Botulism
Definition
Botulism is a rare but serious illness caused by Clostridium botulinumbacteria. The bacteria may enter the body
through wounds, or they may live in improperly canned or preserved food.
Symptoms
Symptoms usually appear 8 - 36 hours after consuming contaminated food. There is NO fever with this infection.
In adults, symptoms may include:

Abdominal cramps

Breathing difficulty that may lead to respiratory failure

Difficulty swallowing and speaking

Double vision

Dry mouth

Nausea

Temporary lack of breathing

Vomiting

Weakness with paralysis (equal on both sides of the body)
Symptoms in infants may include:

Constipation

Weakness, loss of muscle tone

Weak cry

Poor feeding and weak sucking

Respiratory distress

Alertness, despite weakness
Causes & Risk Factors
Clostridium botulinum is found in soil and untreated water throughout the world. It produces spores that survive in
improperly preserved or canned food, where they produce toxin. When eaten, even tiny amounts of this toxin can
lead to severe poisoning.
The foods most commonly contaminated are home-canned vegetables, cured pork and ham, smoked or raw fish,
and honey or corn syrup. Botulism may also occur if the organism enters open wounds and produces toxin there.
Infant botulism occurs when living bacteria or its spores are eaten and grow within the baby's gastrointestinal tract.
The most common cause of infant botulism is eating honey or corn syrup.
Clostridium botulinum also occurs normally in the stool of some infants.
Approximately 110 cases of botulism occur in the U.S. per year. The majority are in infants.
Tests & Diagnostics
The doctor will perform a physical exam. There may be signs of:

Absent or decreased deep tendon reflexes

Absent or decreased gag reflex

Eyelid drooping

Muscle function/feeling loss

Paralyzed bowel

Speech impairment

Urine retention with inability to urinate
Blood tests can be done to identify the toxin. A stool culture may also be ordered. Lab tests can be done on the
suspected food to confirm botulism.
Treatments
Botulinus antitoxin is given.
Breathing trouble requires hospitalization. The health care team will establish aclear airway and provide supportive
therapy. A tube may be inserted through the nose or mouth into the windpipe to provide an airway for oxygen. A
breathing machine may be needed.
Intravenous fluids can be given when the patient has swallowing difficulties. A feeding tube may be inserted in the
nose.
Cases of botulism are reported to state health authorities or the U.S. Centers for Disease Control and Prevention by
health care providers so that the contaminated food can be removed from stores. Antibiotics are often given, but have
not been shown to always be beneficial.
Drugs
Older children and adults with botulism are sometimes treated with an antitoxin derived from horse serum that is
distributed by the Centers for Disease Control and Prevention. The antitoxin (effective against toxin types A, B, and
E) inactivates only the botulinum toxin that is unattached to nerve endings. Early injection of the antitoxin, ideally
within 24 hours of onset of symptoms, can preserve nerve endings, prevent progression of the disease, and reduce
mortality.
Unfortunately, infants cannot receive the antitoxin used for adults. For them, human botulism immune globulin (BIG)
is the preferred treatment. It is available in the United States through the Infant Botulism Treatment and Prevention
Program in Berkeley, California. BIG neutralizes toxin types A, B, C, D, and E before they can bind to nerves. This
antitoxin can provide protection against A and B toxins for approximately four months. Though many infants recover
with supportive care, BIG cuts hospital stay in half and, therefore, reduces hospital costs by 50 percent as well.
Aside from the specific antitoxin, no therapeutic drugs are used to treat botulism. Antibiotics are not effective for
preventing or treating botulism because the Clostridium group of toxins are not sensitive to them. In fact, antibiotic
use is discouraged for infants because bacteria could potentially release more toxin into a baby's system as they are
killed. Antibiotics can be used, however, to treat secondary respiratory tract and other infections.
Complications

