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Chapter 16.5 : BotulinumToxin—Clostridium botulinum
Clostridium botulinu. is an anaerobic gram-positive rod that produces spores and is ubiquitous in soil and marine sediments throughout the world. Botulism is a neuroparalytic illness resulting from the action of a toxin produced by strains of C. botulinum. These toxins are extremely hazardous to humans, requiring only a minute quantity to cause profound intoxication and death. There are four distinct forms of botulism: (i) food borne, (ii) wound, (iii) infant, and (iv) adult or child. Food-borne botulism, although the most common form, is relatively rare but often fatal. This form of botulism results from the ingestion of food items containing the preformed toxin. The clinical diagnosis of food-borne botulism can be confirmed by isolating the organism from the feces of the patient. Isolation of the organism from remnants of the consumed food item does not provide confirmatory evidence of botulism in the absence of other supporting laboratory data. The demonstration of botulinum toxin in patient feces or serum or in the suspected food item supports the clinical diagnosis. Wound botulism occurs following the colonization of the wound by C. botulinum. Multiplication of the organism may result in the production of toxin. Confirmation requires demonstration of the organism and toxin in serum, feces, or material from the wound. Infant botulism results when ingested spores germinate within the intestinal tract, causing toxin production. Confirmation of infection is dependent on the demonstration of botulinum toxin in the feces.