Portal latinoamericano de toxicología
Four state prison inmates were hospitalized with suspected botulism poisoning in Arizona
8 August, 2012
4 Arizona inmates hospitalized; botulism from homemade alcohol suspected. By Cecilia Chan. azcentral.com. Aug. 3, 2012.Four state prison inmates were hospitalized with suspected botulism poisoning Friday after apparently drinking homemade prison alcohol, authorities said.Three were reported in stable condition Friday night. The condition of the fourth was not known late Friday.
Clostridium botulinum
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."
Botulism is a rare but serious illness caused by a nerve toxin and is sometimes fatal, according to the Centers for Disease Control and Prevention.
Left untreated, botulism can lead to generalized weakness, difficulty breathing and paralysis.
Murphy said the inmates would be treated with an anti-toxin that the CDC released to the state Department of Health Services.
"They will be treated very, very shortly," Murphy said. "This proactive treatment can shorten the recovery time. We know with the release of the anti-toxin we stand a good chance of recovery."
She said officials are monitoring the health of the other inmates in the same pod but are fairly confident no one else would be affected.
Corrections Officer Michelle Barfield said contraband alcohol is not unusual.
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.
This is not the first time that prison inmates have been diagnosed with botulism following what is suspected to be an attempt at making homemade alcohol.
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.
Communicated by: ProMED-mail
[One form of prison-brewed alcohol is pruno. Pruno, or prison wine, (http://en.wikipedia.org/wiki/Pruno) is an alcoholic liquid variously made from apples, oranges, fruit cocktail, ketchup, sugar, and possibly other ingredients, including crumbled bread. Bread provides the yeast for the pruno to ferment. Pruno originated in (and remains largely confined to) prisons and jails, where it can be produced cheaply, easily, and discreetly. The concoction can be made using only a plastic bag, hot running water, and a towel or sock to conceal the pulp during fermentation. The end result has been colorfully described as a "vomit-flavored wine-cooler," although flavor is often not the primary objective. Depending on the time spent fermenting, the sugar content, and the quality of the ingredients and preparation, pruno’s alcohol content by volume can range from as low as 2 percent (equivalent to a very weak beer) to as high as 14 percent (equivalent to a strong wine).
The following is from Vugia DJ, Mase SR, Cole B, et al: Botulism from drinking pruno. Emerg Infect Dis 2009; 15(1): 69-71 (see abstract) and describes 2 outbreaks of this in California prisons, one of which was covered by ProMED-mail in 2004 (Botulism, prison brew – USA (CA) 20040806.2155):
"In our investigations, the potatoes used in the pruno could have been the source of botulinum toxin. _Clostridium botulinum_ is commonly found in the soil, and its spores have been found on raw potatoes. Several outbreaks of botulism caused by eating potatoes have occurred in the United States, and laboratory studies have shown that _C. botulinum_ spores on the surface of raw potatoes can survive baking and lead to production of botulinum toxin. The warm anaerobic fermentation process of making pruno probably predisposes toward production of botulinum toxin, particularly if any ingredient happens to be contaminated with _C. botulinum_ or its spores, such as the potatoes used in these 2 instances.
"Pruno is popular in prisons across the country, and it is somewhat surprising that botulism caused by pruno consumption has not been previously reported. This lack of reporting may be due to the fact that potatoes are not generally used in the making of pruno; recipes for making pruno and references to pruno found on the Internet do not mention potatoes as an ingredient. Occasional crackdowns on making pruno in some prisons could have driven some inmates to look for alternative ingredients, including potatoes. Nonetheless, with more than 2 million inmates in prisons and jails in the United States, this illicit homemade alcoholic drink may put more inmates at risk for botulism. Anecdotally, making pruno has been attempted outside prisons, possibly extending the potential risk for foodborne botulism carried by this novel vehicle beyond the prison walls. Risk for botulism from consuming pruno should be conveyed to inmates, prison staff, the medical community, and the general public. Any inmate with clinical botulism should be examined for an infected wound caused by drug injection and queried about recent drug use and drinking pruno."
It is not entirely true that botulism is not spread by aerosol. Aerosol transmission of botulism can theoretically be transmitted following the rupture of a botulism-containing bloated can and has been reported in the early 1960s as part of the German biowarfare program. Laboratory worker exposed rabbits and guinea pigs to aerosolized botulism toxin type A (1). By the third day after the exposures, the workers, who wore "completely protective clothing", developed pooling of secretions in the mouth and some dysphagia to solids. The following day, increased weakness, difficulties with gait and speech and oculomotor pareses developed (2). The 3 workers were treated with botulinum antitoxin and had slow recoveries. Serum of the workers was shown to contain type A toxin in a murine assay.
