2.0.CO;2 |url=http://www.archivesofpathology.org/doi/pdf/10.1043/1543-2165(2004)128%3C653:CBATCL%3E2.0.CO;2}}</ref>
-The growth of the spores releases [[botulinum toxin]], which is then absorbed into the bloodstream and taken throughout the body, causing paralysis by blocking the release of acetylcholine at the [[neuromuscular junction]].  Typical symptoms of infant botulism include constipation, lethargy, weakness, difficulty feeding and an altered cry, often progressing to a complete descending [[flaccid paralysis]].  Although constipation is usually the first symptom of infant botulism, it is commonly overlooked.
-[[Honey]] is the only known dietary reservoir of [[Clostridium botulinum|''C. botulinum'']] spores linked to infant botulism.  For this reason honey should not be fed to infants less than one year of age.<ref name=Caya2004/> Other cases of infant botulism are thought to be caused by acquiring the spores from the natural environment.  ''[[Clostridium botulinum]]'' is a ubiquitous soil-dwelling bacterium.  Many infant botulism patients have been demonstrated to live near a construction site or an area of soil disturbance.{{citation needed|date=September 2012}}
-Infant botulism has been reported in 49 of 50 US states,<ref name="SSAIBchap"/> and cases have been recognized in 26 countries on five continents.<ref name="globalIB">Koepke R, Sobel J and Arnon SS [http://pediatrics.aappublications.org/cgi/reprint/122/1/e73 Global Occurrence of Infant Botulism, 1976–2006] ''Pediatrics'' 2008;122;e73-e82</ref>
-===Complications===
-Infant botulism has no long-term side effects, but can be complicated by [[nosocomial]] adverse events. The [[case fatality]] rate is less than 1% for hospitalized infants with botulism.
-Botulism can result in death due to [[respiration (physiology)|respiratory]] failure. However, in the past 50 years, the proportion of patients with botulism who die has fallen from about 50% to 7% due to improved supportive care. A patient with severe botulism may require [[mechanical ventilation]] (breathing support through a ventilator) as well as intensive medical and nursing care, sometimes for several months. Patients who survive an episode of botulism poisoning may have [[fatigue (physical)|fatigue]] and shortness of breath for years and long-term therapy may be needed to aid their recovery.
-==Cause==
-''[[C. botulinum]]'' is an [[Anaerobic organism|anaerobic]], [[Gram positive]], spore-forming rod. Botulinium toxin is one of the most powerful known toxins: about one [[microgram]] is lethal to humans. It acts by blocking [[nerve]] function ([[neuromuscular blockade]]) through inhibition of the excitatory [[neurotransmitter]] [[acetyl choline]]'s release from the [[presynaptic]] membrane of [[neuromuscular junction]]s in the [[somatic nervous system]]. This causes paralysis. Advanced botulism can cause [[respiratory failure]] by paralysing the muscles of the chest; this can progress to [[respiratory arrest]].
-In all cases illness is caused by the botulinium toxin produced by the bacterium ''[[C. botulinum]]'' in anaerobic conditions, and not by the bacterium itself. The pattern of damage occurs because the toxin affects nerves that fire (depolarise) at a higher frequency first.<ref>Oxford Textbook of Medicine, 4th Ed., Section 7.55</ref>
-Four main modes of entry for the toxin are known. The most common form in Western countries is ''infant botulism''. This occurs in small children who are [[Colonisation (biology)|colonized]] with the bacterium during the early stages of their lives. The bacterium then releases the toxin into the intestine, which is absorbed into the bloodstream. The consumption of [[honey]] during the first year of life has been identified as a risk factor for infant botulism; it is a factor in a fifth of all cases.<ref name=Sobel/> The adult form of infant botulism is termed ''adult intestinal toxemia'', and is exceedingly rare.<ref name=Sobel/>
-''Foodborne botulism'' results from contaminated foodstuffs in which ''C. botulinum'' spores have been allowed to germinate in anaerobic conditions. This typically occurs in home-canned food substances and fermented uncooked dishes{{dubious|date=February 2013}}. Given that multiple people often consume food from the same source, it is common for more than a single person to be affected simultaneously. Symptoms usually appear 12–36 hours after eating, but can also appear within 6 hours to 10 days.<ref>{{cite web  | title = Facts About Botulism | url = http://www.bt.cdc.gov/agent/botulism/factsheet.asp |work=Emergency Preparedness and Response | publisher =[[Centers for Disease Control and Prevention]]  | date =Oct 14, 2001  | accessdate = Jul 2 2011 }}</ref>
-''Wound botulism'' results from the contamination of a wound with the bacteria, which then secrete the toxin into the bloodstream. This has become more common in [[Intravenous drug use (recreational)|intravenous drug users]] since the 1990s, especially people using [[black tar heroin]] and those [[skin popping|injecting heroin into the skin]] rather than the veins.<ref name=Sobel/>
-Isolated cases of botulism have been described after [[inhalation]] by laboratory workers and after cosmetic use of inappropriate strengths of [[botulinum toxin|Botox]].<ref name=Sobel/>
-==Diagnosis==
-For infant botulism, diagnosis should be made on clinical grounds.  Confirmation of the diagnosis is made by testing of a stool or enema specimen with the mouse [[bioassay]].