Aspiration pneumonia and infection

Long-lasting weakness

Nervous system problems for up to 1 year

Respiratory distress
Prevention
NEVER give honey or corn syrup to infants younger than 1 year old -- not even just a little taste on a pacifier.
Prevent infant botulism by exclusively breastfeeding, if possible.
Always throw away bulging cans or foul-smelling preserved foods. Sterilizing home-canned foods by pressure
cooking at 250 degrees Fahrenheit for 30 minutes may prevent botulism.
Keep foil-wrapped baked potatoes hot or in the refrigerator, not out in room temperature.
Botulism
Definition
By Mayo Clinic staff
Botulism is a rare but serious condition caused by toxins from bacteria called Clostridium botulinum.
Botulism comes in three main forms:

Infant botulism. This most common form of botulism begins after Clostridium botulinum bacterial spores
grow in a baby's intestinal tract. It typically occurs between the ages of 2 and 6 months.

Food-borne botulism. The harmful bacteria thrive and produce the toxin in environments with little
oxygen, such as in canned food.

Wound botulism. If these bacteria get into a cut, they can cause a dangerous infection that produces the
toxin.
Because all types of botulism can potentially cause death, all types of botulism are considered medical
emergencies.
Symptoms
By Mayo Clinic staff
Signs and symptoms of food-borne botulism typically begin between 12 and 36 hours after the toxin gets
into your body. If infant botulism is related to food, such as honey, problems will generally begin within
this time frame, too. However, the symptoms of wound botulism typically start about 10 days after you're
infected by the bacteria.
Food-borne and wound botulism
Signs and symptoms of food-borne and wound botulism include:

Difficulty swallowing or speaking

Facial weakness on both sides of the face

Blurred vision

Drooping eyelids

Trouble breathing

Nausea, vomiting and abdominal cramps (only in food-borne botulism)

Paralysis
Infant botulism

Constipation (often the first sign)

Floppy movements due to muscle weakness, and trouble controlling the head

Weak cry

Irritability

Drooling

Drooping eyelids

Tiredness

Difficulty sucking or feeding

Paralysis
Certain signs and symptoms usually aren't present with botulism, including no elevation in blood pressure
or heart rate, no confusion and no fever. However, fever is sometimes present with wound botulism.
When to see a doctor
Seek urgent medical care if you suspect that you have botulism. Early treatment increases your chances
of survival. Seeking medical care promptly may also serve to alert public health authorities, who can keep
other people from eating contaminated food.
Causes
By Mayo Clinic staff
Infant botulism
Babies get infant botulism after consuming spores of the bacteria, which then grow and multiply in the
intestine and make toxins. The source of infant botulism may be honey, but is more likely to be exposure
to soil contaminated with the bacteria.
Food-borne botulism
The source of food-borne botulism is often home-canned foods that are low in acid, such as green beans,
corn and beets. A common source of the illness in Alaska is fermented seafood. However, the disease
has also occurred from chili peppers, baked potatoes and oil infused with garlic. When you eat food
containing the toxin, it disrupts nerve function, causing paralysis.
Wound botulism
When C. botulinum bacteria get into a wound — possibly caused by an injury you might not notice — they
can multiply and produce toxin. Wound botulism has increased in recent decades in people who inject
heroin, which can contain spores of the bacteria. Some people have also gotten botulism from inhaling
the spores from cocaine.
Are there benefits to botulinum toxin?
You might wonder how something so toxic could ever be beneficial, but scientists have found that the
paralyzing effect of botulinum toxin makes it useful in certain circumstances. Botulinum toxin (Botox,
Myobloc) can be an effective medication when used in very small amounts.
Botulinum toxin has been used to reduce facial wrinkles by preventing contraction of muscles beneath the
skin, and for medical conditions, such as eyelid spasms and severe underarm sweating. However, there
have been rare occurrences of serious side effects, such as muscle paralysis extending beyond the
treated area, with the use of botulinum toxin for medical reasons.
Complications
By Mayo Clinic staff
Because it affects muscle control throughout your body, botulinum toxin can cause many complications.
The most immediate danger is that you won't be able to breathe, which is the most common cause of
death in botulism. Other complications may include:

