9/18/2016 Learning Objectives Food 1.Use basic biochemical characteristics to identify Clostridium bot九ulim 2.Understand what conditions in foods favor the Chapter 10 AN INTRODUCTION growth of C.botulinum 3.Recognize.from symptoms and time of onset, case of botulism Clostridium botulinum 4.Choose appropriate interventions to prevent the growth of C.botulinum 5.Identify environmental sources of C.botu/inum 6.Understand the roles of spore,anaerobic conditions,and heat sensitivity of the toxin in causing or preventing botulism Botulism is a rare but deadly Self-Inflicted Botulism disease 116 outbreaks in botulism in US between 1999-2008 Average number of cases ·Outbreak1 reported to CDC yearly home-canned carrots and green beans 24 cases of foodborne same day 2 on ventilators,next day 1 on ventilator,1 milder symptoms,2 okay botulism ·one only ate a forkful 3 cases of wound botulism toxin isolated from patients and food -71 cases of intestinal ·Outbreak2 "infant"botulism home-canned green beans,tomatoes,pears Tasted bad but ate them anyway 40%of cases are due to ·Outbreak3 improper home canning home-canned asparagus no sign of spoilage but the lid had popped 义
9/18/2016 1 Chapter 10 Clostridium botul num i Learning Objectives 1. Use basic biochemical characteristics to identify Clostridium botulinum 2. U d t d h t diti i f d f th Understand what conditions in foo ds favor th e growth of C. botulinum 3. Recognize, from symptoms and time of onset, a case of botulism 4. Choose appropriate interventions to prevent the growth of C botulinum C. botulinum 5. Identify environmental sources of C. botulinum 6. Understand the roles of spore, anaerobic conditions, and heat sensitivity of the toxin in causing or preventing botulism • Botulism is a rare but deadly disease • Average number of cases reported to CDC yearly - 24 cases of foodborne botulism - 3 cases of wound botulism - 71 cases of intestinal “infant” botulism • 40% of cases are due to improper home canning Self-Inflicted Botulism 116 outbreaks in botulism in US between 1999-2008 • Outbreak 1 - home-canned carrots and green beans - same day 2 on ventilators, next day 1 on ventilator, 1 milder symptoms, 2 okay - one only ate a forkful - toxin isolated from patients and food • Outbreak 2 - home-canned green beans, tomatoes, pears - Tasted bad but ate them anyway • Outbreak 3 - home-canned asparagus - no sign of spoilage but the lid had popped
9/18/2016 Range of symptoms typical of botulism -Nausea Four Faces of Botulism ·Vomiting 1.Foodborne botulism ·Dry mouth Traditionally associated with canned foods,partic Neurological issues such as blurred vision.bilateral home-canned foods paralysis,slurred speech,fatigue,difficulty Commercial cases (9%)usually involve small companies swallowing and breathing,dizziness,change in speech 1971,FDA released a warning after learning that a New york man and his wife became seriously ill from Root of the cause botulism after eating a can of Bon Vivant vichyssoise Failure to use proper pressure cooker processes SOUD >50-yr old procedures >FDA found the company's processing practices >Neighbor's advice questionable and ordered a shutdown of the company's plant and destruction of all products >Ignored correct instruction due to a hot kitchen >5 of 324 cans were contaminated with botulinum >Ignorant of risk associated with botulism toxin >Ignored signs of spoilage Investigation revealed that workers misunderstood how to operate the canning Foodborne botulism is often associated machines with temperature abuse In response,FDA instituted good Spikes in botulism due to temp abuse manufacturing practices (GMPs)for low- acid foods (pH 4.6 and water activity 0.86 -Canning machine operators are certified Changes in processing schedules is done by processing authorifies