-Physicians may consider diagnosing botulism if the patient's history and physical examination suggest botulism. However, these clues are often not enough to allow a diagnosis. Other diseases such as [[Guillain-Barré syndrome]], [[stroke]], and [[myasthenia gravis]] can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, [[cerebrospinal fluid]] examination, nerve conduction test ([[electromyography]], or EMG), and an [[edrophonium]] chloride (Tensilon) test for myasthenia gravis. A definite diagnosis can be made if botulinum toxin is identified in the food, stomach or intestinal contents, vomit or feces. The toxin is occasionally found in the blood in peracute cases. Botulinum toxin can be detected by a variety of techniques, including [[enzyme-linked immunosorbent assay]]s (ELISAs), [[electrochemiluminescent]] (ECL) tests and mouse inoculation or feeding trials. The toxins can be typed with neutralization tests in mice. In toxicoinfectious botulism, the organism can be cultured from tissues. On egg yolk medium, toxin-producing colonies usually display surface iridescence that extends beyond the colony.<ref>Weber,J.T. "Botulism" In Infectious Diseases, 5th ed. Edited by P. D. Hpeprich, [[J. B. Lippincott & Co|J. B. Lippincott Company]], 1994, pp. 1185–1194.</ref>
-=== In animals ===
-In cattle, the symptoms may include drooling, restlessness, uncoordination, urine retention, dysphagia, and sternal recumbency. Laterally recumbent animals are usually very close to death. In sheep, the symptoms may include drooling, a serous nasal discharge, stiffness, and incoordination. Abdominal respiration may be observed and the tail may switch on the side. As the disease progresses, the limbs may become paralyzed and death may occur.
-Phosphorus-deficient cattle, especially in southern Africa, are inclined to ingest bones and carrion containing clostridial toxins and consequently suffer ''lame sickness'' or ''lamsiekte''.
-The clinical signs in horses are similar to cattle. The muscle paralysis is progressive; it usually begins at the hindquarters and gradually moves to the front limbs, neck, and head. Death generally occurs 24 to 72 hours after initial symptoms and results from respiratory paralysis. Some foals are found dead without other clinical signs.
-Pigs are relatively resistant to botulism. Reported symptoms include anorexia, refusal to drink, vomiting, pupillary dilation, and muscle paralysis.<ref>"Botulism." In the Merck Veterinary Manual, 8th ed. Edited by S.E. Aiello and A. Mays. Whitehouse Station, NJ: Merck and CO., 1988, pp.442–444.</ref>
-In poultry and wild birds, [[flaccid paralysis]] is usually seen in the legs, wings, neck and eyelids. Broiler chickens with the toxicoinfectious form may also have diarrhea with excess urates.
