(from
Latin ''botulus'', "sausage") is a rare but serious paralytic illness caused by a nerve
Toxin ,
Botulin , that is produced by the bacterium ''
Clostridium Botulinum ''. Botulin is the most potent known toxin, blocking nerve function and leading to respiratory and musculoskeletal
Paralysis .
There are three main kinds of botulism:
- is a form of Foodborne Illness and is caused by eating foods that contain the Botulism Toxin .
- is caused by toxin produced from a wound infected with ''Clostridium botulinum''.
- is caused by consuming the Spore s of the botulinum bacteria, which then grow in the Intestine s and release toxin.
All forms of botulism can be fatal and are considered medical emergencies. Foodborne botulism can be especially dangerous as a
Public Health problem because many people can be poisoned from a single contaminated food source.
In the
United States an average of 110 cases of botulism are reported each year. Of these, approximately 25% are foodborne, 72% are infant botulism, and the rest are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur during most years and usually are caused by eating contaminated home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of
Black Tar Heroin , especially in
California .
Classic symptoms of botulism occur between 12-36 hours after consuming the
Botulinum Toxin , but they can occur as early as 6 hours or as late as 10 days. Those symptoms usually include dry mouth, difficulty swallowing, slurred speech, muscle weakness, double vision, vomiting, and severe
Diarrhea , along with a progressive muscle
Paralysis . These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk, respiratory muscles, and possibly eventual death. In all cases the toxin made by ''C. botulinum'' causes illness, not the bacterium itself.
Infant botulism (first recognized in 1976) is the most common form of the ailment in the United States. The mode of action of this form is through actual infection by germinating
Spore s in the gut of an infant. Infection results in constipation, general weakness, loss of head control and difficulty feeding. Because of these symptoms, infant botulism is often referred to as ''floppy baby syndrome''.
environment creates an ideal medium for botulinum spores to grow and produce toxin. Botulinum spores are among the few bacteria that survive in
Honey , but they also are widely present in the environment. While these spores are harmless to adults, because of
Stomach Acid ity, an infant's
Digestive System is not yet developed enough to destroy them, and the spores could potentially cause infant botulism. For this reason, it is advised that neither honey, nor any other sweetener, should be given to children until they are weaned.
The leading explanation for why some infants become infected with ''C. botulinum'' is that infants do not yet have sufficient numbers of resident
Microbiota in their intestines to competitively exclude ''C. botulinum''. Thus, without competition, ''C. botulinum'' is able to establish itself in the gut of an infant.
s accidentally ingested material from anaerobic layers in a river (normally out of their reach), and were struck by botulism symptoms.
Botulinum toxin is also used cosmetically, for example in reducing facial wrinkles or excessive transpiration, and is commercially known as
Botox .
Physicians may consider the diagnosis if the patient's history and physical examination suggest botulism. However, these clues are usually not enough to allow a diagnosis of botulism. Other diseases such as
Guillain-Barré Syndrome ,
Stroke , and
Myasthenia Gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan,
Cerebrospinal Fluid examination, nerve conduction test (
Electromyography , or EMG), and a Edrophonium Chloride (Tensilon) test for myasthenia gravis. The most direct way to confirm the diagnosis is to demonstrate the botulinum toxin in the patient's
Serum or stool by injecting serum or stool into mice and looking for signs of botulism. The bacteria can also be isolated from the stool of persons with foodborne and infant botulism.
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a
Breathing Machine for weeks, plus intensive medical and nursing care. After several weeks, the
Paralysis slowly improves. If diagnosed early, foodborne and wound botulism can be treated with an antitoxin which blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using
Enema s. Wounds should be treated, usually surgically, to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of botulism. Currently antitoxin is not routinely given for treatment of infant botulism.
Furthermore each case of botulism is a potential public health emergency in that it is necessary to identify the source of the outbreak and ensure that all persons who have been exposed to the toxin have been identified, and that no contaminated food remains.
Botulism can result in death due to
Respiratory failure. However, in the past 50 years, the proportion of patients with botulism who die has fallen from about 50% to 8%. A patient with severe botulism may require a
Breathing Machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have
Fatigue and shortness of breath for years and long-term therapy may be needed to aid recovery.
Commercially canned goods are required to undergo a "botulinum cook" (121°C for 3 minutes) and so rarely cause botulism, there have however been notable exceptions (such as the 1978 Alaskan salmon outbreak). Foodborne botulism has more frequently been from home-canned foods with low acid content, such as in
Oil ,
Chile Peppers ,
Tomato es, improperly handled baked
Potato es wrapped in
Aluminum foil, and home-canned or
Fermented Fish . Persons who do home canning should follow strict
Hygienic procedures to reduce contamination of foods. Oils infused with garlic or herbs should be refrigerated. Potatoes which have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Because the botulism toxin is destroyed by high temperatures, persons who eat home-canned foods should consider boiling the food for 10 minutes before eating it to ensure safety. Canned foods may also indicate botulism infestation by characteristic outward bulges which result from the bacteria causing pressure to rise inside the can due to gas produced as a waste product, it would be safest to simply throw such cans away. Because honey, and other sweeteners, can form an ideal medium for botulism growth, infants should not be fed them until they are weaned and their digestive juices become too acidic for the bacteria to grow. Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.