9/18/2016 2 • Range of symptoms typical of botulism - Nausea - Vomiting - Dry mouth - Neurological issues such as blurred vision, bilateral paralysis, slurred speech, fatigue, difficulty swallowing and breathing, dizziness, change in speech • Root of the cause - Failure to use proper pressure cooker processes 50-yr ld d o procedures Neighbor’s advice Ignored correct instruction due to a hot kitchen Ignorant of risk associated with botulism Ignored signs of spoilage Four Faces of Botulism 1. Foodborne botulism Traditionally associated with canned foods, particularly home-canned foods - Commercial cases (9%) usually involve small companies 1971, FDA released a warning after learning that a New York man and his wife became seriously ill from botulism after eating a can of Bon Vivant vichyssoise soup FDA found the company FDA found the company s processing practices 's processing practices questionable and ordered a shutdown of the company's plant and destruction of all products 5 of 324 cans were contaminated with botulinum toxin - Investigation revealed that workers misunderstood how to operate the canning machines - In response, FDA instituted good manuf i i (GMP ) f l facturing practices (GMPs) for lowacid foods (pH > 4.6 and water activity > 0.86 - Canning machine op f erators are certified - Changes in processing schedules is done by processing authorities • Foodborne botulism is often associated with temperature abuse - Spikes in botulism due to temp abuse
9/18/2016 Large outbreak in Clovis,New Mexico 2.Infant botulism/intestinal botulism >1978,40 people who ate at a local salad bar Infants are not thriving,cannot lift began showing various signs of paralysis themselves up,and have poor muscle tone >Potato salad implicated after FDA investigation -Deaths resemble sudden death syndrome >Leftover potatoes stored in a box at room temp Associated with eating raw agricultural products like honey >When enough accumulate,they are used in potato salad Infants have a less diverse intestinal microbiota that protects adults from without heating consumed spores >Perfect scenario Immunocompromised or antibiotic o Spores found on potatoes treatment lead to intestinal botulism in o Heating kills vegetative cells and drives off adults oxygen Recommended that children under the age o Spores germinate and toxin is produced of 2 not be feed raw agricultural products 3.Wound botulism is not foodborne but 4.Agent of bioterrorism can still be fatal .2003,spore-laden letter sent to politicians that contained Bacillus Spores are introduced into the body anthracis tissue below the skin Drug users injecting with ."Select agents"are now under strict governmental regulation contaminated heroin =a ) 言三三化。&惑 29500
9/18/2016 3 - Large outbreak in Clovis, New Mexico 1978, 40 people who ate at a local salad bar began showing various signs of paralysis Potato salad implicated after FDA investigation Leftover potatoes stored in a box at room temp When enough accumulate, they are used in potato salad without heating Perfect scenario o Spores found on potatoes o Heating kills vegetative cells and drives off oxygen o Spores germinate and toxin is produced 2. Infant botulism / intestinal botulism - Infants are not thriving, cannot lift themselves up, and have poor muscle tone - Deaths resemble sudden death syndrome - A i t d ith ti i lt l Associated with eating raw agricultural products like honey - Infants have a less diverse intestinal microbiota that protects adults from consumed spores - Immunocompromised or antibiotic treatment lead to intestinal botulism in adults - Recommended that children under the age of 2 not be feed raw agricultural products 3. Wound botulism is not foodborne but can still be fatal • Spores are introduced into the body tissue below the skin • Drug users injecting with contaminated heroin 4. Agent of bioterrorism • 2003, spore-laden letter sent to politicians that contained Bacillus anthracis • “Select agents” are now under strict governmental regulation
9/18/2016 ·Select agents must be Biosafety Levels -inventoried Biosafety levels range from BSL-1 to BSL-4 -kept locked in a room assessable only microbes do not consimimol poreease rd tn me m。po in healtl to people cleared by the Dept of Justice BSL-2-microbes pose moderate hazards to lab -handled using BSL-3 level work workers and the environment and are associated practices High Riak Mlernes with diseases of varying severity BSL-3-microbes cause serious or potentially lethal disease through respiratory transmission BSL-4-microbes are dangerous and exotic,posing 85L2 BSL-1 freatment or vaccines. Disease Characteristics Mild to serious disease that can kill within a day Symptoms 12-36 h but up to 14 days following ingestion of the neurotoxin Earlier the symptoms the more severe the disease First-nausea and vomiting -Then-neurological symptoms >double vision,drooping eyelids >loss of normal mouth and throat function >general fatigue >lack of muscle coordination >respiratory impairment-main cause of death
