Definition Botulism is a rare but potentially fatal disorder. It is caused by a toxin, or poison, produced by the bacteria Clostridium botulinum. It can result in paralysis, or the loss of sensation or muscle function, if left untreated. It can also cause breathing difficulty.
What is going on in the body? Botulinum toxins are among the most powerful poisons known. Even in adults, the toxins can cause severe nerve and muscle damage. The bacteria reproduce by forming spores. Spores are reproductive cells that wait for the right conditions to grow and multiply. Foodborne botulism can occur when a person eats food containing the Clostridium botulinum bacterium. Most adults are protected against the spores in food, because the stomach acid destroys them. Infant botulism can occur because an infant's stomach is not able to destroy the spores. Instead, the spores multiply and produce the toxin in the infant's intestines. Infant botulism is the most common kind of botulism.
Rarely, wound botulism can be acquired when a wound becomes infected with the bacteria. When this happens, the bacteria grow in the wound and produce its toxin. Wound botulism has increased due to the use of black-tar heroin injections.
What are the signs and symptoms of the condition? Symptoms include:
weakness
paralysis
double or blurred vision
dry mouth
difficulty swallowing and/or talking
In infants, the signs are subtle and include constipation, poor feeding, weak cry, choking, and weakness.
In adults, symptoms usually begin within 12 to 36 hours of eating contaminated food; in infants it's anywhere from 3 to 30 days. Symptoms begin within 4 to 14 days for wound botulism.
What are the causes and risks of the condition? Botulism is caused by a toxin made by the bacteria. If not promptly treated, the condition may progress and cause paralysis of the arms, legs, trunk, and breathing muscles. The toxin is acquired by eating improperly preserved or stored food that contains the toxin, or the bacteria themselves can enter a wound, grow, and produce the toxin.
What can be done to prevent the condition? Foods should be preserved or home canned only by those who know how to prevent food contamination. Strict hygienic procedures should be followed when preparing and storing food. Pressure cooking at 116 degrees Celsius can destroy the bacteria. Food containers that bulge should be discarded. Parents should not give honey, which is known to contain Clostridium botulinum spores, to children under the age of 1 year old. Wounds should be carefully washed with antibacterial soap to prevent Clostridium botulinum infection. Injectable street drugs should not be used.
How is the condition diagnosed? The organism can be detected in stool samples and in foods. The toxin also can be found in serum, which is the watery portion of blood. Electromyography, which is measurement of a muscle's electrical activity, may be ordered. Brain scans, and spinal fluid examinations can also be helpful in making the diagnosis.
What are the long-term effects of the condition? If botulism is untreated, individuals can suffer paralysis or respiratory failure. Even with treatment, recovery can be long, especially with infant botulism. Individuals can suffer complications from the paralysis, such as pneumonia or other infections.
What are the risks to others? The infection is not spread person-to-person.
What are the treatments for the condition? Early diagnosis and treatment is important. Foodborne and wound botulism can be treated with an antitoxin, which blocks the action of toxin in the blood. Antitoxin doesn't undo the damage already done, but it can slow or prevent further damage. Antitoxin is not routinely given for treatment of infant botulism. Intravenous fluids can be given if a person can't swallow. A breathing machine, or ventilator, is often used to treat breathing difficulties.
Antibiotics should only be used to treat infectious complications. Use of antibiotics can result in the absorption of even more toxin as spores are killed in the intestine.
What are the side effects of the treatments? Many people experience allergic reactions to the antitoxin derived from horse serum. There is a human-derived antitoxin that does not cause as many reactions.
What happens after treatment for the condition? With proper treatment, the body is often able to repair the damage over a period of several months.
Author: Reviewer: eknowhow Medical Review Panel Editor: Dr John Hearne Last Updated: 7/1/2005 Contributors Potential conflict of interest information for reviewers available on request
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