Botulinum Drinks Contamination Potential 1920x1204@1x


Introduction

“...spores are heat resistant: 31.5 % of them survive to a standard pasteurisation treatment at a temperature of 77 ºC for 15 minutes”

The bacterium Clostridium botulinum, first investigated two centuries ago, is capable to produce botulinum toxin, the most powerful toxin known.   275 times more poisonous than cyanide and 100,000 times more toxic than sarin: in an adult weighing 70 kilograms the symptoms may occur with just 70 micrograms of toxin.   It is an anaerobic bacterium, gram-positive, spore-forming found in soil.   The spores are heat resistant: 31.6 % of them survive to a pasteurisation treatment at a temperature of 77 ºC for 15 minutes.   In the ideal environment the spores will germinate into toxin-producing bacteria.  This toxin then causes an illness named botulism within its host, presenting with descending paralysis.  A paralysis fatal when affecting the body’s ventilatory function.  

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  Botulism disease is much more dangerous than the Anthrax, caused by the rod-shaped endospores of the Bacillus anthracis








Six different forms of botulism poisoningdifferentiated by the means of acquisition, are known:                                                                                                                                                       

  1. Food- or Beverage-borne
  2. infant, due to accidental ingestion of spores in the dust, 
  3. wound,
  4. adult intestinal, when toxin is produced within the gastrointestinal tract of an infected adult host, 
  5. inadvertent injection-related,  
  6. inhalational, 1 gram of aerosolized botulinum toxin is enough to kill over 1,000,000 people. 


A Bug with Beauty and Weapon





Clostridium botulinum toxin does not affect the central nervous system: it is too large to cross the blood-brain barrier.  That’s why it is only the peripheral nervous system’s cells, where acetylcholine acts to activate muscles, which result affected.  The toxin is a polypeptide made up of a heavy and a light chain.  It breaks down the protein complex required for the fusion of acetylcholine-containing vescicles at the nerve terminal.  Thus irreversibly acting to prevent release of acetylcholine at the neuromuscular junction.   Muscle contraction becomes impossible and paralysis is the unavoidable outcome. 

A Bug with Beauty and Weapon

Clostridium botulinum toxin is too large to cross the blood-brain barrier and therefore it targets cells in the peripheral nervous system where acetylcholine acts to activate muscles.  The toxin is a polypeptide made up of a heavy and a light chain.  It breaks down the protein complex required for the fusion of acetylcholine-containing vescicles at the nerve terminal.  Thus, irreversibly acting to prevent release of acetylcholine at the neuromuscular junction.  Muscle contraction becomes impossible and paralysis is the unavoidable outcome. It is important to recognize that botulism presents as symmetric, descending flaccid paralysis that always begins in the bulbar musculature.  With the exception of wound botulism, it is an afebrile illness that does not decrease the patient’s mental status despite ensuing weakness and paralysis until later in the process when carbon dioxide narcosis occurs due to hypoventilation.   At any age, recovery occurs when the body sprouts new motor axon threads for reinnervation of paralyzed muscle fibers, which takes up to six months.   Considering just the date released by the Centers for Disease Control and Prevention, approximately 145 cases of botulism are reported yearly in the United States, so shared: 

infant (65%), 
food-borne (15%), 
wound botulism (20%),
seldom adult enteric infections.

  Clostridium botulinum toxin, the most powerful toxin existing, breaks down the protein complex required for the fusion of acetylcholine-containing vescicles at the nerve terminal.  Recovery occurs when the human body sprouts new motor axon threads for reinnervation of paralyzed muscle fibers


“1 gram of aerosolized botulinum toxin could kill over 1,000,000 people”



The most common botulism’s symptom is a symmetric, descending paralysis.   Paralysis beginning in the bulbar musculature.  With the exception of wound botulism, it is an afebrile illness. Meaning that it does not decrease the patient’s mental status, despite ensuing weakness and paralysis, until later in the process when carbon dioxide narcosis occurs due to hypoventilation.  At any age, recovery occurs when the human body sprouts new motor axon threads for reinnervation of paralyzed muscle fibers, which takes up to six months.  Considering just the date released by the Centers for Disease Control and Prevention (CDC), ~ 145 cases of botulism are reported yearly in the USA, so shared: 

  • infant (65%), 
  • food-borne (15%), 
  • wound botulism (20%),
  • adult enteric infections (< 0.5 %).
A Bug with Beauty and Weapon

Clostridium botulinum toxin is too large to cross the blood-brain barrier and therefore it targets cells in the peripheral nervous system where acetylcholine acts to activate muscles.  The toxin is a polypeptide made up of a heavy and a light chain.  It breaks down the protein complex required for the fusion of acetylcholine-containing vescicles at the nerve terminal.  Thus, irreversibly acting to prevent release of acetylcholine at the neuromuscular junction.  Muscle contraction becomes impossible and paralysis is the unavoidable outcome. It is important to recognize that botulism presents as symmetric, descending flaccid paralysis that always begins in the bulbar musculature.  With the exception of wound botulism, it is an afebrile illness that does not decrease the patient’s mental status despite ensuing weakness and paralysis until later in the process when carbon dioxide narcosis occurs due to hypoventilation.   At any age, recovery occurs when the body sprouts new motor axon threads for reinnervation of paralyzed muscle fibers, which takes up to six months.   Considering just the date released by the Centers for Disease Control and Prevention, approximately 145 cases of botulism are reported yearly in the United States, so shared: 

infant (65%), 
food-borne (15%), 
wound botulism (20%),
seldom adult enteric infections.