9/18/2016 4 • Select agents must be - inventoried - kept locked in a room assessable only to people cleared by the Dept of Justice - handled using BSL-3 level work practices Biosafety Levels Biosafety levels range from BSL-1 to BSL-4 • BSL-1 - microbes do not consistently cause disease in healthy adults and present minimal potential hazard to lab workers and the environment • BSL-2 – microbes pose moderate hazards to lab workers and the environment and are associated with diseases of varying severity • BSL-3 – microbes cause serious or potentially lethal disease through respiratory transmission • BSL-4 – microbes are dangerous and exotic, posing a high risk of aerosol-transmitted infections. Infections are frequently fatal and without treatment or vaccines. Disease Characteristics • Mild to serious disease that can kill within a day • Symptoms - 12-36 h but up to 14 days following ingestion of the neurotoxin - Earlier the symptoms the more severe the disease - First – nausea and vomiting - Then – neurological symptoms double vision, droopgy in e elids loss of normal mouth and throat function general fatigue lack of muscle coordination respiratory impairment – main cause of death
9/18/2016 Disease Characteristics Often incorrectly diagnosed as another Infant botulism starts with abdominal pain disease,most commonly Guillain-Barre -diarrhea syndrome constipation 女女 Botulinum toxin as agent of biowarfare ·Fatality rates -not enough ventilators or antitoxin -early1900s>50% nationwide Present day about 10% ·Treatment >if attack involves 40,000 antisera targeting the >only 4,000 ventilators available toxin respiratory support systems Botulinum Toxin as a Weapon Treatment Initial treatment involves inactivation of the Favoring Use as a Weapon Limiting Use as a Weapon neurotoxin ·Available in nature ·Not contagious 1.Neutralizing circulating toxin with antiserum ·Spread as an aerosol ·Production takes 2 Enemas to remove residual neurotoxin from the skill bowel Broken down by 3.Gastric lavage(stomach pump)or treatment ·Highly lethal heat and sunlight with emetics to remove remaining food ·Labile in normal Antiserum is most effective in the early stages atmosphere (1%per Iraq admitted to producing 3x Subsequent treatment is mainly ventilators to min) the amount of toxin required to counteract paralysis of the respiratory muscles kill the entire human population Infant botulism-mainly high-quality supportive care 9
9/18/2016 5 Disease Characteristics • Infant botulism starts with - abdominal pain - diarrhea - constipation • Fatality rates - early 1900s > 50% - Present day about 10% • Treatment - antisera targeting the toxin - respiratory support systems - 3-4 months on a ventilator and years of therapy to fully recover • Often incorrectly diagnosed as another disease, most commonly Guillain-Barré syndrome • Botulinum toxin as agent of biowarfare - not enough ventilators or antitoxin nationwide if attack involves 40,000 onl 4 000 l l bl ly 4,000 ventilators availabl e Botulinum Toxin as a Weapon Favoring Use as a Weapon • Available in nature Limiting Use as a Weapon • Not conta gious • Spread as an aerosol • Spread in food or water • Highly lethal g • Production takes skill • Broken down by heat and sunlight • Labile in normal atmosph ( % here (1% per min) Iraq admitted to producing 3x the amount of toxin required to kill the entire human population Treatment • Initial treatment involves inactivation of the neurotoxin 1. Neutralizing g circulating toxin with antiserum 2. Enemas to remove residual neurotoxin from the bowel 3. Gastric lavage (stomach pump) or treatment with emetics to remove remaining food • Antiserum is most effective in the early stages • Subsequent treatment is mainly ventilators to counteract paralysis of the respiratory muscles • Infant botulism – mainly high-quality supportive care