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Botulism

Definition

Botulism is a potentially deadly illness that is caused by a toxin produced by specific bacteria.

Causes

The bacteria are found in the soil and at the bottom of lakes, streams, and oceans. The intestinal tracts of fish, mammals, crabs, and other shellfish may contain the bacteria and its spores. Bacterial spores can survive in improperly prepared foods. A very small amount of the botulism toxin can cause illness. People are exposed to this toxin in one of three ways:
In some cases, the source of the bacteria is unknown. Botulism toxin is also a potential bioterrorism agent.

Risk Factors

Factors that increase your chance of botulism include:

Symptoms

Symptoms begin in the face and eyes, and progress down both sides of the body. If left untreated, muscles in the arms, legs, and torso, as well as those used in breathing become unable to move. Death can occur.
Symptoms can range from mild to severe and include:
In adults:
In babies:
When food is the cause of botulism, symptoms usually start within 36 hours of eating the contaminated food. Some people notice symptoms within a few hours. Others may not develop symptoms for several days. Some people experience nausea, vomiting, and diarrhea.
When a wound is the cause of botulism, symptoms start within 4-14 days.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Blood, stool, and stomach contents will be tested for the toxin. In infants, stool will also be tested. If available, samples of questionable food may also be tested for the toxin and bacteria. A wound culture will be done if wound botulism is suspected.
Your doctor may need to test other bodily fluids with lumbar puncture.
Your doctor may need to evaluate the nerves in your body. This can be done with nerve conduction tests.

Treatment

Supportive Care

The most serious complication is respiratory failure. Treatment aims to maintain adequate oxygen supply. This may require mechanical ventilation and close monitoring in an intensive care unit. IV fluids or feeding through a tube may also be necessary.
Intubation to Assist with Breathing
Intubation for respiration
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Antitoxin

If treatment begins early, an antitoxin can stop the paralysis from progressing and may shorten symptoms. It is usually given before the disease is confirmed. It does not reverse the disease process.

Methods to Eliminate the Toxin or Bacteria

Methods to eliminate the toxin include:
  • Surgery to clean a wound
  • Antibiotics to treat a wound infection

Prevention

High temperatures can destroy the botulism toxin. Strategies to prevent botulism include:

RESOURCES

Centers for Disease Control and Prevention http://www.cdc.gov

Food Safety—US Department of Health and Human Services http://www.foodsafety.gov

CANADIAN RESOURCES

Canadian Partnership for Consumer Food Safety Education http://www.canfightbac.org

Health Canada http://www.hc-sc.gc.ca

References

Botulism. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism. Updated July 26, 2011. Accessed August 7, 2013.

Botulism. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated March 6, 2014. Accessed June 16, 2014.

Botulism. US Department of Health and Human Services Food Safety website. Available at: http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/botulism/index.html. Accessed August 7, 2013.

Botulism. Nemours Kids Health website. Available at: http://kidshealth.org/kid/watch/house/botulism.html. Updated October 2011. Accessed August 7, 2013.

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