S5 E9: Paralysis on Purpose: The Story of Botulism

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1:38 The dark circles aren't as prominent either. If you're thinking that maybe you should start taking better care of your skin, I encourage you to try Codex. Head on over to www. Codex Labscorp dot com and use promo code cause of Death twenty for twenty percent off your first purchase. It's www. Codex Labscorp dot com and use promo code cause of Death twenty. Hi. I'm Laney Hobbs, host of True Crime Cases with Laney. It's an immersive narrative podcast that shares a new case each episode. The crimes covered in my show range from the seemingly innocent granny who poisons her victims to the serial killer who conned the state of Wisconsin. As always, I engage with empathy when recounting these cases. Download and subscribe to True Crime Cases with Laney on your favorite podcatcher or head to Truecrime Cases podcast dot com. You won't want to miss an episode. Hi, this is Kelly and this is Jenna. We're the hosts of ODFN. That's why from Murder. Each week we discuss a true crime murder case and intertwine our unique sense of dark humor. Each episode relates to a word starting with the letter D. The stories we tell are serious and true, our opinions are not, but be warned we don't hold back on the details of the case or our inappropriate comments and colorful language. Join

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4:48 Again, that's www. Drink fita dot com slash cause of death for forty percent off your first order of twenty four cans of FAID. Hello and welcome to Cause of Death one hundred seconds to midnight. I'm your host, Jackie Morante. I've worked in research for sixteen years in various capacities. If there's one thing I know about, its infectious disease, and I think all of you should know about it too. It's important that people have a basic understanding of the diseases that affect people, animals, and the environment. I bring these stories to you through the lens of history, education and my personal experiences in the lab. With that, I want to start with a listener letter.

5:48 I love listener letters. Mary sent me an email with a news article attached. The articles said that forty seven percent of people don't say that life will ever get back to normal after the COVID nineteen pandemic. If you listen to the smallpox episodes, the Spanish flu episode, and the polio episode, many of the same things happened that happened during the COVID pandemic. Schools were shut down, social distancing was a thing. People wore masks, They were encouraged to stay home. There was grocery delivery, There were vaccine mandates, and there were travel cards. People had to prove that they were vaccinated before they could travel. During the polio epidemic, no one could leave New York City without proof that they had been vaccinated. As I sit here today.

6:43 The COVID nineteen pandemic has had relatively little long term effect on people. We're no longer wearing masks or social distancing. I haven't had to show my vaccination card in ages. What it comes down to is this, people as a rule are extremely shortsighted. They don't see past next week or maybe next month. They think everything is going to last forever, especially if that thing is something they view as negative. In truth, very few policies surrounding healthcare crises remain permanent. Our society is more concerned with war than public health. This is why nine to eleven caused way more changes to society than COVID nineteen ever will. At the end of the day, we're far more concerned about the cost of rebuilding infrastructure than we are with any sort of human destruction, even though human destruction is priceless. Thank you Mary for sending that in. It was a great article, and maybe there will be an episode on that subject.

7:48 It's something else to add to my list. Now that I've given you that bit of insight, let's get onto today's subjectism. This is the last disease in the restaurant Rogue season. I'll have one more episode in season five on the difference between food poisoning and food toxicity. Then we'll move on to what I think will be my favorite season. Season six will be all about wildlife diseases. It's going to be a rather long season with four wildlife diseases and at least three one hundred seconds to midnight episodes all about how the clock is ticking for wildlife as well as people. We're all connected, my friends, so if one of us goes down, we all go down. That season is going to be called Who's Who Outside of the Zoo. Okay, let's begin where we always begin, with ideology and pathology. Botulism is caused by a gram positive anaerobic spore forming rod in the family Clostridium bachulie. While it can also be caused by C. Baratii or cebutyricum, these are very rare instances. These organisms form spores that are ubiquitous in the environment and are capable of surviving indefinitely through most naturally occurring conditions, as well as boiling and

9:20 other routine cooking practices. People routinely eat bogulism spores, but they rarely become ill. It's only when the spores germinate that the toxin can become dangerous or even fatal. The circumstances have to be just right for the spores to germinate, and the confluence of these events are very very rare. The conditions have to be anaerobic, pH must be lower than four point five. There must be a low salt and sugar content, and temperatures must range between thirty seven degrees fahrenheit or three celsius and ninety nine degrees fahrenheit or thirty seven degrees celsius.