-==Prevention==
-Although the botulinum toxin is destroyed by thorough cooking over the course of a few minutes,<ref name=whodestroy/> the spore itself is not killed by the temperatures reached with normal sea-level-pressure boiling, leaving it free to grow and again produce the toxin when conditions are right.{{Citation needed|date=May 2011}}
-A recommended prevention measure for infant botulism is to avoid feeding honey to infants less than 12 months of age. In older children and adults the normal intestinal bacteria suppress development of ''C. botulinum''.<ref name="honey-risk"/>
-While commercially canned goods are required to undergo a "botulinum cook" in a pressure cooker at {{convert|121|°C|°F}} for 3 minutes, and so rarely cause botulism, there have been notable exceptions such as the 1978 Alaskan salmon outbreak and the 2007 [[Castleberry's Food Company]] outbreak. Foodborne botulism is the rarest form though, accounting for only around 15% of cases (US)<ref name="cdc.gov"/> and has more frequently been from [[Home canning|home-canned]] foods with low acid content, such as [[carrot juice]], [[asparagus (vegetable)|asparagus]], green [[bean]]s, [[beet]]s, and [[maize|corn]]. However, outbreaks of botulism have resulted from more unusual sources. In July, 2002, fourteen [[Alaska]]ns ate ''muktuk'' ([[whale meat]]) from a [[beached whale]], and eight of them developed symptoms of botulism, two of them requiring [[mechanical ventilation]].<ref>{{cite journal |author= |title=Outbreak of botulism type E associated with eating a beached whale--Western Alaska, July 2002 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=52 |issue=2 |pages=24–6 |year=2003 |month=January |pmid=12608715 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5202a2.htm |author1= Centers for Disease Control and Prevention (CDC)}}</ref>
-Other, but much rarer sources of infection (about every decade in the US<ref name="cdc.gov"/>) include [[garlic]] or herbs<ref name="Infusions">[http://www.ext.colostate.edu/safefood/newsltr/v2n4s08.html Oil Infusions and the Risk of Botulism], Colorado State University Cooperative Extension, Safefood new – Summer 1998 – Vol 2 / No. 4</ref> stored covered in [[Cooking oil|oil]] without acidification,<ref>{{cite journal |author= |title=Update: international outbreak of restaurant-associated botulism--Vancouver, British Columbia, Canada |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=34 |issue=41 |page=643 |year=1985 |month=October |pmid=3930945 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00000627.htm |author1= Centers for Disease Control (CDC)}}</ref> [[capsicum|chilli peppers]],<ref name="cdc.gov">http://www.cdc.gov/ncidod/aip/research/bot.html</ref> improperly handled baked potatoes wrapped in [[aluminum]] foil,<ref name="cdc.gov"/> tomatoes,<ref name="cdc.gov"/> and home-canned or [[fermented fish]]. Persons who do home canning should follow strict [[hygiene|hygienic]] procedures to reduce contamination of foods.
-Oils infused with fresh garlic or herbs should be acidified and refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, home-canned foods are best boiled for 10 minutes before eating.<ref>{{cite web|last=U.S. Food and Drug Administration|title=Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins Handbook Clostridium botulinum|url=http://www.fda.gov/food/foodsafety/foodborneillness/foodborneillnessfoodbornepathogensnaturaltoxins/badbugbook/ucm070000.htm|accessdate=12 January 2013}}</ref> Metal cans containing food in which bacteria, possibly botulinum, are growing may bulge outwards due to gas production from bacterial growth; such cans should be discarded.
-Any container of food which has been heat-treated and then assumed to be airtight which shows signs of not being so, e.g., metal cans with pinprick holes from rust or mechanical damage, should also be discarded. Contamination of a canned food solely with ''C. botulinum'' may not cause any visual defects (e.g. bulging). Only sufficient thermal processing during production should be used as a food safety control.
-Wound botulism can be prevented by promptly seeking medical care for infected wounds, and by avoiding punctures by unsterile things such as needles used for street drug injections. It is currently being researched at [[USAMRIID]] under BSL-434.
-==Treatment==
-Most infant botulism patients require supportive care in a hospital setting.  The only drug currently available to treat infant botulism is Botulism Immune Globulin Intravenous-Human (BIG-IV or BabyBIG). BabyBIG was developed by the Infant Botulism Treatment and Prevention Program at the California Department of Public Health.<ref>{{cite journal |author=Brook I |title=Infant botulism |journal=J Perinatol |volume=27 |issue=3 |pages=175–80 |year=2007 |month=March |pmid=17314986 |doi=10.1038/sj.jp.7211651}}</ref>
-The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a ventilator for weeks, plus intensive medical and nursing care. After several weeks, the [[paralysis]] slowly improves. If diagnosed early, foodborne and wound botulism can be treated by inducing [[passive immunity]] with a horse-derived [[antitoxin]], which blocks the action of toxin circulating in the blood.<ref>{{cite journal |author=Shapiro RL, Hatheway C, Swerdlow DL |title=Botulism in the United States: a clinical and epidemiologic review |journal=Ann. Intern. Med. |volume=129 |issue=3 |pages=221–8 |year=1998 |month=August |pmid=9696731 |doi= 10.1059/0003-4819-129-3-199808010-00011|url=}}</ref>
-This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the stomach by inducing vomiting or by using [[enema]]s. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism.<ref>Brook I. Botulism: the challenge of diagnosis and treatment. Rev Neurol Dis. 2006;3:182-9.</ref>
-Furthermore each case of food-borne botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.
