Botulism historical perspective

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.


Clostridium botulinum botulism was named In 1870 by Muller (German physician). In 1895 Clostridium botulinum was first isolated by Emile Van Ermengem and It was in 1949 when Burgen's group discovered that botulinum toxin blocks neuromuscular transmission.

Historical Perspective

Food-borne botulism may be one of the first illnesses that has accompanied mankind since its beginning. The documents containing historical soureces and perspective on food poisoning before the 19th century have not been found yet. As there are some ancient dietary laws and taboos, some knowledge about the life-threatening consumption of poisoned foods may be reflected by them. One example of such a dietary taboo is the 10th century edict of Emperor Leo VI of Byzantium in which manufacturing of blood sausages was forbidden[1]. There are also ancient case reports on intoxications with Atropa belladonna that seems like symptoms of patients with food-borne botulism, because the combination of dilated pupils and fatal muscle paralysis cannot be attributed to an atropine intoxication, although it was different they didn't think about it as a new disease. At the end of the 18th century, some well-documented outbreaks of “sausage poisoning” in Southern Germany, especially in Württemberg, led to early systematic botulinum toxin research. The first accurate and complete description of the clinical symptoms of food-borne botulism was published between 1817 and 1822 by the German physician and poet Justinus Kerner (1786–1862). He called the toxin as “sausage poison” or "Canadian bacon pathogen". He also developed the idea of a possible therapeutic use of botulinum toxin. Kerner’s had an amazing scientific approach to the problems of food poisoning during the period of enlightenment: after describing and categorizing empirical phenomena, he started animal experiments and clinical experiments on himself, developed hypotheses on the pathophysiology of the toxin, suggested measures for prevention and treatment of botulism, and, finally, developed visions and ideas about future perspectives regarding the toxin, including the idea of its therapeutic use[2]. Although his amazing work, Kerner did not succeed in defining the suspected biological poison. Eighty years after Kerner's work, in 1895, a botulism outbreak after a funeral dinner with smoked ham in the small Belgian village of Ellezelles led to the discovery of the pathogen Clostridium botulinum by Emile Pierre van Ermengem, Professor of bacteriology at the University of Ghent. The bacterium was so called because of its pathological association with the sausages (Latin word for sausage = “botulus”) and although its shape is truely like a sausage, the reason they call ii is not associated with its microscopic shape. Modern botulinum toxin treatment which is known as chemodenervation therapy was pioneered by Alan B. Scott and Edward J Schantz in 1973 with monkey experiments and in 1980 with human applications.

United States

All data regarding botulism antitoxin releases and laboratory confirmation of cases in the US are recorded annually by the Centers for Disease Control and Prevention and published on their website.[3]

  • Between March 31 and April 6, 1977, 59 individuals developed type B botulism. All ill persons had eaten at the same Mexican restaurant in Pontiac, Michigan and all had consumed a hot sauce made with improperly home-canned jalapeño peppers, either by adding it to their food, or by eating a nacho that had had hot sauce used in its preparation. The full clinical spectrum (mild symptomatology with neurologic findings through life-threatening ventilatory paralysis) of type B botulism was documented.[4]
  • In April 1994, the largest outbreak of botulism in the United States since 1978 occurred in El Paso, Texas. Thirty persons were affected; 4 required mechanical ventilation. All ate food from a Greek restaurant. The attack rate among persons who ate a potato-based dip was 86% (19/22) compared with 6% (11/176) among persons who did not eat the dip (relative risk [RR] Å 13.8; 95% confidence interval [CI], 7.6–25.1). The attack rate among persons who ate an eggplant-based dip was 67% (6/9) compared with 13% (24/189) among persons who did not (RR Å 5.2; 95% CI, 2.9–9.5). Botulism toxin type A was detected from patients and in both dips. Toxin formation resulted from holding aluminum foil-wrapped baked potatoes at room temperature, apparently for several days, before they were used in the dips. Food handlers should be informed of the potential hazards caused by holding foil-wrapped potatoes at ambient temperatures after cooking.[5]
  • Beginning in late June 2007, 8 people contracted botulism poisoning by eating canned food products produced by Castleberry's Food Company in its Augusta, Georgia plant. It was later identified that the Castleberry's plant had serious production problems on a specific line of retorts that had under-processed the cans of food. These issues included broken cooking alarms, leaking water valves and inaccurate temperature devices, all the result of poor management of the company. All of the victims were hospitalized and placed on mechanical ventilation. The Castleberry's Food Company outbreak was the first instance of botulism in commercial canned foods in the United States in over 30 years.
  • One person died, 21 cases were confirmed, and 10 more were suspected in Lancaster, Ohio when a botulism outbreak occurred after a church potluck in April 2015. The suspected source was a salad made from home-canned potatoes. [6]

