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Preventing, Diagnosing and Treating Botulism

Botulism is a rare but serious infection that can be lethal. Caused by bacteria in food, water and animals, it releases dangerous toxins which attack a human’s nervous system.

It is normally very rare for an average, healthy adult to contract the disease but those who prepare their own long term food storage at home are at increased risk. Storing food for any length of time will always increase the likelihood of infection when compared to eating fresh, but if you want to be ready for whatever the future brings, you might want to cook and stockpile your own food.

Being ready for anything means being able to notice when things are going wrong as well as right. People infected with the disease initially show fairly mild symptoms like stomach cramps and vomiting. If left untreated however this can develop and become more severe, with paralysis starting at the head and working its way down the body.

Onset can happen in as little as 12 hours, although it can take up to 3 days before anyone realises what is actually going on. All hospitals in the developed world will hold in stock a life saving anti-toxin. The disease is so severe however that even with this medicine 5-10% of people who contract Botulism still die. It’s best therefore to make sure you are prepared and avoid contracting it in the first place.

Botulism & Its Symptoms

There are 8 different types of bacteria that produce the toxins that give a person or animal botulism.  Each produces a different selection of toxins, A to H, which essentially cause the same condition. Botulism A, B, E and F affect humans, with the A and E strains eventually leading to paralysis.

Looking for whole body paralysis as a symptom is a bad idea as it is clearly too late by this point. First the toxins released by the bacteria affect the gut and then the whole body from the top down. Below we have a list of symptoms which are common to botulism infection ranked from early to late in terms of when they appear.

  1. Nausea and vomiting
  2. Dry mouth
  3. Difficulty swallowing
  4. Drooping face, especially eyelids
  5. Double vision
  6. Slurred speech
  7. Fast heart rate
  8. Difficulty breathing

Luckily botulism cannot be spread from person to person, even with the above symptoms. The spores spread by vomiting for example are too few to make someone else in the vicinity unwell. As the more first-aid aware of you might have noticed, if you ignore the stomach upset and miss the dry mouth it could almost seem like the sufferer is having a stroke.

In fact, even when admitted to hospital Botulism can be mistaken for other neurological conditions like Guillain-Barré. There is no need to worry however as the toxins can be positively identified in the stomach contents or stool of a patient, allowing treatment to be started right away.

This is why if you suspect someone could be a victim they should seek medical attention immediately. If they get to the stage where it is hard to catch their breath, even if they receive treatment in time to save their life they could need to be connected to a machine to help them breathe. This could be needed for for up to 8 weeks after the infection has cleared. This long lasting effect is why people pay 1000s of dollars to have it injected into their face!

The most common treatment is a trivalent anti-toxin which treats type A, B and E. This is available to local government from the CDC.

Types of Botulism

Ingested

This is the main area of concern for those who prepare their own food for use either at home or out in the wilderness. When preparing for times ahead, you want to feel confident that your time and effort has been well spent protecting you and your family.

One of the core ways of doing this is proper food canning technique. This stops the dangerous and lethal bacteria from ever having the chance to replicate and be consumed by someone. These bacteria grow best in warm, moist environments and can form outside just canned foods, for example when smoking fish in surroundings that are too warm. By focusing on prevention you will be much safer in the long run than not doing your due diligence and relying on a closeby medical centre to have an anti-toxin available.

Prevention

Primary prevention is proper food preparation. It is rare in the western world to buy prepared food that has become infected by poor practices and hygiene at the food plant. In fact only 15% of Botulism cases in the US come from prepared food.

Much more likely is finding that your own self prepared food has become dangerously overrun with bacteria. Food cans that are bulging in any way after sealing at home are likely to have bacteria multiplying inside them, they release gas which pressurizes the cans and distorts their shape.

Any time you eat canned food you have prepared yourself, it is always best practice to check the food even if the cans look fine. When opening the can, any foaming or spurting of the liquid inside could be a sign that the contents are spoiled.

One sign that can be overlooked in the case of botulism is the smell of cheese. Canned foods that smell overly cheesy compared the ingredients you know are in them is a telltale sign of the bacteria multiplying. The bottom line is, if you are worried that the food has gone bad, it has. Do not taste it to test it! This will make you ill; just throw it out and move onto the next can.

