Home-canned food kills Argentinean man: Botulism in food causing deaths for over 1000 years

Mrs. Kalisz, my grade 7 and 8 family studies teacher warned of the dangers of botulism by showing our class a bulging can of beans (which she kept in a ziplock bag). What I took away from that story was to never buy or use dented cans (although that practice can be debated). Botulism from commercially canned foods has been pretty rare in North America since the 1970s with only a couple of cases in 40+ years.pickled.onion

The first case of food-related botulism recorded in the medical literature occurred in Germany in 1735 and was traced to uncooked fermented blood sausage. Food safety history guru (and pretty decent margarita recipe developer) Carl Custer pointed out in an IAFP workshop that botulism concerns (and regulatory responses) go back further than that. In the 10th century, Emperor Leo VI of Byzantium prohibited the manufacture of blood sausage because of repeated illnesses leaving folks paralyzed and dying not too long after exposure. Botulism (derived from botulus, the latin word for sausage) is pretty nasty.

In 2002, a Meaford, Ontario man fell ill with botulism after eating a toxin-containing baked potato from a local restaurant. A 35-year old father of two was still on life support two months later. Potatoes wrapped in tinfoil, baked, and then held at room temperature can create the perfect conditions for Clostridium botulinum problems.

The spores, found fairly commonly in soil, germinate and outgrow in anaerobic conditions (like partially-fermented sausages, under processed canned food, seafood and foil-wrapped baked potatoes) resulting in vegetative cells. A byproduct of the cells’ multiplication is the toxin.

Although the memorable outbreaks are linked to commercial food, the most common source of botulism in North America is improperly canned home preserves, usually from low acid foods being placed into a jar and then heating enough to seal –  but not enough to inactivate the C. botulinum spores. A few weeks ago Doug asked me for a recipe for acidified pickled onions which he wanted to keep refrigerated to control pathogen growth instead of messing with processing (right, exactly as shown). In 2012, a few unlucky folks attending a Oregon family gathering ate some beets that had been boiling-water-bathed, reaching just 212F instead of the needed 240F.

According to Diario Uno, 69 year-old Argentinean man died of botulism on March 10, 2013 after reportedly consuming home canned foods,

The man arrived at the hospital on Wed 6 Mar 2013, with acute pain; his condition deteriorated and he was admitted in the intensive care unit, where he died on Sun 10 Mar 2013. During the time of admission”different doctors treated him and carried out all possible diagnostic tests, arriving at a diagnosis of botulism for which the patient received treatment.” Dr Pedro Farran said, “Home canning is very common in our area; the problem is not in the food preparation but in its improper canning. Even marinades with low content of vinegar can transmit the disease.”

Honey is a risky food for infants

I didn’t know much about infant botulism until a call came into the toll-free line that was run out of our Guelph lab. The inquirer wanted to know what the risk of a less-than-one year old kid acquiring botulism from cereal like honey nut cheerios was. After having two kids I now know that Cheerios are often one of the first introduced solid foods – but this was back in my grad school days when babies were an unknown to me.

I was sitting close to Sarah Wilson, then infocenter manager extrordinare, when the call came in and we chatted about cereal processing and whether the baking process would inactivate C. botulinum spores. Spores, a dormant-but-protected state that some bacterial cells resort to when stressed, are tough to address because they are pretty heat-stable. 1x1_breakfast_for_sixOnce the spores get into the digestive system of an infant, which hasn’t fully developed and has a gastric pH higher than 4.6, they can germinate and outgrow. The result is a cell that multiplies and secretes a toxin as a byproduct. The rub, for the honey industry is that consumption is a factor in almost all infant botulism cases. There is also some evidence that infant botulism may be a risk factor for SIDS.

The literature wasn’t much help on the cereal question – we knew that 240-250F was necessary to inactivate the spores but didn’t know what the honey processing/cereal baking situation was. We called a couple of processors’ customer service folks and the response we got was that the incoming honey could be contaminated and that the processing likely wouldn’t reduce the risk. Who knows whether this is evidence-based or not. If the cereal companies are addressing this risk somehow they should share that info.

Public health folks like the CDC in the U.S. and recently Health Canada suggest that honey is an avoidable source of C. botulinum spores and have warned against honey and honey-product consumption for infants. The honey industry’s best practices include labeling warning parents about risks.

Tragic stories around infant botulism still have popped up over the past couple of years.
In Philadelphia Infant Amanda Zakrzewski was diagnosed with infant botulism and had to undergo 9 days of antitoxin treatment in hospital. Amanda wouldn’t eat, her eyes glassed over and she wasn’t able to suckle due to the paralysis the botulinum outgrowth caused. The result was months of rehab.