United Kingdom

The largest recorded outbreak of foodborne botulism in the United Kingdom occurred in June 1989. A total of 27 patients were affected; one patient died. Twenty-five of the patients had eaten one brand of hazelnut yogurt in the week before the onset of symptoms. This yogurt contained hazelnut conserve sweetened with aspartame rather than sugar. Control measures included the cessation of all yogurt production by the implicated producer, the withdrawal of the firm's yogurts from sale, the recall of cans of the hazelnut conserve, and advice to the general public to avoid the consumption of all hazelnut yogurts.[7]

Botulinum Toxin as a Therapy

By 1973, Alan B Scott, MD, of Smith-Kettlewell Institute used botulinum toxin type A (BTX-A) in monkey experiments, and, in 1980, he officially used BTX-A for the first time in humans to treat strabismus. In December 1989, BTX-A (BOTOX) was approved by the US Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in patients over 12 years old. The cosmetic effect of BTX-A was initially described by ophthalmologist Jean Carruthers and dermatologist Alastair Carruthers, a husband-and-wife team working in Vancouver, Canada, although the effect had been observed by a number of independent groups. On April 15, 2002, the FDA announced the approval of botulinum toxin type A (BOTOX Cosmetic) to temporarily improve the appearance of moderate-to-severe frown lines between the eyebrows (glabellar lines). BTX-A has also been approved for the treatment of excessive underarm sweating. Botulinum Toxin Type B (BTX-B) received FDA approval for treatment of cervical dystonia on December 21, 2000. Trade names for BTX-B are Myobloc in the United States, and Neurobloc® in the European Union.The acceptance of BTX-A use for the treatment of spasticity and muscle pain disorders is growing, with approvals pending in many European countries and studies on headaches (including migraine), prostatic symptoms, asthma, obesity and many other possible indications are ongoing.

Botox is manufactured by Allergan Inc (U.S.) for both therapeutic as well as cosmetic use. The formulation is best stored at cold temperature of 2-8 degrees Celsius. Dysport is a therapeutic formulation of the type A toxin developed and manufactured in the UK and which is licensed for the treatment of focal dystonias, symptoms of cerebral palsy, and certain cosmetic uses in many territories world wide.


  1. Erbguth FJ (2004). "Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin". Mov. Disord. 19 Suppl 8: S2–6. doi:10.1002/mds.20003. PMID 15027048.
  2. Erbguth FJ, Naumann M (1999). "Historical aspects of botulinum toxin: Justinus Kerner (1786-1862) and the "sausage poison"". Neurology. 53 (8): 1850–3. PMID 10563638.
  3. "National Case Surveillance: National Botulism Surveillance | CDC National Surveillance". 2013-06-25. Retrieved 2014-02-12.
  4. Terranova, William; Breman, Joel G.; Locey, Robert P.; Speck, Sarah (1978). "Botulism type B: epidemiologic aspects of an extensive outbreak". American Journal of Epidemiology. 108 (2): 150–6. PMID 707476.
  5. Angulo, F. J.; Getz, J.; Taylor, J. P.; Hendricks, K. A.; Hatheway, C. L.; Barth, S. S.; Solomon, H. M.; Larson, A. E.; Johnson, E. A.; Nickey, L. N.; Ries, A. A. (1998). "A Large Outbreak of Botulism: The Hazardous Baked Potato". Journal of Infectious Diseases. 178 (1): 172–7. doi:10.1086/515615. PMID 9652437.
  6. "1 dead in botulism outbreak linked to Ohio church potluck". CNNWIRE. CNN. 28 April 2015. Retrieved 19 July 2015.
  7. O'Mahony, M; Mitchell, E; Gilbert, RJ; Hutchinson, DN; Begg, NT; Rodhouse, JC; Morris, JE (1990). "An outbreak of foodborne botulism associated with contaminated hazelnut yoghurt". Epidemiology and Infection. 104 (3): 389–95. PMC 2271776. PMID 2347382.

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