Botulism – Australia

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There has been a recent case of botulism in New South Wales, Australia, possibly associated with the intravenous injection of methamphetamine.

The case developed acute onset ophthalmoplegia and bulbar dysfunction several hours after using methamphetamine intravenously. This progressed to motor weakness and respiratory muscle paralysis, requiring intubation and mechanical ventilation.

Several items associated with methamphetamine use by the case were obtained. Microbiological testing identified spore-forming bacteria, and C. botulinum toxin B was detected by PCR. Food history remains incomplete, but may include consumption of old food. The living environment was reported to be unclean.

Photo: Clostridium botulinum.

Foodborne botulism is a severe intoxication caused by eating the preformed toxin present in contaminated food. It occurs when spores of bacterium Clostridium botulinum germinate and the organism is allowed to grow and produce toxin in food that is later eaten without sufficient heating or cooking to inactivate the spores. Botulinum toxin is one of the most potent neurotoxins known.

Typically in a few hours to several days after ingestion of the contaminated food, one will start to show the classic symptoms: blurred vision, dry mouth, and difficulty in swallowing. Gastrointestinal symptoms may or may not occur. If untreated, the paralysis can descend through the body starting at the face and working its way down.

Prevention is primarily by proper food preparation. The toxin, though not the organism, is destroyed by heating it to more than 85 C (185 F) for longer than 5 minutes. Honey can contain the organism, and for this reason, honey should not be fed to children under 12 months.

Globally, botulism is fairly rare, with approximately 1,000 cases yearly.

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