Botulism cases in U.S. linked to Carrot Juice

Two out of the four cases of Botulism reported in the U.S. are being linked with the consumption of carrot juice, which was consumed by the patients a week before the illness.

Dr. Elizabeth Rea, associate medical officer said that three patients were suspected of having taken ill due to the toxic juice, but one case has been winnowed out.

Botulism is a rare but serious paralytic illness caused by a nerve toxin, botulin, which is produced by the bacterium Clostridium botulinum. Botulin is a potent known toxin, blocking nerve function and leading to respiratory and musculoskeletal paralysis.

All forms of botulism can be fatal and are considered medical emergencies. Food borne botulism can be especially dangerous as a public health problem because many people can be poisoned from a single contaminated food source.

Rea said that both the patients are in a very serious condition but it has not been confirmed whether they have paralysis.

The cases resulted from the ingestion of carrot juice produced by Bolthouse Farms in Bakersfield, California, which distributes the juice to the U.S., Canada and Mexico.

Rea explained that the symptoms of food borne botulism occur between 18-36 hours after consuming the botulinum toxin, but they can occur as early as 6 hours or as late as 10 days. Symptoms usually include dry mouth, difficulty in swallowing, slurred speech, muscle weakness, double vision, vomiting, and sometimes diarrhea. These symptoms may progress to cause paralytic ileus with severe constipation, and eventually body paralysis. The respiratory muscles are affected as well, which may cause death due to respiratory failure.

She added that an anti-toxin can reverse the effect if administered early enough.

"People have a decent chance to recover but it can take months," she said. "If they make it off the ventilator they have a decent chance, but it does take months."

Davendra Sharma, food safety and recall officer for the Canadian Food Inspection Agency, said that on September 30, 2006, Bolthouse recollected its Carrot Juice, Earthbound Farm Organic Carrot Juice and President's Choice Organics 100 % Pure with a best-before date of November 11, 2006.

After the cases were reported in the city, Toronto Public Health and the Canadian Food Inspection Agency have called for an alert.

Some tests of the patients are pending, which will confirm if the symptoms were caused due to carrot juice produced in the U.S.

Toronto Public Health are looking into the patient’s possible exposure to botulism, however Rea explained this was not extraordinary. "Botulism lives in the soil and it's a relatively common soil bacteria so it's not such a bizarre thing for botulism spores to be on carrots," she said. "That's why it's important to scrub root vegetables."

The source of food borne botulism is often home-canned foods that are low in acid, such as green beans, corn, beets, carrots, mushrooms and asparagus, she said.

In the United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are food borne, 72% are infant botulism, caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin and 3% are wound botulism, which is caused by toxin produced from a wound infected with Clostridium botulinum.

Outbreaks of food borne botulism involving two or more persons occur during most years and usually are caused by eating contaminated home-canned foods. The number of cases of food borne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black tar heroin, especially in California.