Botulism

Question 1

What organism causes botulism?

Answer 1

Clostridium botulinum

This bacterium produces a potent toxin that causes illness.

Question 2

Is botulism a nationally notifiable disease?

Answer 2

Yes - urgent for labs and doctors.

Question 3

What serotypes of botulinum toxin commonly cause human disease?

Answer 3

• A
• B
• E
• F

Question 4

Where is Clostridium botulinum commonly found?

Answer 4

Soil and agricultural products.

Widespread in environment as spores (resistant to heat / drying)

Question 5

How is botulism transmitted?

Answer 5

Not spread human to human
Foodborne, via wound, or inhalation

Question 6

What is infant botulism caused by?

Answer 6

Ingestion of spores.

Question 7

What are the clinical features of botulism?

Answer 7

• Severe paralytic illness
• Fatigue
• Weakness
• Vertigo
• Blurred vision
• Difficulty swallowing/speaking
• Paralysis

Question 8

What is the case fatality rate (CFR) for botulism?

Answer 8

10%.

Question 9

What are the symptoms of infant botulism?

Answer 9

• Lethargy
• Weakness
• Poor feeding
• Loss of head control
• Hypotonia

Question 10

What is the case definition of botulism?

Answer 10

Confirmed only - detection / isolation AND clinical

Question 11

How is botulism diagnosed?

Answer 11

Detection of toxin in stool, serum, gastric aspirate, or wound tissue; culture from gastric aspirate or stool.

Question 12

What is the incubation period for botulism?

Answer 12

12-36 hours (range 6 hours to 8 days).

Question 13

What is the infectious period for botulism?

Answer 13

N/A

Question 14

What defines a botulism outbreak?

Answer 14

One or more cases.

Question 15

How common are botulism cases?

Answer 15

Very rare; cases are sporadic.

Question 16

In which situations are outbreaks seen?

Answer 16

General / family outbreaks where food is prepared / preserved by methods that do not destroy spores and permit toxin formation

Question 17

T / F: botulinum toxin is a potential bioterrorism threat

Answer 17

True

Question 18

How can botulism be prevented?

Answer 18

• Food processing - effective control of processing/preparation of commercially canned and preserved foods
• Education - home canning, other food preservation techniques e.g. cooking time, pressure, temperature, adequate refrigeration and storage

Question 19

What food processing methods can result in botulism?

Answer 19

Processing of smoked, salted and other preserved meats, fruits, jams and vegetables.

For tinned food, the absence of a bulging lid does not preclude contamination.

Question 20

What resources are available for PH management of botulism?

Answer 20

DH protocol
(No SoNG)

Question 21

How are cases of botulism managed?

Answer 21

Interview - speak to clinician; testing- sera, gastric aspirates, stool specimen
T - heptavalent botulinum antitoxin (types A–G) ASAP; botulism Ig (BabyBIG) for infant; wound debridement/drainage
I - NA unless diarrhoea (standard exclusions for school/ECEC)
E - transmission, correct food handling procedures esp. preservation

Question 22

How are contacts (eaten contaminated food) be managed?

Answer 22

Interview - urgently identify
T - consider enemas/emetics if within 6 hours; consider antitoxin
I- NA
M - observe for 3 days
E - transmission, correct food handling procedures esp. preservation

Question 23

What management is recommended for botulism?

Answer 23

• Heptavalent botulinum antitoxin (types A–G) ASAP
• Botulism Ig (BabyBIG) for infants
• Wound debridement/drainage

Question 24

What environmental actions should be taken in case of botulism?

Answer 24

• Involve Food Safety Unit, OzFoodNet, FSANZ
• Identify and recall implicated food
• Samples for analysis
• Dispose of food appropriately - EHOs/safety officers
• Decontaminate - clean contaminated utensils - boiling / bleach
• Determine method of contamination and take steps to prevent in future

R - recall food
R - testing, decontamination, future prevention
A