Botulism

Causes

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 bacteria enter open wounds and produce toxins there.

Infant botulism occurs when a baby eats spores and the bacteria grow in the baby's gastrointestinal tract. The most common cause of infant botulism is eating honey or corn syrup.

Clostridium botulinum can be found normally in the stool of some infants.

About 110 cases of botulism occur in the U.S. per year. Most of the cases are in infants.

Symptoms

Symptoms usually appear 8 - 36 hours after you eat 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
• Nausea
• Vomiting
• Weakness with paralysis (equal on both sides of the body)

Symptoms in infants may include:

• Constipation
• Drooling
• Poor feeding and weak sucking
• Respiratory distress
• Weak cry
• Weakness, loss of muscle tone

Exams and Tests

The health care provider will perform a physical exam. There may be signs of:

• Absent or decreased deep tendon reflexes
• Absent or decreased gag reflex
• Eyelid drooping
• Loss of muscle function/feeling
• 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.

Treatment

You will need medicine to fight the bacteria, called botulinus antitoxin.

You will have to stay in the hospital if you have breathing trouble. A tube may be inserted through the nose or mouth into the windpipe to provide an airway for oxygen. You may need a breathing machine.

Patients who have trouble swallowing may be given fluids through a vein (by IV). A feeding tube may be inserted.

Health care providers must tell state health authorities or the U.S. Centers for Disease Control and Prevention about patients with botulism, so that the contaminated food can be removed from stores.

Some people are given antibiotics, but they may not always help.

Outlook (Prognosis)

Prompt treatment significantly reduces the risk of death.

Possible Complications

• Aspiration pneumonia and infection
• Long-lasting weakness
• Nervous system problems for up to 1 year
• Respiratory distress

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you suspect botulism.

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 breastfeeding only, if possible.

Always throw away bulging cans or foul-smelling preserved foods. Sterilizing home-canned foods by pressure cooking them at 250 degrees Fahrenheit for 30 minutes may reduce the risk for botulism.

Keep foil-wrapped baked potatoes hot or in the refrigerator, not at room temperature.

References

Arnon SS. Botulism (Clostridium botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.

Reddy P, Bleck TP. Clostridium botulinum (botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 245.

Long SS. Clostridium botulinum (Botulism). In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.

Update Date: 8/15/2012

Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.