Canning Food

When you think of canned food you may either think of the cheaper food in your local supermarket or you may think of packing for an expedition. Back in 19th century Europe it was all the rage with the middle class who wanted to show off the latest gadget available. By the time of the 20th century however canned food was integral on the western front during the world wars. Factories back at home had long known that canning food would extend its shelf life at least a year or more so it was given to soldiers on the front line to reduce the impact of many food borne infections. The technology has now long been perfected and today you can buy canned food all over the world, in any cuisine.

Cans are a great alternative to other methods like using glass jars which are heavier to carry, more likely to break and less able to withstand internal or external pressure. The modern US Army issues MREs or Meals Ready to Eat, which are stored in vacuumed laminate pouches. When hiking, camping or preparing for long journeys where you want to be self sustaining, these new 21st century versions are easier to pack and lighter than even cans. The army have replaced cans with pouches since 1981 as their packing of choice.

If you still want to make your own rations rather than buying from a store, there are 2 techniques to use depending on the food you want to preserve. If you are canning fruit or pickled vegetables then you can use the basic canning method of a boiling water bath.

If you want to can meat, vegetables or even dairy products you must use a pressure canner unless you can make the food more acidic than usual. A pH of 4.6 is the maximum for canning food without a pressurizer. If the pH is higher than 4.6, or less acidic, then additives must be added to lower the pH. Manufacturers and factories will also have access to techniques like freeze driers, ionizing radiation and salt baths that those at home are unlikely to have.

As mentioned above, most foods need sterilization with a pressure cooker. This is because the food must be boiled in water over 100 degrees, often up to 130. You can pick up a cheap pressure cooker at a local store as long as you also buy a thermometer to double check the temperature of your food.

For those who have a bit more to spend on survival preps, you can buy an electronic pressure cooker and set the time and temperature you need to cook your food at. Once a safe minimum temperature has been reached, at least 114 degrees, you must make sure the pressure inside the cooker reaches at least 10psi (pounds per square inch). Don’t forget that your container must be cleaned and then sterilised too before using it to store food!

child with botulism

Photo above: a 14 year old with botulism, by Herbert L. Fred, MD and Hendrik A. van Dijk (http://cnx.org/content/m14960/latest/) [CC BY 2.0 ], via Wikimedia Commons 

Infant

This type of botulism is picked up because the immune system of babies, that fights the world of bacteria around them, is still developing. Research shows that they are most likely picking up the bacteria in tiny amounts from everyday surfaces and from playing in the ground. The bacteria are left unchallenged in their bodies and start to multiply, eventually forming a full blown infection. If your baby contracts botulism this is unlikely to be as a result of being in a dirty or unclean environment. In fact if an older child or adult came into contact with a surface that left a baby ill they wouldn’t go on to become infected.

For pregnant women and new mothers there is a tidal wave of information on the internet on what to give and what not to give a baby. One food commonly mentioned is honey, and the reason behind this is the risk of botulism. Different strains of honey have different levels of water and acidity in them based on the region and type of bee they are harvested from. There are no reported cases of adults becoming unwell in this way, but the tiny amounts of bacteria in honey go on to be a big health risk for infants.

The USDA recommends that children under the age of 1 year are not fed any type of honey to avoid this exact issue. If you have a small child it can be harder to detect the warning signs of botulism early on. Make sure you read ahead to the symptoms section below to make sure you are equipped with the right knowledge for a loved one or someone else’s child.

Injected

Your local beauty clinic and heroin user have one thing in common. Botulism toxin and needles, or as it is more commonly known: Botox. Heroin users have a weakened immune system as a result of their drug use, piercing their skin with dirty needles is what eventually gives them the infection.

Beauticians and plastic surgeons use very controlled amounts of toxin (not the infectious bacteria!) to make what is essentially a muscle relaxant. The toxins block the neuron receptors, weakening your facial muscles and reducing the appearance of wrinkles. As it is the same toxin that makes you ill, Botox from a untrained technician or taken at home can kill you.

Inhaled

Following on from the previous section, you might wonder where Botox is harvested from? The bacteria is grown in labs around the world and the toxins are then separated from the mix to be sold to pharmaceutical companies. What does this do with inhaling Botox? Well be reassured knowing that there have been almost no cases of infection from breathing in the bacteria or toxins. When this has happened, it has been because of an accident or mistake in a lab where it is being isolated. A vial or glass bottle used to grow the bacteria releases the spores when broken, potentially infecting any scientist near it.