-There are two primary botulinum antitoxins available for treatment of wound and foodborne botulism. Trivalent (A,B,E) botulinum antitoxin is derived from equine sources utilizing whole [[Antibody|antibodies]] (Fab & Fc portions). This antitoxin is available from the local health department via the [[Centers for Disease Control|CDC]]. The second antitoxin is [[hepta]]valent (A,B,C,D,E,F,G) botulinum antitoxin which is derived from "despeciated" equine [[IgG]] antibodies which have had the Fc portion cleaved off leaving the F(ab')2 portions. This is a less immunogenic antitoxin that is effective against all known strains of botulism where not contraindicated. This is available from the [[US Army]]. On 1 June 2006 the US [[Department of Health and Human Services]] awarded a $363 million contract with Cangene Corporation for 200,000 doses of heptavalent botulinum antitoxin over five years for delivery into the [[Strategic National Stockpile]] beginning in 2007.<ref>{{cite web |url=http://archive.hhs.gov/news/press/2006pres/20060601.html |title=HHS Awards BioShield Contract For Botulism Antitoxin |date=June 1, 2006 |work=HHS Archive |publisher=Department of Health and Human Services |accessdate=July 2, 2011}}</ref>
-==Prognosis==
-{{Confusing|date=February 2009}}<!-- "type a" and "type b" not discussed in article -->
-Infant botulism has no long-term side effects, but can be complicated by [[nosocomial]] adverse events. The [[case fatality]] rate is less than 1% for hospitalized infants with botulism.{{fact|date=September 2012}}
-Between 1910 and 1919 the death rate from botulism was 70% in the United States, dropping to 9% in the 1980s and 2% in the early 1990s, mainly because of the development of artificial respirators. Up to 60% of botulism cases are fatal if left untreated.{{fact|date=September 2012}}
-The [[World Health Organization]] (WHO) reports that the current mortality rate is 5% (type B) to 10% (type A). Other sources report that, in the U.S., the overall mortality rate is about 7.5%, but the mortality rate among adults over 60  is 30%. The mortality rate for wound botulism is about 10%. The infant botulism mortality rate is about 1.3%.{{fact|date=September 2012}}
-Death from botulism is common in waterfowl; an estimated 10,000 to 100,000 birds die of botulism annually. In some large outbreaks, a million or more birds may die. Ducks appear to be affected most often. Botulism also affects commercially raised poultry. In chickens, the mortality rate varies from a few birds to 40% of the flock. Some affected birds may recover without treatment{{fact|date=September 2012}}.
