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Botulism

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Botulism

Definition

Botulism is a potentially deadly illness that is caused by a toxin produced by a bacterium called Clostridium botulinum .

Causes

The bacterium are found in the soil and at the bottom of lakes, streams, and oceans. The intestinal tracts of fish, mammals, crabs, and other shellfish may contain C botulinum and its spores. The bacterium's spores can survive in improperly prepared foods. A very small amount of the botulism toxin can cause illness. People come in contact with this toxin in one of three ways:
  • Food can be contaminated with the bacteria and its toxin. It is the toxin produced by C botulinum —not C botulinum itself—that causes botulism in humans. Food that may be contaminated with the toxin include:
    • Home-canned goods
    • Sausage
    • Meat products
    • Seafood
    • Canned vegetables
    • Honey
  • If an infant swallows C botulinum spores, they will grow in the baby's body and produce the toxin. Unlike adults and older children, infants become sick from toxin produced by bacteria growing in their own intestines. Honey is a prime source of infant botulism. Other sources include soil and dust.
  • A wound can become infected with the bacteria (rare in the US). The toxin then travels to other parts of the body through the bloodstream.
In some cases, the source of the bacteria is unknown. Botulism toxin is also a potential bioterrorism agent.

Risk Factors

Factors that increase your chance of getting botulism include:
  • Eating improperly cooked or canned foods
  • For infants, consuming honey
  • Using IV drugs (rare)

Symptoms

Symptoms begin in the face and eyes, and progress down both sides of the body. If left untreated, muscles in the arms, legs, and torso, as well as those used in breathing become paralyzed. Death can occur.
Symptoms can range from mild to severe and include:
In adults:
  • Muscle weakness
  • Dizziness
  • Double or blurred vision
  • Droopy eyelids
  • Trouble swallowing
  • Dry mouth
  • Sore throat
  • Slurred speech
  • Difficulty breathing
  • Constipation
In babies:
  • Constipation
  • Not eating or sucking
  • Little energy
  • Poor muscle tone
  • Weak cry
When food is the cause of botulism, symptoms usually start within 36 hours of eating the contaminated food. Some people notice symptoms within a few hours. Others may not develop symptoms for several days. Some people experience nausea, vomiting, and diarrhea .
When a wound is the cause of botulism, symptoms start within 4-14 days.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Blood, stool, and stomach contents will be tested for the toxin. In infants, stool will also be tested for C botulinum . If available, samples of questionable food may also be tested for the toxin and bacteria. A wound culture will be done if wound botulism is suspected.
  • Your doctor may need to test your bodily fluids. This can be done with:
  • Your doctor may need pictures of the inside of your brain. This can be done with an MRI scan .
  • Your doctor may need to evaluate the nerves in your body. This can be done with nerve conduction tests .

Treatment

Supportive Care

The most serious complication is respiratory failure. Treatment aims to maintain adequate oxygen supply. This may require a ventilator and close monitoring in an intensive care unit. Feeding through a tube may also be necessary.
Intubation to Assist with Breathing
Intubation for respiration
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Antitoxin

If treatment begins early, an antitoxin can stop the paralysis from progressing and may shorten symptoms. It does not reverse the disease process.

Methods to Eliminate the Toxin

Methods to eliminate the toxin include:
  • Surgery to clean a wound
  • Antibiotics to treat a wound infection

Prevention

High temperatures can destroy the botulism toxin. Strategies to prevent botulism include:
  • Do not feed honey to children less than one year old.
  • Refrigerate oils that contain garlic or herbs.
  • Bake potatoes without foil. If potatoes are wrapped in foil, keep them hot until served or refrigerate them.
  • Do not taste foods that appear spoiled.
  • Do not eat food from a can that is bulging.
  • Boil home-canned foods for 10-20 minutes before eating.
  • Practice good hygiene when canning. Follow government recommendations.
  • Seek medical care for wounds. Return to the doctor if a wound looks infected (redness, warmth, pus, tenderness).
  • Do not inject illicit drugs.

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov/

FoodSafety.gov http://www.foodsafety.gov/

CANADIAN RESOURCES

Canadian Partnership for Consumer Food Safety Education http://www.canfightbac.org/en/

Health Canada http://www.hc-sc.gc.ca

References

Botulism. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/ . Updated October 6, 2010. Accessed January 7, 2013.

Botulism. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated October 5, 2012. Accessed January 7, 2013.

Botulism. FoodSafety.gov website. Available at: http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/botulism/index.html . Accessed January 7, 2013.

Botulism. KidsHealth.org website. Available at: http://kidshealth.org/kid/watch/house/botulism.html . Updated October 2011. Accessed January 7, 2013.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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