Botulism is a serious illness caused by Botulinum toxin. It is a foodborne disease and can cause paralysis partially or entirely and can also be fatal. In this article, we discuss botulism from drinking prison-made illicit alcohol.
Botulism is caused by a special type of bacteria known as Clostridium Botulinum. It releases neurotoxin, which is a poison for the nerves and attacks the nervous system. This bacterium usually thrives in conditions where there is no oxygen. Canned foods and vegetables are potent grounds for these bacteria to grow. Paralysis starts from the hands to the limbs and then to the rest of the body. If the bacteria reach the respiratory system, it can cause respiratory failure and even death.
Foodborne botulism is caused by the botulinum toxin produced by Clostridium botulinum and sometimes Clostridium butyricum and Clostridium baratii bacteria, which spreads through food and other drinkable products. Botulism is a rare but serious case where the toxins attack the body’s nerve. It can cause difficulty in breathing, muscle paralysis, drooping eyelids, double vision or blurred vision, difficulty swallowing, slurred speech, dry mouth, along with muscle weakness and even death. The symptoms of botulism are highly variable and grow rapidly. Here, we will look at botulism from drinking prison-made alcohol and discuss a case related to it.
Botulism from Drinking Prison-Made Illicit Alcohol
In October 2011, eight security inmates in Utah prison were diagnosed with foodborne Botulism.1 An investigation conducted by the Salt Lake Valley Health Department, the Utah Department of Health and the CDC found out that Pruno, a form of illicit alcohol is the main cause. The main ingredients of Pruno were fruits, sugar, and water but depending on the availability in the prison, there were some additional ingredients as well. Baked potato served several weeks ago was added to this Pruno which was identified as the main carrier of the Clostridium Botulinum bacteria. The affected inmates experienced severe condition and some of them even suffered prolonged hospitalization.
Considering botulism from drinking prison-made illicit alcohol is important to prevent such occurrences. This investigation will help the public health sector determine the connection between promo and botulism and will also enable them to correct and prevent future outbreaks.
In November 2017, pruno, an alcoholic beverage, which is typically made by fermenting fruit and sugar in water along with potato, corn, bed, rice affected 8 prisoners with symptoms of cranial nerve palsies and weakness, dysphagia or impaired gag reflex.2 Their serum samples were tested and reported positive with botulinum toxin. Because of respiratory muscle paralysis, the patients were intubated for 11-14 days before receiving tracheostomies. 31 prisoners from a prison in Mississippi were sickened last year and 24 required hospitalization after drinking a beverage known as “pruno” or “hooch”. In 1978, 34 cases of botulism were linked to bean or potato salad from country club in New Mexico, which is considered as the largest botulism outbreak in the US. Most of the prisoners reported that they had never heard of the term botulism and were unaware of its causes.
Botulism from drinking prison-made illicit alcohol is surely a concern but botulism occurring from any contaminated food or drink can be dangerous Appropriate investigations and diagnosis, timely treatment and hospitalization, are important.
Signs of Botulism Among The Prisoners
It is important to understand the signs seeing in people with botulism from drinking prison-made illicit alcohol. The patients showed signs of double vision, dysphagia, impaired gag reflex, weakness, and vomiting. The patients who admitted drinking Pruno were transferred to the neuro-critical care unit of the hospital and were treated accordingly. The hospitalized patients showed signs of Botulism 37 hours after their consumption of the brew. The patients were placed under medical observation for 24 hours. The minimum hospital stay ranged from 2-23 days while the time spent in non-prison healthcare centers ranged from 2-58 days. All patients were given Heptavalent Botulinum Anti-toxin. This drug was overviewed without any adverse side effects. The patients were examined in the prison infirmary after their hospital discharge. According to the medical examiner, the patients showed clinical complaints even after 11 months of the consumption of alcohol. Symptoms included weakness, loss of muscle mass, dysphagia and reflux. No deaths were reported but patients still showed signs of sleeping difficulty, increased anxiety and depression. These side effects were not too significant and neither consistent.