-Botulism seems to be relatively uncommon in domestic mammals; however, in some parts of the world, epidemics with up to 65% mortality are seen in cattle. The prognosis is poor in large animals that are recumbent. Most dogs with botulism recover within 2 weeks.{{fact|date=September 2012}}
-==Epidemiology==
-Between 1990 and 2000, the [[Centers for Disease Control]] reported 263 individual 'cases' from 160 foodborne botulism 'events' in the United States with a case-fatality rate of 4%. Thirty-nine percent (103 cases and 58 events) occurred in Alaska, all of which were attributable to traditional Alaska aboriginal foods. In the lower 49 states, home-canned food was implicated in 70 (91%) events with canned asparagus being the most numerous cause. Two restaurant-associated outbreaks affected 25 persons. The median number of cases per year was 23 (range 17–43), the median number of events per year was 14 (range 9–24). The highest incidence rates occurred in Alaska, Idaho, Washington, and Oregon. All other states had an incidence rate of 1 case per ten million people or less.<ref>{{Cite document |last=Sobel |first=Jeremy |publisher=Centers for Disease Control |date= September 2004 |title=Foodborne Botulism in the United States, 1990–2000 |url=http://www.cdc.gov/ncidod/EID/vol10no9/03-0745.htm |accessdate=September 29, 2010 |postscript=<!-- Bot inserted parameter. Either remove it; or change its value to "." for the cite to end in a ".", as necessary. -->{{inconsistent citations}}}}</ref>
-The number of cases of food borne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of [[black tar heroin]], especially in [[California]].<ref>{{cite journal |author=Passaro DJ, Werner SB, McGee J, Mac Kenzie WR, Vugia DJ |title=Wound botulism associated with black tar heroin among injecting drug users |journal=JAMA |volume=279 |issue=11 |pages=859–63 |year=1998 |month=March |pmid=9516001 |doi=10.1001/jama.279.11.859}}</ref>
-==Outbreaks==
-===Castleberry's Food Company outbreak===
-{{Main|Castleberry's Food Company}}
-Beginning in late June 2007, 8 people contracted botulism poisoning by eating canned food products produced by [[Castleberry's Food Company]] in its [[Augusta, Georgia]] plant. It was later identified that the Castleberry's plant had serious production problems on a specific line of retorts that had under-processed the cans of food. These issues included broken cooking alarms, leaking water valves and inaccurate temperature devices, all the result of poor management of the company.
-All of the victims were hospitalized and placed on mechanical ventilation. The Castleberry's Food Company outbreak was the first instance of botulism in commercial canned foods in the United States in over 30 years.
-===Bon Vivant incident===
-{{Main|1971 Bon Vivant botulism case}}
-On July 2, 1971, the [[U.S. Food and Drug Administration]] (FDA) released a public warning after learning that a New York man had died and his wife had become seriously ill due to botulism after eating a can of Bon Vivant [[vichyssoise]] soup.
-==In other species==
-Botulism can occur in many [[vertebrate]]s and [[invertebrate]]s. Botulism has been reported in rats, mice, chicken, frogs, toads, goldfish, [[aplysia]], squid, crayfish, [[drosophila]], leeches, etc.<ref name="pmid10865130">{{cite journal |author=Humeau Y, Doussau F, Grant NJ, Poulain B |title=How botulinum and tetanus neurotoxins block neurotransmitter release |journal=Biochimie |volume=82 |issue=5 |pages=427–46 |year=2000 |month=May |pmid=10865130 |doi=10.1016/S0300-9084(00)00216-9 |url=}}</ref>
-==See also==
-*[[Centers for Disease Control and Prevention]] (CDC)
-*[[List of foodborne illness outbreaks]]
-==References==
-{{Reflist|2}}
-==External links==
-* [http://www.upmc-biosecurity.org/website/focus/agents_diseases/fact_sheets/botulinum.html Agent Fact Sheet: Botulism], [[Center for Biosecurity]]
-* [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_t.htm Botulism] (Technical information from the [[Centers for Disease Control and Prevention|CDC]])
-* [http://www.infantbotulism.org Infant Botulism Treatment and Prevention Program]
-* [http://www.cfsan.fda.gov/~mow/chap2.html Clostridium Botulinum] ([[Food and Drug Administration|FDA]]/CFSAN)
-* [http://www.who.int/mediacentre/factsheets/who270/en/ Botulism] ([[WHO]])
-* [http://wildlifedisease.nbii.gov/diseasehome.jsp?disease=Avian%20Botulism&pagemode=submit Avian Botulism]
-* [http://patricbrc.org/portal/portal/patric/Taxon?cType=taxon&cId=1491 Clostridium botulinum] genomes and related information at [http://patricbrc.org/ PATRIC], a Bioinformatics Resource Center funded by [http://www.niaid.nih.gov/ NIAID]
-{{Gram-positive bacterial diseases}}
-{{Chicken}}
-{{Consumer Food Safety}}
-[[Category:Biological weapons]]
-[[Category:Conditions diagnosed by stool test]]
-[[Category:Foodborne illnesses]]
-[[Category:Myoneural junction and neuromuscular diseases]]
-[[Category:Poultry diseases]]
-{{Link FA|ru}}
-[[lij:Botulismo]]