10:05 And even that depends on the serotype of the toxin. The precise lethal dose for bochulynum remains unknown, but these toxins are the most potent biologic toxins known to man. To give a bit of an idea of what we're dealing with here, lethal doses for purified crystalline botulinum toxin type A in a one hundred and fifty four pound man are estimated to be roughly seventy micrograms when induced orally. If the toxin is inhaled, the dose drops significantly to anywhere between point eighty and point ninety micrograms. Again, this isn't something we know for sure it's just an estimate, but that's not a lot of toxin to make someone die. There are seven antigenetically distinct botulinum toxins A, B, C, D, E, F, and G. Most strains produce a single toxin, but there have been strains identified that produced two toxins. Type A is the most potent toxin, followed by types B and F. Types A, B and E are usually associated with systemic botulism and humans. Types C, D and E cause illness in other mammals, birds, and fish.

11:37 All bochulinum toxins have similar structures. They consist of a zinc endopeptidase protein formed by a heavy chain of approximately one hundred thousand daltons and a light chain of approximately fifty thousand daltons. These are linked by a disulfide bond. All serotype interfere with neural transmission by blocking the release of acetal cooline, which is the main neurotransmitter at the neuromuscular junction. Intermuscular administration of botulinum toxin acts at the neuromuscular junction to cause muscle paralysis by inhibiting the release of acetalcholine from presynaptic motor neurons. Bochulinum toxins act at four sites in the body, the neuromuscular junction, the autonomic ganglia, postganglionic parasympathetic nerve endings, and postganglionic sympathetic nerve endings that release acetal coline. The heavy chain of the toxin binds selectively and irreversibly to high affinity receptors at the presynaptic surface of cholinergic neurons, and the toxin receptor complex is taken up into the cell by endocytosis. The disulfide bond between the two chains is cleaved and the toxin escapes into the cytoplasm. The light chain interacts with different proteins in the nerve terminals to prevent fusion of acetocholine vesicles

13:11 with the cell membrane. There are several different kinds of botulism, food born, wound, infant, adult intestinal colonization, inhalation, and injection. About one hundred and ten cases of botulism are reported in the US each year. Of these, approximately twenty five percent are food born, seventy two percent are infant botulism, and the rest are wound botulism. Food born botulism is very serious and potentially fatal. However, it's relatively rare. It's considered a food intoxication that's usually caused by ingestion of neurotoxins that have formed in contaminated food.

14:01 Symptoms of food born botulism begin with marked fatigue, weakness in vertigo, usually followed by blurred vision, dried in mouth, and difficulty swallowing and speaking. Vomiting diarrhea, constipation, and abdominal swelling may also occur. As the disease progresses, there will be weakness in the neck and arms. Then the respiratory muscles and the muscles of the lower body will begin to weaken. Finally, there can be descending flaccid paralysis that can cause respiratory failure. There will be no fever or loss of consciousness. Symptoms will usually appear within twenty four to thirty six hours after exposure. This disease is fatal in five to ten percent of cases. Immediate diagnosis and care are paramount to survival. Machulinum toxin has been found in a variety of foods in including low acid preserved vegetables such as green beans, spinach, mushrooms, and beads, fish including canned tuna, fermented, salted and smoked fish, and meat products such as ham and sausage.

15:16 The big thing is home canning. Most botulism cases come from improperly canned foods. Infant moutulism occurs mostly in infants under six months of age. This occurs when infants ingest the spores, which germinate into bacteria that colonize the gut and release toxins. Because children under six months of age have developing immune systems, they are more susceptible to botulinum toxin. Symptoms include constipation, loss of appetite, weakness, an altered cry, and a loss of head control. There are several sources of infant bautulism, but the most common is honey.

15:58 In recent years, it has been sted that parents shouldn't feed honey to their children before they turn a year old. Wound botulism occurs when the spores get into an open wound and are able to reproduce. Symptoms are similar to food born botulism and may take up to two weeks to appear. This form of botulism has been associated with drug abuse, particularly when injecting black tar heroin. So just don't do that. Ever, inhalation botulism does not occur naturally. You're not going to get it from sniffing flowers. This form is associated with accidental or intentional events which result in the release of the toxins in aerosols.