1. Holzer VE: Botulismus durch inhalation. Med Klin. 1962;41: 1735-1738.2. Middlebrook JL, Franz DR: Botulinum toxins, in Medical Aspects of Chemical and Biological Warfare, Sidell FR, Takafuji ET, Franz DR (eds), 1997, Borden Institute, Walter Reed Army Medical Center, Washington, DC, pp. 643-654. – Mod.LL
"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."
Botulism is a rare but serious illness caused by a nerve toxin and is sometimes fatal, according to the Centers for Disease Control and Prevention.
Left untreated, botulism can lead to generalized weakness, difficulty breathing and paralysis.
Murphy said the inmates would be treated with an anti-toxin that the CDC released to the state Department of Health Services.
"They will be treated very, very shortly," Murphy said. "This proactive treatment can shorten the recovery time. We know with the release of the anti-toxin we stand a good chance of recovery."
She said officials are monitoring the health of the other inmates in the same pod but are fairly confident no one else would be affected.
Corrections Officer Michelle Barfield said contraband alcohol is not unusual.
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.
This is not the first time that prison inmates have been diagnosed with botulism following what is suspected to be an attempt at making homemade alcohol.
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.
Communicated by: ProMED-mail
[One form of prison-brewed alcohol is pruno. Pruno, or prison wine, (http://en.wikipedia.org/wiki/Pruno) is an alcoholic liquid variously made from apples, oranges, fruit cocktail, ketchup, sugar, and possibly other ingredients, including crumbled bread. Bread provides the yeast for the pruno to ferment. Pruno originated in (and remains largely confined to) prisons and jails, where it can be produced cheaply, easily, and discreetly. The concoction can be made using only a plastic bag, hot running water, and a towel or sock to conceal the pulp during fermentation. The end result has been colorfully described as a "vomit-flavored wine-cooler," although flavor is often not the primary objective. Depending on the time spent fermenting, the sugar content, and the quality of the ingredients and preparation, pruno’s alcohol content by volume can range from as low as 2 percent (equivalent to a very weak beer) to as high as 14 percent (equivalent to a strong wine).
The following is from Vugia DJ, Mase SR, Cole B, et al: Botulism from drinking pruno. Emerg Infect Dis 2009; 15(1): 69-71 (see abstract) and describes 2 outbreaks of this in California prisons, one of which was covered by ProMED-mail in 2004 (Botulism, prison brew – USA (CA) 20040806.2155):
"In our investigations, the potatoes used in the pruno could have been the source of botulinum toxin. _Clostridium botulinum_ is commonly found in the soil, and its spores have been found on raw potatoes. Several outbreaks of botulism caused by eating potatoes have occurred in the United States, and laboratory studies have shown that _C. botulinum_ spores on the surface of raw potatoes can survive baking and lead to production of botulinum toxin. The warm anaerobic fermentation process of making pruno probably predisposes toward production of botulinum toxin, particularly if any ingredient happens to be contaminated with _C. botulinum_ or its spores, such as the potatoes used in these 2 instances.
"Pruno is popular in prisons across the country, and it is somewhat surprising that botulism caused by pruno consumption has not been previously reported. This lack of reporting may be due to the fact that potatoes are not generally used in the making of pruno; recipes for making pruno and references to pruno found on the Internet do not mention potatoes as an ingredient. Occasional crackdowns on making pruno in some prisons could have driven some inmates to look for alternative ingredients, including potatoes. Nonetheless, with more than 2 million inmates in prisons and jails in the United States, this illicit homemade alcoholic drink may put more inmates at risk for botulism. Anecdotally, making pruno has been attempted outside prisons, possibly extending the potential risk for foodborne botulism carried by this novel vehicle beyond the prison walls. Risk for botulism from consuming pruno should be conveyed to inmates, prison staff, the medical community, and the general public. Any inmate with clinical botulism should be examined for an infected wound caused by drug injection and queried about recent drug use and drinking pruno."
It is not entirely true that botulism is not spread by aerosol. Aerosol transmission of botulism can theoretically be transmitted following the rupture of a botulism-containing bloated can and has been reported in the early 1960s as part of the German biowarfare program. Laboratory worker exposed rabbits and guinea pigs to aerosolized botulism toxin type A (1). By the third day after the exposures, the workers, who wore "completely protective clothing", developed pooling of secretions in the mouth and some dysphagia to solids. The following day, increased weakness, difficulties with gait and speech and oculomotor pareses developed (2). The 3 workers were treated with botulinum antitoxin and had slow recoveries. Serum of the workers was shown to contain type A toxin in a murine assay.
1. Holzer VE: Botulismus durch inhalation. Med Klin. 1962;41: 1735-1738.2. Middlebrook JL, Franz DR: Botulinum toxins, in Medical Aspects of Chemical and Biological Warfare, Sidell FR, Takafuji ET, Franz DR (eds), 1997, Borden Institute, Walter Reed Army Medical Center, Washington, DC, pp. 643-654. – Mod.LL