Treatment of Botulism in Prisoners
Doctors treat botulism by a drug known as an antitoxin. Though it does not heal the condition all of a sudden breakout it prevents the bacteria from causing further damage. The delay in providing antitoxin can degrade the condition of the patient as there is no continual production of toxins after the initial consumption. The patient is kept under treatment in the hospital for a term of period depending on the seriousness of the symptoms. A thorough neurological examination is a must for the patients showing symptoms as the stool examination may not be enough and it takes days to show a report which may delay the patient’s treatment increasing the toxic pile in the body.
The health department and correctional facilities should provide awareness about prison-made illicit alcohol and botulism and its effects. Prison health care providers should notify the health department if they find any suspicion of consuming pruno and the spread of botulism. Prisoners have reported that pruno is widely used in correctional units and is an essential part of the prison culture. The consumption of pruno can be reduced by educating the prisoners about it, however, it is difficult to prevent its production.
Symptoms of Botulism
In foodborne botulism, signs normally occur 18-36 hours after the consumption of the contaminated food or drink. The symptoms include:
- Abdominal Distention
- Drooping eyelids
- Double or blurred vision
- Difficulty swallowing
- Shortness of speech
- Slurred speech
- Poor muscle tone
- Poor feeding
- Weak cry
- Facial weakness.
Risks of Botulism
Botulism can cause severe risks but it is not contagious. It cannot spread from one person to another. Possible risks include long term breathing problems and respiratory failure, which can be fatal. Patients with severe symptoms might need a breathing machine or some intensive care which might last for several years. Fatigue and shortness of breath can last for many years. Fatal illnesses may develop in a patient depending on their condition. A paralyzed patient might recover from botulism with the help of anti-toxins, but certain damages of functions may not be altered.
Diagnosis of Botulism
Signs and symptoms of botulism are quite visible and evident but the doctors still run certain tests to rule out any other medical conditions. These include
- Physical examination to look for signs such as muscle weakness, weak voice or drooping eyelids.
- History taking about the consumption of food and drink.
- Reports of lab tests for stool and blood identification to confirm the signs of Botulism.
The symptoms of botulism are similar to that of a stroke and immune attacks so the test might take a few days to present the appropriate results.
Some other advanced investigations may include
- A brain scan.
- Cerebrospinal fluid examination.
- Edrophonium Chloride test.
Prevention of Botulism
Botulism can be prevented by staying away from contaminated food and brews. In prison, it is very important not to store food or drink for several days. This is because of the lack of ventilation in the prison cells can allow the botulism bacteria to breed. Pruno should be banned and the prisoners should be thoroughly checked to find out any such possession.
Some general measures to prevent botulism include:
- It is important to maintain proper hygiene.
- Extreme temperatures can kill botulism bacteria. So canned food should be boiled for 10 minutes before eating.
- Proper refrigeration can also prevent the growth of bacteria.
- The baked potatoes should be kept in a foil for as long as they are hot.
The preventive measure is really difficult to follow in prison. So the prison officials and medical personnel need to do a routine check-up of their prisoners to take care of their health and rule out any possible consumption of contaminated food or drink. This way botulism from drinking prison-made illicit alcohol can be prevented.
Effects of Botulism
The patients are never entirely cured of Botulism. Some long term effects are always seen. Some of the effects include:
- Dry mouth.
- Difficulty performing the strenuous task.
- Patients have also reported the loss of a happy and peaceful life.
Is Botulism Fatal?
Botulism can be fatal if not treated well or left untreated. This is why it is important to consult a doctor. Doctors use a wide range of treatments to remove botulism toxins from the body. Most commonly anti-toxins are prescribed to neutralize the effects of botulism toxins in the body. Some people might also need hospitalization and ventilators to cure respiratory problems. For any side effects after the treatment of botulism, it is best to seek advice from a doctor.
This was an important case of botulism from drinking prison-made illicit alcohol. The association between botulism and Pruno is not common hence these cases remain unrecognized. Botulism is a rare but serious illness. It is possibly life-threatening and paralytic. Hence, it is necessary to take all precautions to prevent botulism.
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