16:45 This can include acts of bioterrorism. Botulism is on the list of potential bioterrorism sources. The medium lethal dose for people has been estimated at two nanograms of botulinum talk and per kilogram of body weight. This is about three times less than the doses for food boutualism. The symptoms are the same for inhalation botulism as they are for food botulism. Symptoms appear about one to three days after exposure and proceed along the same path as food born intoxication, eventually ending with respiratory failure and muscle paralysis. If inhalation exposure is suspected, additional exposure to others must be prevented. The patient's clothing must be removed immediately and stored in plastic bags until they can be washed thoroughly in soap and water. The patient should shower and be decontaminated immediately. Botulism is often misdiagnosed as stroke, gullium bar syndrome, or myasthenia gravis. Antitoxin should be administered as soon as possible diagnosis. The earlier this is treated, the better the prognosis. Severe cases will include supportive treatment, including mechanical ventilation, which may be required long term.

18:14 There is a vaccine, but it is rarely used because the efficacy has not been proven and it has some very severe side effects. Bachelinum toxin has been used for a variety of medical conditions. People have been using it cosmetically since the late eighties, but it's been prescribed for a variety of medical conditions as well. It has been improved for use in certain cases of overactive bladder, treatment of incontinence, neurogenic detrusor overactivity, chronic migraines, muscle spasms, cervical dystorha axillary hyperhydrosis, strabismus, and disorders of the seventh cranial nerve.

18:57 Off label uses include TMJ disorders, myofascial pain, neurogenic thoracic outlet syndrome, epicondolitis, post stroke pain, post herpetic neuralgia, diabetic neuropathy, trigerminal neuralgia, neuropathic pain, spinal cord injury, and bladder pain. Since batilinum toxin is an acetocholine inhibitor, it does reduce muscle contraction and spasm. Cosmetically, the paralysis of facial muscles temporarily treats wrinkles. Let's face it, folks, You're going to get older, and unless you want to totally paralyze your face, it's going to wrinkle. Contraindications are pretty severe. Muscles can permanently atrophy, Exonal sprouting may begin, and extrajunctional acetocholine receptors can be formed. Reinnervation may also occur, which will reverse the effects of the toxin. If toxicity occurs, the patient will experience neuromuscular weakness, dysphasia, dysphonia, weakness, dyspinia, or respiratory distress. In recent years, there have been several incidences of adverse effects on people who have received botox treatments by unlicensed estheticians. Some of these instances have had irreversible consequences. Okay, we're going to take a

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22:26 It'll be going on from August twenty fifth to the twenty seventh in twenty twenty three. This festival features panel discussions, workshops, live podcasts, all focusing on ethics and advocacy in the true crime sphere. Get your tickets now at www dot Truecrime Podcast Festival dot com and join us in Austin for an unforgettable experience. Don't miss out on the chance to connect with other advocates and take your passion for true crime and paranormal to the next level. Use code Consequences at check out for fifteen percent off the ticket price. That's Truecrime Podcast Festival dot Com with promo code Consequences at checkout for fifteen percent off the ticket price. Special guests will include Julie Murray, Terranewell, and Call your Landry to name a few. I'll be there representing another podcast that I'm involved with, True Consequences. Come by and meet Eric carter Landein and I We would love to meet you. Food born botulism has probably been around since a DNA mankind. The ways that people stored food were perfect for growing sea botulinum, ham stored in barrels of brine, poorly dried and stored, herring trout packed to ferment in willow baskets, sturgeon row not yet salted and piled on heaps of horse hides, lightly smoked fish or ham in poorly heated smoking chambers.

24:02 Then, of course, there are insufficiently boiled blood sausages. There have been ancient dietary laws that could reflect botulism toxicity, going back to the tenth century, when Emperor Leo the sixth of Byzantium banned the manufacture of blood sausage. There have also been some ancient case reports of atropa belladonna intoxication that parallel food born botulism, but the combination of dilated pupils and fatal muscle paralysis can't be attributed to belladonna poisoning. There was a time when shamans would suggest adding just a touch of botulism to the plate of a guest that the maharajas would rather see dead. The Shamans even had a recipe for such a thing. They would take a bit of the powder extracted from blood sausages. This powder would be dried under anaerobic conditions and added to the enemy's food at a banquet.

