Botulism is a rare but serious condition caused by toxins from bacteria called Clostridium botulinum.
Botulism comes in three main forms:
* Infant botulism. This most common form of botulism begins after
Clostridium botulinum bacterial spores grow in a baby's intestinal
tract. It typically occurs between the ages of 2 and 6 months.
* Food-borne botulism. The harmful bacteria thrive and produce the
toxin in environments with little oxygen, such as in canned food.
* Wound botulism. If these bacteria get into a cut, they can cause a dangerous infection that produces the toxin.
Because all types of botulism can potentially cause death, all types of botulism are considered medical emergencies.
Signs and symptoms of food-borne botulism typically begin between 12 and
36 hours after the toxin gets into your body. If infant botulism is
related to food, such as honey, problems will generally begin within
this time frame, too. However, the symptoms of wound botulism typically
start about 10 days after you're infected by the bacteria.
Food-borne and wound botulism
Signs and symptoms of food-borne and wound botulism include:
* Difficulty swallowing or speaking
* Facial weakness on both sides of the face
* Blurred vision
* Drooping eyelids
* Trouble breathing
* Nausea, vomiting and abdominal cramps (only in food-borne botulism)
* Constipation (often the first sign)
* Floppy movements due to muscle weakness, and trouble controlling the head
* Weak cry
* Drooping eyelids
* Difficulty sucking or feeding
Certain signs and symptoms usually aren't present with botulism,
including no elevation in blood pressure or heart rate, no confusion and
no fever. However, fever is sometimes present with wound botulism.
When to see a doctor
Seek urgent medical care if you suspect that you have botulism. Early
treatment increases your chances of survival. Seeking medical care
promptly may also serve to alert public health authorities, who can keep
other people from eating contaminated food.
Babies get infant botulism after consuming spores of the bacteria, which
then grow and multiply in the intestine and make toxins. The source of
infant botulism may be honey, but is more likely to be exposure to soil
contaminated with the bacteria.
The source of food-borne botulism is often home-canned foods that are
low in acid, such as green beans, corn and beets. A common source of the
illness in Alaska is fermented seafood. However, the disease has also
occurred from chili peppers, baked potatoes and oil infused with garlic.
When you eat food containing the toxin, it disrupts nerve function,
When C. botulinum bacteria get into a wound — possibly caused by an
injury you might not notice — they can multiply and produce toxin. Wound
botulism has increased in recent decades in people who inject heroin,
which can contain spores of the bacteria. Some people have also gotten
botulism from inhaling the spores from cocaine.
Are there benefits to botulinum toxin?
You might wonder how something so toxic could ever be beneficial, but
scientists have found that the paralyzing effect of botulinum toxin
makes it useful in certain circumstances. Botulinum toxin (Botox,
Myobloc) can be an effective medication when used in very small amounts.
Botulinum toxin has been used to reduce facial wrinkles by preventing
contraction of muscles beneath the skin, and for medical conditions,
such as eyelid spasms and severe underarm sweating. However, there have
been rare occurrences of serious side effects, such as muscle paralysis
extending beyond the treated area, with the use of botulinum toxin for
Because it affects muscle control throughout your body, botulinum toxin
can cause many complications. The most immediate danger is that you
won't be able to breathe, which is the most common cause of death in
botulism. Other complications may include:
* Difficulty speaking
* Trouble swallowing
* Long-lasting weakness
* Shortness of breath
Preparing for your appointment
You may first see your primary care doctor. However, you'll likely be
sent to the hospital for immediate treatment. At the hospital, you'll
probably also see a doctor who specializes in neurology (neurologist) or
What you can do
* Bring any medications you take with you, and let your doctor know about any vitamins or supplements that you're taking.
* Write down questions to ask your doctor. Although you may not have
time to write down questions before your first appointment, write down
any questions you want to ask at your follow-up appointments.
For botulism, some basic questions to ask your doctor include:
* How did I get botulism?
* Will I have any lasting problems?
* What types of side effects can I expect from treatment?
* Are there any dietary restrictions that I need to follow?
* How can I prevent this from happening again?
In addition to the questions that you've prepared to ask your doctor,
don't hesitate to ask questions any time you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
* When did you first begin experiencing symptoms?
* Have your symptoms been continuous or occasional?
* Have you or your child eaten any canned food recently?
* If your infant is ill, has he or she consumed honey?
* Did anyone else eat the food suspected of making you ill?
Tests and diagnosis
To diagnose botulism, your doctor will check you for signs of muscle
weakness or paralysis, such as drooping eyelids and a weak voice. Your
doctor will also ask about the foods you've eaten in the past few days,
and ask if you may have been exposed to the bacteria through a wound. A
blood test can confirm the presence of the toxin.
In cases of possible infant botulism, the doctor may ask if the child
has eaten honey recently and has had problems such as constipation and
Analysis of stool or vomit for evidence of the toxin may help confirm an
infant or food-borne botulism diagnosis, but because these tests may
take days, your doctor's clinical examination is the primary means of
Treatments and drugs
For cases of food-borne botulism, doctors sometimes clear out the
digestive system by inducing vomiting and giving medications to induce
bowel movements. If you have botulism in a wound, a doctor may need to
remove infected tissue surgically.
If you're diagnosed early with food-borne or wound botulism, injected
antitoxin reduces the risk of complications. The antitoxin attaches
itself to toxin that's still circulating in your bloodstream and keeps
it from harming your nerves. The antitoxin cannot, however, reverse any
damage that's already been done.
Antitoxin is not, however, recommended for cases of infant botulism,
since it doesn't affect the disease-causing germs in the baby's
digestive system. A treatment called botulism immune globulin is used to
If you're having trouble breathing, you will probably need a mechanical
ventilator. The ventilator forces air into your lungs through a tube
inserted in your airway through your nose or mouth. You may remain on
the ventilator for up to several weeks as the effects of the toxin
As you recover, you may also need therapy to improve your speech, swallowing and other functions affected by the disease.
Use proper canning techniques
Be sure to use proper techniques when canning foods at home to ensure that any botulism germs in the food are destroyed:
* Pressure cook these foods at 250 F (121 C) for at least 30 minutes.
* Consider boiling these foods for 10 minutes before serving them.
Prepare and store food safely
* Don't eat preserved food if its container is bulging or if the
food smells spoiled. However, taste and smell won't always give away the
presence of C. botulinum. Some strains don't make food smell bad or
* If you wrap potatoes in foil before baking them, eat them hot or store them in the refrigerator — not at room temperature.
* Store oils infused with garlic or herbs in the refrigerator.
To reduce the risk of infant botulism, avoid giving honey — even a tiny taste — to babies under the age of 1 year.
To prevent wound botulism and other serious bloodborne diseases, never inject or inhale street drugs.