Animal

This is important for anyone who might use hunting as a means of finding food in the outdoors. While it is exceptionally unlikely that an infected bird or other animal can infect you directly, eating an animal that had the bacteria in their system will.

When hunting for game or raising poultry and other farm animals, always make sure that you observe the animal’s behavior beforehand. If they look slow or unwell, regardless of whether you think it is botulism, you shouldn’t be eating it. There are any number of infections that an animal could have, signs of illness should be a warning not to eat them, wild or domesticated. Protect your hunting dog as well! If they begin to eat downed prey like ducks they are equally at risk.

The Final Word

There is no home or wilderness treatment for botulism. The toxins that course through your body are some of the strongest neurotoxins known to man and science. If you do develop symptoms they will only get worse, not better. Even if your body is able to fight and kill off the bacteria there is no way to clear your body of the toxins which shut down your nervous system.

If you are out in the wild, far from civilization, you should always have a rescue plan in place so you can contact emergency services. Remember the signs and symptoms and check your food, living or canned before you decide to eat it!

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About Shane Jackson (MBChB - Bachelor of Medicine, Bachelor of Surgery)

Shane Jackson (MBChB - Bachelor of Medicine, Bachelor of Surgery)
Shane is a medical doctor with over 8 years experience in both hospital medicine and surgery. He's completed over 2 years of surgical work focusing on trauma & orthopaedics alongside maxillofacial surgery. He has been involved in education since medical school and have written courses and taught classes. Having trained in Advanced Trauma and Life Support he is at the forefront of practical, out-of-hospital medicine which can be applied by the public to save lives.

6 comments

  1. Will antibiotics help at all?

  2. I ate some deli ham that had been in my refrigerator too long on Monday August 18, 2018. Several hours later, I was cramping and bloating and in intense pain. I knew that garlic was antiviral, anti-bacterial, anti- fungal and kills parasites. I went through all of the natural medical books that I have here. I started taking Nature’s Bounty’s 2,000mg Garlic, 500mg Ginger, 1,000mg of Turmeric, 2 teaspoons of Organic India Moringa, 1,00mg Cinnamon and drinking a cup of mixed mint tea every two hours. I did not sleep for 48 hours. It began easing after 38 hours. I ate a little organic 3 minute oatmeal several times the second day.
    I am now taking the herbs and spices only once a day. I am not hurting at all and I started drinking 40 billion live probiotics today I have added fruit smoothies today and ate a baked chicken thigh and some English Peas tonight.
    I know that the garlic will keep any bug from mutating because of the complex bond between the sulfur-rich amino acid Allin and the protein based enzyme Allinase, because it has the ability to inhibit RNA synthesis and DNA polymerases. (disrupts the bacterium’s entire enzyme system responsible for cell replication). I am no longer hurting and the gas iis almost completely gone. Am I still in any dangers, if I am still sore from the stomach being stretched. Have I eliminated the threat by what I have done?

  3. There are three phases of botulism, toxin, bacteria and spores. The toxin is the most deadly and is generated by the bacteria. Allegedly 70 degrees C will kill the bacteria, and 80 decrees C will disable (denature) the toxin. Thus boiling (100 degrees C) will take care of both of these. However boiling will NOT harm the spores at all. That takes at least 121 degrees C.

    The spores themselves are harmless, however under conditions of low oxygen, they can regenerate the bacteria which then produce the toxin. Ingesting spores is not a significant problem, but storing ingestibles containing the spores can be a problem.

  4. This was a nice essay. I believe a useful followup would be another one with suggestions on how to avoid food poisoning in “survival” situations”. Say, you have limited fuel and no refrigeration. What can a person do with “leftovers” in this kind of case?

    Regarding honey, if I had to use the stuff, I believe I’d pressure cook it and to the devil with what that does to the flavor. Even then I’d try to limit my use of that honey to topical applications for infections and ulcerated places on the skin. Even the presumably sterilized honey would be fed to infants only in the case when the calories from it was a matter of life or death.

    I remember reading many years ago about an OSS biowar project during WW2, and after a bit of effort dug it out of my memory to the point of being able to make a search.

    https://brooklynbrainery.com/blog/a-story-about-botulism-prostitutes-and-wwii

    I’m not sure I believe the part about the donkeys, but I’ve little doubt that a microscopic amount of the poison would be extremely dangerous. This is a really important topic, and deserves plenty of attention.

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