In 2011, 16-week-old Logan Douglas was temporarily blinded and paralyzed from infant botulism. He fully recovered after six months, but at one point the illness was so severe that doctors had discussed turning off life support systems as the toxin was attacking his body. His mother revealed following the incident that she had fed Logan honey.

I can’t imagine what the parents of a 5-month old in Colorado are going through right now. According to the San Francisco Chronicle,

Keona Hinkel has been on a breathing machine at the Rocky Mountain Hospital for Children for two weeks, but she’s improving.Doctors think indirect honey exposure or contaminated soil from a home under renovation may have sickened Keona.
She wasn’t fed honey but mother Kari Hinkel said that she cooked with honey. It’s possible she touched her daughter with it or it got on her pacifier.

No honey for kids under 1; preventing botulism in infants

Logan Douglas was temporarily blinded and paralyzed as the botulism he contracted at 16-weeks-old ravaged his body.

Six months after his parents, Theresa Fitzpatrick and Alex Douglas, were faced with the decision of whether to turn off his life support as baffled medics feared the worst, Logan is doing great (right, photo from The Sun).

When a limp and ill Logan was first taken to physicians, he was admitted to hospital and, after a battery of tests, a Glasgow-based doctor ordered a test for infantile botulism for Logan.

Devastated Theresa has revealed she still blamed herself after feeding her baby honey. 
She wasn’t aware that the food wasn’t suitable for children so young.

Health Canada is advising parents and caregivers not to feed honey to infants less than one year of age. Honey is the only food in Canada to which infant botulism has been linked. Healthy children over one year of age can safely eat honey because they have a very low risk of developing infant botulism.

Infant botulism is caused by bacteria called Clostridium botulinum, which commonly exist in nature. Although the bacteria are unable to grow and produce toxins in honey, they may grow and produce toxins in the baby’s body should an infant consume honey and could cause paralysis.

Since the first reported case in 1979, there have been 42 reported cases of infant botulism in Canada. Parents and caregivers can prevent infant botulism by never feeding honey to infants less than one year of age. This includes never adding honey to baby food and never using honey on a soother.

Most honey produced in Canada is not contaminated with the bacteria that cause infant botulism, however you are better off playing it safe.

The bacteria that cause botulism are microscopic and do not change the colour, odour or taste of food. The bacteria are not destroyed by cooking or pasteurization.

7 inmates stricken with botulism from homemade hooch

There are lots of ways to get contraband into prisons: with open visitation, the long kiss with a balloon full of whatever seemed popular; with closed access, the cigarette butt stuffed with goodies; or bribe a guard.

But those didn’t involve botulism.

For those who worked in the kitchen, homemade alcohol of some sort in various contraptions was convenient: fun with fermentations. But, things can go wrong (which is probably why they’re in prison).

CBS5 reports seven inmates are suspected of getting botulism from prisoner-made alcohol over the weekend in the Special Management Unit 1 on the Arizona State Prison Complex Eyman in Florence.

Starting Saturday four inmates were hospitalized because of severe illness, they are now undergoing treatment. A fifth man arrived late Saturday and two sick inmates arrived before noon Sunday. All seven inmates are now in the intensive care unit.

It is suspected that the inmates may have contracted the botulism poisoning from “hooch,” a prison homemade alcohol, that is made from fermented fruit. Samples of the hooch were sent for testing and officials are still waiting on the lab results for confirmation.

Botulism risk in Ontario pumpkin butter

The Canadian Food Inspection Agency (CFIA) and Birtch Farms and Estate Winery are warning the public not to consume the Birtch Farms and Estate Winery brand Pumpkin Butter because it may be contaminated with Clostridium botulinum. Toxins produced by these bacteria may cause botulism, a life-threatening illness.

The affected product, Birtch Farms and Estate Winery brand Pumpkin Butter, was sold in 110 ml and 250 ml jars. All lot codes are affected by this alert.

This product has been distributed in Ontario.

There have been no reported illnesses associated with the consumption of this product.

Protein Shots recalled for possible botulism risk

On August 17, 2012, Protica Inc. of Whitehall, PA had undertaken a voluntary product withdrawal of four products including Body Choice "Protein Shots", Nutritional Resources "Protein Wave", ProBalance "Protein to Go French Vanilla Latte" and "Protein to Go Milk Chocolate Shake" because they have the potential to be contaminated with Clostridium botulinum.

Consumers are warned not to use the product even if it does not look or smell spoiled. Botulism, a potentially fatal form of food poisoning, can cause the following symptoms: general weakness, dizziness, double-vision and trouble with speaking or swallowing.