25:07 Death would occur days after said enemy jested the fatal dose, so no one would be the wiser. In seventeen ninety three, thirteen people were involved in the first well recorded bachulism outbreak in the small German town of Wildbad. Six of these people died at first blush. It was believed that all thirteen had suffered from atropine poisoning, but as scientists tend to do, they argued over it, and the term sausage poisons started getting thrown around the medical experts of the time to blame blunson, which was a popular local food made from cooked pork stomach filled with blood and spices. I'll pass thanks. By the end of the seventeen hundreds, the instances of bachulism increased amatically due to the poverty caused by the Napoleonic Wars. Of course, when there is a critical event that causes people to lose everything they have, infrastructure gets lost. Also, sanitary measures began to decline in rural food production. In July of eighteen o two, the Royal Government of Wootenburg in Stuttgart issued a public warning about the consumption of smoked blood sausages. These outbreaks prompted early research in the cause of the disease. It also prompted the royal government to ban the production of blood

26:37 sausage for a while. In August of eighteen eleven, the medical section of the Department of Internal Affairs of the Kingdom of Wittenburg at Stuttgart again began studying the sausage poisoning problem. At this point they thought it had something to do with hydrocyanic acid, also known as prussic acid. The members of the medical faculty of the University of Tuggingjen disputed that prussic acid could be the culprit. They put the idea forth that this had to be caused by some biological agent. Johann Heinrich Ferdinand Attenrith was a professor at the University of Tubigin He asked the government to collect the reports of doctors and health officers on cases of food poisoning for scientific analysis data data data. I cannot make bricks without clay.

27:40 After Ottenrith studied the reports, he compiled a list of symptoms of sausage poisoning. This list was issued to health officials with the comment that he blamed housewives for the poisoning because they didn't soak the sausages long enough in boiling water. In eighteen fifteen, a health officer in the village of Hahrenberg, J. G. Steinberg, sent reports of seven patients who had gotten botulism from eating liver, sausage and peas. Three of the patients had died so much for soaking blood sausages and boiling water. Justina's Kerner, who was oddly enough a medical officer and a romantic poet. I guess that at least one of those professions would make a decent living, reported a lethal food poisoning from the small village that he was living in at the time. Art and Writhe took the reports of Steinbuch and Kerner into consideration and published both of them in a medical journal called two Binger Papers for Natural Sciences. In eighteen seventeen, Kerner also suspected a biological agent as the cause of food poisoning by sausage. He continued to look into the events, and after observing a few more cases, he wrote a paper in eighteen twenty called New Observations on the lethal poisoning that occurs so frequently in Wurtenburg, owing to the consumption of smoked sausages, in which

29:12 he summarized the case histories of seventy six patients and gave a complete clinical description of what we now call botulism. Kerner compared various recipes and ingredients of the sausages that his seventy six case studies had consumed. He found that the recipes differed in the type of meats, blood, liver, brain, fat, salt, pepper, coriander, pimento, ginger, and bread. The only common ingredients were fat and salt. He ruled out salt and concluded that it had to have something to do with the fat. He later speculated about the connections between what he was now calling fat poison and other known poisons, which as atropine, scopelman, nicotine, and snake venom. Somehow he came to the conclusion that fat poison was a biological poison rather than an acid or other poison. In eighteen twenty two, he published another paper that included one hundred and fifty five case reports, including post mortem studies of patients with botulism.

30:25 He put forth the hypothesis that quote the fat poison or the fatty acid and its effects on the animal body system a contribution to the examination of the substance responsible for the toxicity of bad sausages end quote. He gave a very accurate description of the muscle symptoms and clinical details of the entire range of autonomic disturbances that had occurred in the patients that he had observed. These included mydriasis, decrease of lacrimation and secretion from the salivary glands, and gastro intestinal and bladder paralysis. He experimented on various species of animals by feeding them the extracts of bad sausages, and finally he began to experiment on himself. He found from clinical symptoms that he experienced that the toxin could interrupt the motor and autonomic nervous signal transmission. His conclusions were quote the nerve conduction is brought by the toxin to a condition in which its influence on the chemical processes of life is interrupted.

