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What is botulism?
Botulism is a rare but serious paralytic illness caused by a nerve toxin that is
produced by the bacterium Clostridium botulinum. There are three kinds of naturally
occuring botulism:
Foodborne botulism is caused by eating foods that contain the toxin.
Wound botulism is caused by toxin produced from a wound infected with clostridium botulinum.
Infant botulism is caused by consuming the spores of the botulinum bacteria, which then grow in the intestines and release toxin.
All forms can be fatal and are considered medical emergencies.
What kind of germ is Clostridium botulinum?
Clostridium botulinum is the name of a group of bacteria commonly found in soil. These
rod-shaped organisms grow best in low oxygen conditions. There are seven types of
botulism toxin designated by the letters A thru G; only A, B, E, and F cause illness in
humans.
How common is botulism?
In the U.S. an average of 110 cases are reported each year. 25% are foodborne, 72% are infant
botulism, and the rest are wound botulism.
What are the symptoms?
Double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing,
dry mouth, and muscle weakness are the classic symptoms. Infants with botulism appear
lethargic, feed poorly, are constipated, and have poor muscle tone. If untreated, these
symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory
muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating
contaminated food, but can occur as early as 6 hours or as late as 10 days.
How is botulism diagnoised?
The most direct way to confirm the diagnosis is to demonstrate the toxin in the
patient’s serum or stool. The bacteria can also be isolated from the stool of
persons with foodborne and infant botulism.
How can botulism be treated?
If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which
blocks the action of toxin circulating in the blood. This can prevent patients from
worsening, but recovery still takes many weeks. Good supportive care in a hospital is
the mainstay of therapy for all forms of botulism. Antitoxin is not routinely given for
treatment of infant botulism.
How can botulism be prevented?
Botulism can be prevented. Foodborne botulism has often been from home-canned foods. However,
outbreaks of botulism from more unusual sources such as chopped garlic in oil, chile
peppers, tomatoes, and improperly handled baked potatoes wrapped in aluminum foil. So
people who do home canning should follow strict hygienic procedures to reduce the
contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes
that have been baked while wrapped in aluminum foil should be kept hot until served or
refrigerated. Because high temperatures destroy botulism toxin, persons who eat home-canned
foods should consider boiling the food for 10 minutes before eating it to ensure
safety. Because honey can contain spores of Clostridium botulinum and this has been a
source of infection for infants, children less than 12 months old should not be fed honey.
What sort of isolation is required for botulism?
Body Substance Isolation should be observed for patients diagnosed with botulism. As always,
handwashing is the most important and easiest way to protect yourself and your patient.
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