How does botulinum toxin enter the body?

Botulinum toxin can enter the body through food consumption, open wounds, or even infant formula.

Botulinum is an extremely potent neurotoxin. Once inside the body, it binds tightly to nerves, causing complete muscle paralysis. A characteristic feature of botulinum-induced paralysis is flaccid paralysis, symmetrical on both sides, radiating from the head down to the feet. Severe paralysis can lead to respiratory failure and death.

According to Dr. Nguyen Trung Nguyen, Director of the Poison Control Center at Bach Mai Hospital, the most common type of poisoning is through food and drink , commonly known as food poisoning. Most botulinum poisoning cases recently have occurred after consuming contaminated food, such as vegetarian pate (in 2020), pickled fish (March 2023), and suspected cases of eating Vietnamese pork sausage (May 2023 - cause yet to be determined).

Packaged meat, vegetables, fruits, and seafood can all be contaminated with toxins. For example, in Thailand, there have been cases of botulinum poisoning from eating canned bamboo shoots, while China has recorded cases of poisoning after eating fermented beans.

Clostridium botulinum bacteria are abundant in the environment in the form of encapsulated spores, can be found in many types of food ingredients, and can withstand normal cooking temperatures.

Bacteria are anaerobic, meaning they only grow in an oxygen-deficient environment and cannot thrive in acidic (pH < 4.6) or salty (salt concentration > 5%). Therefore, food contaminated with bacterial spores due to unsanitary production processes, or food packaged in airtight containers such as bottles, jars, cans, or bags without sufficient acidity or salt content, creates conditions conducive to bacterial growth and botulinum toxin production.

According to Dr. Nguyen, Vietnam has also recorded cases of botulinum poisoning in breastfed infants . Two years ago, a baby treated at the National Children's Hospital presented with paralysis symptoms that were mistaken for encephalitis. Upon investigating the case, doctors determined the baby had botulinum poisoning, likely caused by spores from the environment, such as dust or dirty bottles, contaminating the baby's milk.

The digestive tract of infants under 12 months old, especially during the first 6 months, is not yet fully developed and lacks sufficient beneficial bacteria to counteract harmful bacteria in the gut. If infants are fed formula too early, in unclean environments, some spores may contaminate the formula and food. At this time, these spores "mature" in the infant's digestive tract, producing toxins and causing poisoning.

"Even more dangerous is that many children infected with botulinum toxin are easily mistaken for having encephalitis, respiratory failure, or pneumonia because the symptoms are similar," Dr. Nguyen said, recommending breastfeeding. If a child must be fed formula, ensure a clean environment and sterile utensils for preparing the formula.

Another form of botulinum toxin poisoning is through wounds. People with wounds from work accidents, traffic accidents, or daily life activities can be exposed to spores from the environment, which will develop and produce toxins. "There are as many cases of tetanus as there are cases of botulinum infection, because bacteria of the same family behave similarly," Dr. Nguyen explained.

Therefore, to prevent this type of poisoning, people need to follow the principles of initial first aid, cleaning, and then treating and caring for the wound as directed by a doctor.

Additionally, another form of botulinum poisoning is due to national security terrorism involving biological weapons, but this is rare.

Botulinum toxin antitoxin (BAT - Botulism Antitoxin Heptavalent), priced at $8,000 per vial, is very rare in Vietnam. Photo: Provided by the hospital. — Botulinum toxin antitoxin (BAT - Botulism Antitoxin Heptavalent), priced at $8,000 per vial, is very rare in Vietnam. Photo: *Provided by the hospital* .

Recently, there have been a series of botulinum poisoning incidents. Most recently, five people in Thu Duc City were poisoned by botulinum toxin after eating street-sold pork sausage, and one person after eating fermented fish sauce. This disease requires an antidote within 72 hours of poisoning. At that time, Vietnam only had two vials of the BAT antidote, which were administered to three children. The remaining three could only receive symptomatic treatment. A week later, the person who ate the fermented fish sauce died before receiving the antidote donated by the World Health Organization (WHO); the other two died after the "golden time" for treatment and were almost completely paralyzed.

Le Nga

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