 Blocking the  fusion of acetylcholine-containing vescicles at the nerve terminal, the toxin irreversibly acts to prevent release of acetylcholine at the neuromuscular junction, thus inhibiting muscle contraction and causing paralysis


Milk + Botulinum Toxin 

Botulinum toxin 

and Milk

The tiniest amount of toxin, 1 nanogram per kilogram of human body mass, will cause symptoms in the human being.  Mathematical models predict that 1 gram of the toxin in commercially-distributed milk consumed by more than 550,000 people would result in 100,000 casualties.   A threat to humans is a release of botulinum toxin in cold drinks.   For example, the milk supply has been studied because of the multiple and rapid steps in transportation and processing, wide distribution, and for the fact that it is a highly consumed food.   If 1 gram of botulinum neurotoxin was: 

released into a holding tank of ~180,000 litres of raw milk,
all of this milk distributed and consumed without detection, 
100,000 casualties should arise, based on 68.4% inactivation of the toxin by heat treatment at a temperature of 770 C for 15 minutes.

A threat to humans is a release of botulinum toxin in cold drinks.   A tiny amount of toxin, 1 nanogram (1 billionth of gram) per kilogram of human body mass, will cause symptoms in the human being.  For example, the milk supply is particularly exposed to these risks because of the multiple, rapid steps in transportation and processing, wide distribution, and because it is a highly consumed food.   If 1 gram of botulinum neurotoxin should be: 

  1. released into a holding tank of ~ 180,000 litres of raw milk,
  2. all of this milk distributed and consumed without detection, 

100,000 casualties should arise, based on 68.4% inactivation of the toxin by heat treatment at a temperature of 77 ºC for 15 minutes.  


 1 gram of the neurotoxin in 180,000 litres of commercially-distributed milk, consumed by more than 550,000 people, would result in 100,000 casualties




Botulinum toxin and  

Water

The possibility of contamination of water supplies is an additional threat, as botulinum toxin has been shown to retain up to 50% of its activity for 5 to 70 days in various types of untreated water and beverages.  There are however barriers like: 

dilution, 
inactivation from chlorine, 
disinfectants, 
hydrolysis, 
sunlight, 
microbes, 
filtration 
concurring to make this contamination less likely.      



The plastic safety seal adopted by Nestle’ Waters™ to assure the safety of part of its beverages, also reduces the risk of ingestion of spores.  What a share of all today existing bottled beverages reach the Market packaged this way ?

Water + Botulinum Toxin   


The possibility of contamination of water supplies is an additional threat, as botulinum toxin has been shown to retain up to 50% of its activity for 5 to 70 days in various types of untreated water and bottled beverages.  There are however barriers like: 

  • dilution, 
  • inactivation from chlorine, 
  • disinfectants, 
  • hydrolysis, 
  • sunlight, 
  • microbes, 
  • filtration, 

concurring to make this contamination less likely than others.     


  The plastic safety seal adopted by Nestle’™ to assure the safety of its beverages, also reduces the risk of ingestion of spores.  What a share of all today existing bottled beverages reaches the Market packaged so carefully ?



Food + Botulinum Toxin







To illustrate the importance of the clinician’s ability to recognize botulism poisoning, we’ll expose in the following is a case that went undetected in Vancouver, Canada.   Between July and September of 1985 one bottle of garlic sometimes used in a restaurant, caused a botulism outbreak.   36 people were affected.  Botulism started to be correctly diagnosed very late: 2 months after the start of the outbreak and many days after the last patient ate at the restaurant.   This, even when the median incubation period from ingestion to neurologic symptoms was only 2.3 days and the median period from ingestion to hospitalization is 7 days.   In this outbreak, the patients did present with typical symptoms of botulism poisoning, including: 

  • muscle weakness (100%), 
  • dysphagia (91%), 
  • blurred vision (88%), 
  • dry mouth (85%), 
  • dysphonia (82%), 
  • dizziness (73%), 
  • diplopia (67%).

Most patients were hospitalized, some required mechanical ventilation, and there was no mortality associated with this outbreak.  This example is eloquent: garlic at high concentration, is notoriously a difficult environment for bacteria reproduction.  It lets us imagine what could be the risk associated to more favourable environments.   Like the containers filled with juice and sugar in the pictures at right side.  Images shot immediately at the outfeed of an Aseptic Filling Bloc.  All of them open containers, where the Clostridium Botulinum spores may freely enter.   


Caps inclined, caps too high and broken tamper evident rings.  All of them open containers allowing entrance of spores, photographed at the outfeed of a Capper Machine in an Aseptic Filling Line.  

    


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