Agent |
Toxin produced by Clostridium botulinum, an encapsulated, anaerobe, gram-positive, spore-forming, rod-shaped (bacillus) bacterium |
Disease |
Botulism is a neuroparalytic (muscle-paralyzing) disease. There are four forms of naturally occurring botulism:
- Foodborne botulism
Caused by ingestion of pre-formed toxin
- Infant botulism
Caused by ingestion of C. botulinum which produces toxin in the intestinal tract
- Wound botulism
Caused by wound infection with C. botulinum that secretes the toxin
- Adult intestinal colonization
Rare, caused when C. botulinum colonizes the intestinal tract of children or adults, usually with gastrointestinal abnormalities
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Botulinum Toxin as a Biological Weapon |
- Aerosolized botulinum toxin is a possible mechanism for a bioterrorism attack
- Inhalational botulism does not occur naturally
- Inhalational botulism cannot be clinically differentiated from the 3 naturally occurring forms
- Indications of intentional release of a biologic agent may include:
- An unusual geographic clustering of illness (e.g., persons who attended the same public event or gathering)
- A large number of cases of acute flaccid paralysis with prominent bulbar palsies, especially if occurring in otherwise healthy persons
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Transmission |
Botulism is not transmissible from person-to-person |
Incubation |
For foodborne botulism, symptoms begin within 6 hours to 10 days after exposure (often within 12-36 hours). Could be shorter in inhalational botulism. |
Symptoms/
Signs |
- Symmetrical cranial neuropathies
- Difficulty swallowing or speaking, dry mouth
- Diplopia (double vision), blurred vision, dilated or non-reactive pupils, ptosis (drooping eyelids)
- Symmetric descending weakness respiratory dysfunction (requiring mechanical ventilation)
- Descending flaccid paralysis
- Intact mental state
- No sensory dysfunction
- No fever
- Constipation more common in infant botulism
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Diagnosis/Lab/
Reporting |
- Clinicians should immediately contact their state health departments to report suspected cases and inquire about testing and treatment
- Diagnosis: history and clinical exam
- Laboratory confirmation:
- Demonstrating the presence of toxin in serum, stool, or food
- Culturing C. botulinum from stool, wound or food
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Differential Diagnoses |
Differential Diagnoses for Adults |
Differential Diagnoses for Infants |
- Guillain-Barre syndrome
- Myasthenia gravis
- Cerebrovascular accident (CVA)
- Bacterial and/or chemical food poisoning
- Tick paralysis
- Chemical intoxication (e.g., carbon monoxide)
- Mushroom poisoning
- Poliomyelitis
- Ingestion of marine biotoxins (eg paralytic shellfish poisoning)
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- Sepsis
- Meningitis
- Electrolyte-mineral imbalance
- Reye’s syndrome
- Congenital myopathy
- Werdnig-Hoffman disease
- Leigh disease
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Treatment |
- Prompt diagnosis is essential
- Antitoxin is effective in reducing the severity of symptoms, if administered early
- A supply of antitoxin against infant botulism is maintained by the California Department of Public Health’s Infant Botulism Treatment and Prevention Program, and a supply of antitoxin against other kinds of botulism is maintained by the CDC
- State health departments should contact CDC to arrange for a clinical consultation by phone, and (if indicated) the release of the antitoxin
- Supportive care as needed, including mechanical ventilation
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Prophylaxis |
- Botulism can be prevented by the administration of neutralizing antibody in the bloodstream
- Passive immunity can be provided by equine botulinum antitoxin or by specific human hyperimmune globulin, while endogenous immunity can be induced by immunization with botulinum toxoid
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Control Measures |
- Medical personnel caring for patients with suspected botulism should use standard precautions
- Patients with suspected botulism do not need to be isolated
- If meningitis is suspected in a patient with flaccid paralysis, medical personnel should use droplet precautions
- Heating to an internal temperature of 85°C for at least 5 minutes will detoxify contaminated food or drink
- When inhalational exposure is anticipated, some protection may be conferred by covering the mouth and nose with clothing such as an undershirt, shirt, scarf, or handkerchief
- In contrast with mucosal surfaces, intact skin is impermeable to botulinum toxin
- After exposure to botulinum toxin, clothing and skin should be washed with soap and water
- Contaminated objects or surfaces should be cleaned with 0.1% hypochlorite bleach solution if they cannot be avoided for the hours to days required for natural degradation
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For more information |
For more information, please visit the Botulism Emergency Preparedness and Response page. You may also contact 1-800-CDC-INFO, or e-mail coca@cdc.gov. |