No illnesses have been confirmed to date.

The problem with the lots below were discovered when investigating the processing parameters for all manufactured products. The products withdrawn were distributed nationally through retail and direct mail and are limited to specific lots of the branded products.

7TH Heaven Gourmet spreads sold at CA farmers’ markets recalled due to botulism risk

Lots of people make great-tasting homemade foods like dips, pickles or salsa. But, just like opening a restaurant isn’t as simple as throwing good dinner parties, moving a good product into commercial production takes a lot of work – including recognizing hazards and controlling them.

To reduce risks to business and brand damage, food retailers usually place a lot of requirements in place for suppliers prior to carrying their products – things like proof of inspection, a validated process, visits to the processor and insurance. These precautions don’t eliminate problems but are an indicator that a retailer is paying attention.

While requirements like these are anecdotally reported at some farmers’ markets, the same level of vendor verification isn’t always in place.

One of the ultimate truths in food safety is that putting low acid foods in a jar and sealing them without either acidifying (with vinegar/fermentation) or processing correctly is a bad idea. Correctly means that someone has validated the process and the operator knows how to verify that their procedure works every time.

In June 2012, the California Department of Public Health (CDPH) urged people to avoid and dispose of One Gun Ranch and Organic Soup Kitchen soups sold at farmers markets in California because they potentially contained botulinum toxin. The vendors involved were quoted as saying they didn’t know the rules (or the risks). Although none of the products tested positive for the toxin (fortunately), the process/procedure to limit the germination of Clostridium botulinum and toxin outgrowth wasn’t validated by anyone.

CDPH is yet again warning patrons of a couple of California farmers markets to avoid a vendor’s wares (those produced by 7TH Heaven Gourmet) for the same reason – lack of validated processing.

No illnesses have been linked to any of the affected products at this time.

7th Heaven Gourmet of Hesperia, California is voluntarily recalling the following varieties of spreads: Pate Mediterraneo and Eggplant & Shitake Tapenade.  These products were sold under the 7th Heaven Gourmet label and packaged in 8 ounce, glass jars with screw-on metal lids.  These food products lack production or date codes.  Photos of affected products may be obtained HERE.

7th Heaven Gourmet jarred spreads were available for purchase between September 2011 and July 2012, and only sold at the following Farmer’s Markets:

• Victorville Farmers Market (Victor Valley College) 18422 Bear Valley Rd, Victorville, CA

• Victoria Garden Farmers Market, 12505 North Mainstreet, Rancho Cucamonga, CA

Consumers in possession of the recalled products should discard them in the trash.
 

Unsolved Mysteries: Three Botulism cases linked to korma sauce in 2011 outbreak

In the world of food safety risks botulism ranks high – while the probability of illness is low, the consequences are pretty dire. Paralysis (often leading to a ventilator) and potentially months of recovery.

Or death.

In November 2011, three kids from the same Scottish family became ill with botulism after eating from a jar of commercially-produced korma sauce. Health Protection Scotland released their report on the outbreak with no concrete answers as to what led to the illnesses: in-home contamination was unlikely, no other illnesses were linked to the product and the processing facility/supply chain controls checked out.

Executive summary of the report is below:

An outbreak of food-borne botulism in Scotland, November 2011

Health Protection Scotland


On Tuesday 8 November 2011, a 5 year old boy was admitted to Forth Valley Royal Hospital (FVRH), NHS Forth Valley (FV) with a history of transient double vision commencing on Monday 7 November, followed by a sore mouth and lower limb weakness. 

On Wednesday 9 November, after a deterioration in his condition he was ventilated and transferred to the Royal  Hospital for Sick Children (RHSC) Yorkhill.  At the time of his transfer the most likely diagnosis was thought to be Guillain-Barré syndrome.

Also on Wednesday 9 November, the boy’s 7 year old sister was admitted to FVRH with similar symptoms and the same date of onset.  Botulism was now considered a possible though unlikely diagnosis.  Later that evening the 7 year old sister was also transferred to RHSC, and ventilated.  By late evening the suspicion of the diagnosis of botulism was sufficiently strong to warrant the obtaining of trivalent botulinum antitoxin which was administered to both children, after which their condition stabilized.

At around 11pm, RHSC informed the Health Protection Agency (HPA) as well as NHS Greater Glasgow  and Clyde (GG&C) Consultant in Public Health Medicine (CPHM) who undertook an interview with the parents of the affected children.  HPA informed Health  Protection Scotland (HPS) who again informed NHS GG&C and NHS FV HPTs.