31:37 The capacity of nerve conduction is interrupted by the toxin in the same way as in electrical conductor by rust end quote. He also listed his findings as one that the toxin develops in bad sausages under anaerobic conditions, two that the toxin acts on the motor nerves and the autonomic nervous system, and three that the toxin is strong and lethal even in small doses. He also postulated that the toxin could be used as a therapeutic agent in cases of quote hyper excitability of the nervous system end quote. He mostly leaned towards treating psychological disorders, but who knew that almost three hundred years later, we would be using boche linum toxin as a cure for several physical disorders. On December fourteenth of eighteen ninety five, a botulism outbreak after a funeral dinner in the small Belgian village of Zelles led to a breakthrough in research. Thirty four people who had attended the lavish funeral celebration of eighty seven year old Antoine Creeteur were struck down by botulism after they ate smoked ham. This led to the discovery of the pathogen

33:07 by Emil Pierre van Irmagem, professor of bacteriology at the University of Ghent. Van Ermagem had worked with Robert Coke in Berlin in eighteen eighty three, and this taught him a thing or two. He isolated the bacterium from the ham and the bodies of the victims. He grew it and he began experimenting on various species of animals. He described the toxin itself and called it Bacillus baculinus. Bodulus is the Latin word for sausage. His observations were published in the Journal of Hygiene and Infectious Disease in eighteen ninety seven. His paper concluded that sausage poisoning was caused by an anaerobic micro organism produced during the salting process.

34:04 He put forth his findings as one, botulism is an intoxication, not an infection. Two, the toxin is produced in food by a bacterium. Three, the toxin is not produced if the salt concentration in the food is high. Four After ingestion, the toxin is not activated by the normal digestive process, five the toxin is susceptible to inactivation by heat, and six not all species of animals are equally susceptible. These findings would springboard further research into the causes and effects of botulism for years to come. In nineteen o four, an outbreak of botulism occurred after several people in the city of Darmstadt, Germany, consumed white beans. This led to the realization that there was more than one stereotype of botulism. The present letter designations would be assigned in nineteen nineteen by Georgina Burke. Commercial canning processes would change after an outbreak of baculism occurred in nineteen o six. Commercially canned pork and beans was the culprit in that instance, and it would spur food manufacturers to lower the pH to below four and heating requirements would change to prevent the toxin from growing. Type C would

35:40 be found in nineteen twenty two by Bankston in the US and in Australia by Seton. Type D would be discovered in the US by Meyer and Gunnison, and type E would be found in Ukraine in nineteen thirty six by Bier. Type F was ident fight in Scandinavia by Muller and Scheibel in nineteen sixty and finally type G was discovered in nineteen seventy in Argentina by GMx and Ciccarelli. In nineteen forty nine, Virgin and his colleagues found that Baculinum toxum blocked the release of acetacoli neuromuscular junctions. Therapeutic research began in the nineteen seventies and has continued ever since. I'm going to add an episode on bacteria as therapeutic agents in my never ending list of things to talk about, but it may be a while before I get to it. For now, that's botulism. Next time, I'll talk about the differences between food poisoning and food intoxication, and that will wrap up season five on The Restaurant Rogues. The beginning of season six will kick off with my podversary episode. I've been at this for two years and I've got a very special episode coming up that I hope will spark some conversation and debate on my socials. If you'd like to get in touch

37:15 with me, you can email me at Jackie at Cause of Death one hundred secs dot net, or leave a message on my website at www cause of Death one hundred sex dot net. Please check the show notes for all of my social media platforms and ways that you can get involved with my Facebook page, my Facebook group, my Twitter feed, and my TikTok. There are several ways to support the show. You can leave a rating and review on Apple Podcasts, you can subscribe to this podcast wherever you're listening now, and most importantly, you can share this podcast with everyone you know. If you'd like to support the show monetarily, please check out my Patreon page or subscribe on Apple subscriptions, and don't forget to support my sponsors. Don't forget to check the show notes for links to all my amazing sponsors and the discount codes.

38:15 Thank you all for listening, and special thanks to all that have subscribed on Apple subscriptions. I can't call you out by name unfortunately, but you know who you are. Your support means the world to me. Until next time, keep the pH of your sausage below four and I'll see you in two weeks