Clostridium botulinum and Clinical Symptoms of Botulism
Clostridium botulinum is a spore-forming, obligately anaerobic, Gram-positive bacillus that produces a heat-labile neurotoxin. This organism is divided into four physiological groups that produce eight antigenically distinct toxin types, which are classified as botulinum toxin types A-H. Botulinum toxin is the most potent toxin known. The mode of action of botulinum toxin is to cleave key proteins that are necessary for the release of acetylcholine into the neuromuscular junction. The result of the toxemia is a descending, bilateral, symmetric, flaccid paralysis. Hallmark clinical features of botulism include: ptosis (droopy eyelids), diplopia (double vision), difficulty swallowing, diminished reflexes, and hypotonia. Complete paralysis of the airway and respiratory muscles may lead to cessation of breathing and death.
Two other clostridial species have acquired the gene to produce botulinum toxin. Very rare strains of
C. butyricum and
C. baratii have been found to produce botulinum toxin type E and toxin type F, respectively. Most of these rare toxigenic
C. butyricum and
C. baratii strains were discovered because they caused intestinal (infant) botulism.
The disease infant botulism is first suspected based on clinical features of the infant patient (12 months of age or younger). Symptoms such as poor feeding, droopy eyelids, constipation and lethargy, together with hypotonia and loss of head control, prompt physicians to consider botulinum toxin as the causative agent. Accordingly, it is necessary for laboratory analysis to be performed without delay to establish the diagnosis. Prompt laboratory diagnosis of infant botulism is necessary for patient management and rules out the possibility of fatal degenerative neuromuscular diseases.
The laboratory diagnosis of infant botulism is a two-part process. The first component is to perform a direct toxin analysis. This requires the extraction of toxin directly from the fecal specimen and the use of specialized techniques to identify and type the toxin. The second part is to culture the feces using specialized media and techniques in order to isolate
Clostridium botulinum .
Fecal specimens for infant botulism diagnostic testing can be collected before or after antitoxin administration. BabyBIG® does not neutralize botulinum toxin present in the lumen of the intestine, nor does it kill or prevent the growth of C. botulinum or inhibit the formation of botulinum toxin in the infant’s large intestine.
Specimen Collection, Storage, and Submission
Specimen Collection, Storage, and Submission (PDF)
Lab Scientist FAQs (PDF)
Infant Botulism Diagnostic Testing Specimen Submission Form (PDF)
CLIA Certificate (PDF)
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