Difficulty speaking

Trouble swallowing

Long-lasting weakness

Shortness of breath
Preparing for your appointment
By Mayo Clinic staff
You may first see your primary care doctor. However, you'll likely be sent to the hospital for immediate
treatment. At the hospital, you'll probably also see a doctor who specializes in neurology (neurologist) or
infectious diseases.
What you can do

Bring any medications you take with you, and let your doctor know about any vitamins or supplements
that you're taking.

Write down questions to ask your doctor. Although you may not have time to write down questions
before your first appointment, write down any questions you want to ask at your follow-up appointments.
For botulism, some basic questions to ask your doctor include:

How did I get botulism?

Will I have any lasting problems?

What types of side effects can I expect from treatment?

Are there any dietary restrictions that I need to follow?

How can I prevent this from happening again?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions any
time you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:

When did you first begin experiencing symptoms?

Have your symptoms been continuous or occasional?

Have you or your child eaten any canned food recently?

If your infant is ill, has he or she consumed honey?

Did anyone else eat the food suspected of making you ill?
Tests and diagnosis
By Mayo Clinic staff
To diagnose botulism, your doctor will check you for signs of muscle weakness or paralysis, such as
drooping eyelids and a weak voice. Your doctor will also ask about the foods you've eaten in the past few
days, and ask if you may have been exposed to the bacteria through a wound. A blood test can confirm
the presence of the toxin.
In cases of possible infant botulism, the doctor may ask if the child has eaten honey recently and has had
problems such as constipation and sluggishness.
Analysis of stool or vomit for evidence of the toxin may help confirm an infant or food-borne botulism
diagnosis, but because these tests may take days, your doctor's clinical examination is the primary
means of diagnosis.
Treatments and drugs
By Mayo Clinic staff
For cases of food-borne botulism, doctors sometimes clear out the digestive system by inducing vomiting
and giving medications to induce bowel movements. If you have botulism in a wound, a doctor may need
to remove infected tissue surgically.
Antitoxin
If you're diagnosed early with food-borne or wound botulism, injected antitoxin reduces the risk of
complications. The antitoxin attaches itself to toxin that's still circulating in your bloodstream and keeps it
from harming your nerves. The antitoxin cannot, however, reverse any damage that's already been done.
Antitoxin is not, however, recommended for cases of infant botulism, since it doesn't affect the diseasecausing germs in the baby's digestive system. A treatment called botulism immune globulin is used to
treat infants.
Breathing assistance
If you're having trouble breathing, you will probably need a mechanical ventilator. The ventilator forces air
into your lungs through a tube inserted in your airway through your nose or mouth. You may remain on
the ventilator for up to several weeks as the effects of the toxin gradually lessen.
Rehabilitation
As you recover, you may also need therapy to improve your speech, swallowing and other functions
affected by the disease.
Prevention
By Mayo Clinic staff
Use proper canning techniques
Be sure to use proper techniques when canning foods at home to ensure that any botulism germs in the
food are destroyed:

Pressure cook these foods at 250 F (121 C) for at least 30 minutes.

Consider boiling these foods for 10 minutes before serving them.
Prepare and store food safely

Don't eat preserved food if its container is bulging or if the food smells spoiled. However, taste and smell
won't always give away the presence of C. botulinum. Some strains don't make food smell bad or taste
unusual.

If you wrap potatoes in foil before baking them, eat them hot or store them in the refrigerator — not at
room temperature.

Store oils infused with garlic or herbs in the refrigerator.
Infant botulism
To reduce the risk of infant botulism, avoid giving honey — even a tiny taste — to babies under the age of
1 year.
Wound botulism
To prevent wound botulism and other serious bloodborne diseases, never inject or inhale street drugs.