On the morning of Thursday 10  November, NHS FV HPT convened a Problem Assessment Group (PAG).   On the afternoon of Thursday 10 November, NHS FV HPT and Stirling Council (SC) Environmental Health Officers (EHOs) undertook an in-depth interview with the father of the children and collected food related specimens.

On Friday 11 November the HPA alerted the competent public health authorities throughout the European Union (EU) via the Early Warning and Response System (EWRS).

On Sunday 13 November, following  epidemiological,  environmental, microbiological and toxicological investigations, a jar of commercially produced korma sauce was identified as the vehicle of intoxication and the UK Food Standards Agency (FSA) took immediate action to withdraw the potentially affected batch from the  supply chain and retail market and informed the European Commission (EC) via the Rapid Alert System for Food and Feed (RASFF).  The FSA also alerted  the public to the potential risks from consumption of sauce from jars of korma sauce from the same batch.

HPS alerted clinicians in Scotland to the incident, reminding them of the early signs and symptoms of botulism.

Five days later, on Monday 14 November 2011, a third (female) sibling aged 3.5 years became unwell and  deteriorated over the course of the following day, choking whilst trying to swallow liquids.  This child was admitted to RHSC on Wednesday 16 November with a diagnosis of suspected botulism. 

SC EHOs’ detailed inspection and history-taking identified no evidence that the jar of korma sauce had been contaminated in the family’s home.  Despite the FSA’s intensive investigations at the production facility and the product’s supply chain, no faults were identified  to explain the contamination.  No evidence suggested that any jar, other than the one purchased by the affected family, had been contaminated.

The incident was closed at an Incident Management Team (IMT) meeting on Tuesday 6 December 2011.  All three children have recovered.

Click here for the report.

There was this one time, when I was in jail; 4 Arizona inmates hospitalized; botulism from homemade alcohol suspected

Being in jail is a training school for how to get away with stuff.

I did 6 weeks dead time between conviction and sentencing in 1981 at the local jail – the equivalent of maximum security — and saw drugs enter daily. Since any visits were behind Plexiglas, the preferred method was via the exercise yard – we got 30 minutes a day in a small basketball-sized court surrounded by 20 feet of brick and topped with razor wire. People on the outside would flick half a cigarette, with the tobacco removed and filled with hashish, over the wall so it looked like another discarded butt.

At the minimum security institution, where visits involved contact, the preferred method was a long kiss and a balloon full of pills. I was just happy with some contact (thank you, Alison).

But, even wise guys can get it wrong.

The Arizona Republic reports that four state prison inmates were hospitalized with suspected botulism poisoning Friday after apparently drinking homemade prison alcohol,.

Three were reported in stable condition Friday night. The condition of the fourth was not known late Friday.

All four inmates had been housed in the maximum-security Eyman complex in Florence.

"It’s not an airborne illness," said Pinal County spokeswoman Heather Murphy. "It has to be ingested or injected. We cannot confirm it at this time, but we believe it to be contraband prisoner-made alcohol."

In some cases, inmates use fruit and bread from their food trays to ferment an alcohol concoction.

Barfield said that she once found about two gallons of homemade alcohol in a garbage bag.

"It’s that easy," Barfield said.

But because the smell is so overpowering, corrections officers can easily detect the contraband, which is flushed down the toilet, she said.

In 2011, 12 inmates at the Utah State Prison in Draper developed botulism after drinking a concoction made from fruit, potatoes, bread, water and sugar.

In 2004, four California inmates were hospitalized after contracting botulism from a two-gallon batch of prison-made alcohol.

New Food Safety Infosheet: Home-canned beets in Oregon linked to three botulism hospitalizations

Three folks who attended a private bbq in Oregon earlier this month ate some home-canned beets that had not been acidified or processed sufficiently and ended up with botulism.  Putting low acid foods in a jar and sealing them without either acidifying (with vinegar/fermentation) or processing using pressure is a bad idea – it creates the ideal enviroment for botulism toxin formation. And botulism is pretty devastating, often resulting in paralysis and a long-term recovery period.

Below is the infosheet and highlights:

– Storing low-acid foods in a jar and sealing them without either acidifying or processing using pressure creates the ideal conditions for toxin formation.

– Tested recipes and directions for safe canning can be found at the National Center for Home Food Preservation:
nchfp.uga.edu.

– In 1977, 59 patrons of a Detroit Mexican restaurant became ill with botulism after consuming improperly canned peppers after restaurant staff put lightly-cooked peppers and water in jars and sealed them.

– Low acid foods (pH greater than 4.6) like beets cannot be safely canned using a boiling water bath unless acidified according to a tested recipe.

Click here to download.