Botulism: Causes, Symptoms And Diagnosis


What Is Botulism?

The many types of foodborne illnesses, botulism is one of the most dangerous. It can cause paralysis and it can be life-threatening, but it is rather rare.

Botulism is usually linked with canning fruits and vegetablesat home. Commercially canned foods can carry the bacteria that cause botulism, but that rarely happens these days.

Botulism is caused by the bacterium Clostridium botulinum(C. botulinum). It releases a neurotoxin, which is a poison that attacks your nervous system. Botulism is a rare but serious illness. The cause is a toxin (poison) made by a bacterium called Clostridium botulinum. It occurs naturally in soil.

There are several kinds of botulism. Foodborne botulism comes from eating foods contaminated with the toxin. Wound botulism happens when a wound infected with the bacteria makes the toxin. It is more common in heroin users. Infant botulism happens when a baby consumes the spores of the bacteria from soil or honey. All forms can be deadly and are medical emergencies.

Symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Treatment may include antitoxins, intensive medical care, or surgery of infected wounds.

To prevent botulism:

  • Be very careful when canning foods at home
  • Do not let babies eat honey
  • Get prompt medical care for infected wounds
  • Botulismcan be caused by foods that were canned or preserved at home. Maybe you’ve had fruits or vegetables that someone picked from the garden in the summer and jarred so they could be eaten during the winter months. These foods need to be cooked at very high temperatures to kill the germs.
  • If not, bacteria called Clostridium botulinum could cause botulism in the people who eat the food. You can’t always see, smell, or taste these bacteria, but they release a poison called a toxin. This toxin travels through the blood to attach to the nerves that control muscles. From several hours to a week after eating contaminated food, the person may get sick.
  • Many botulism cases occur in infants, and experts think that’s because their digestive systems can’t protect them from germs the way an older kid’s or an adult’s digestive system can.
  • Infant botulism can happen if a baby younger than 1 year eats honey, so it’s important that babies don’t eat honey until they’re older.

Botulism: Causes, Symptoms & Diagnosis

Types of Botulism

One way you can get the toxin in your system is by eating tainted food. But there are other ways for you to get it as well:

  • Infant botulism: If babies up to about 6 months old swallow botulinum spores, the spores can germinate into bacteria. For example, they can swallow it from dust and soil, which is most common, or from honey. The bacteria can then release the toxin. As children get older, they build defenses in their intestines to keep the spores from taking root.
  • Infant botulism is a potentially life-threatening disease caused by a bacteria called Clostridium botulinum. It grows inside a baby’s gastrointestinal tract.
  • Foodborne botulismis caused by consuming foods containing the botulinum toxin. The most commonly tainted foods are home-canned vegetables, cured pork, and ham, raw fish, smoked fish, honey, and corn syrup. For example, Home-canned foods and fermented fish and aquatic game from Alaska can be sources of the toxin. Botulism does not grow in acidic foods with a pH of 5 or less.
  • Wound botulismcan occur if the organism enters an open wound and produces toxins within the wound. Injection drug users are at risk for this type of botulism.
  • Infant botulismhappens when an infant consumes the bacteria or their spores, and these grow in the gut. Infant botulism in the U.S. mostly comes from eating honey or corn syrup. The bacterium may also occur naturally in the stool of an infant.
  • Adult intestinal colonizationis a rare form of botulism that occurs when the bacterium colonizes the digestive tract of an adult.
  • Latrogenic botulismcan occur through an overdose of botulism toxin, or botox. Cases of this form of botulism have developed following therapeutic administration of botox.

Signs and symptoms

The signs and symptoms depend on the type of botulism.

In food-borne botulism, signs and symptoms include nausea, vomiting, and diarrhea followed by constipation and abdominal distention. There may be weakness and difficulty breathing. Symptoms normally appear between 18 and 36 hours after consuming the contaminated food, but this can vary between 3 hours and 8 days.

In wound botulism, the nerves that connect the brain to the spine, known as the cranial nerves, experience the first symptoms. This then spreads to the rest of the body. The incubation period is from 4 days to 2 weeks.

Neurological signs and symptoms of adult, food-borne, and wound botulism are the same, but the symptoms of wound botulism ones may take longer to appear.

The patient may experience double or blurred vision, the eyelids may droop, there will be facial weakness, a dry mouth, dysphagia, or difficulty swallowing, and speech slurring. Muscles will become weak.

Next, paralysis will set in. Without treatment, the patient’s breathing muscles will eventually become paralyzed, resulting in respiratory failure and death.

The patient remains conscious during this process.

In infant botulism, signs and symptoms may include:

  • Constipation
  • Poor feeding
  • Bad temper
  • Excessive drooling when feeding
  • Sagging eyelids
  • Flat facial expression
  • Lethargy and listlessness
  • Respiratory difficulties
  • Slow or improper reflexes
  • Weak crying weakly
  • Floppiness and poor muscle tone
  • No gag reflex
  • Unfocused eyes
  • Weak sucking

The incubation period for infant botulism varies from 3 days to 30 days.

No matter how you get botulism, the symptoms are usually the same. The most defining symptom is weakness that starts on both sides of your face, goes down to your neck, and then to the rest of your body. Other early symptoms include:

  • Double or blurred vision
  • Drooping eyelids
  • Difficulty swallowing
  • Slurred speech
  • Shortness of breath

Other symptoms that can follow include vomiting, belly pain, and diarrhea. Later, you may have a very hard time urinating and have severe constipation.

If you don’t get treatment, your symptoms could progress to paralysis of your arms and legs and the muscles used for breathing.

Infants with botulism have symptoms that include:

  • Lethargy
  • Poor muscle tone starting in the head and neck and moving down
  • Poor feeding
  • Drooling
  • Weak cry

When Should I Call a Doctor?

Foodborne botulism symptoms usually appear within 18 to 36 hours of eating food with the bacterium, though they could show up in as little as 6 hours.

In some cases, symptoms of botulism don’t occur for a week to 10 days after exposure.

Infant botulism may not appear for 14 days. A baby with botulism may appear fussy or lethargic, and may be constipated and unwilling to eat.

If you or someone close to you has symptoms that could be signs of botulism, call 911 immediately. Respiratory failure is a concern and close monitoring is important.

Possible Complications

Botulism can cause severe symptoms, but it cannot be spread from one person to another. However, if you are sick with botulism, you very likely will have to stay in the hospital for monitoring and treatment.

You may have long-term breathing problems if your case is severe. Problems include shortness of breath and being easily tired out.

With proper treatment, you can fully recover from botulism. How fast you get over it depends on the severity of your case. When your case is mild, you may need weeks or months for a full recovery. It may take months or years to completely get over a very serious case.

If the illness isn’t treated, botulism can be life-threatening. But people recover in about 90% to 95% of cases.

In the most cases, infant botulism has no long-term effects. According to the NIH, fewer than 1 percent of infant cases in the U.S. are fatal. About 50 years ago, half of all patients with botulism died, compared to between 3 percent and 5 percent today.

Respiratory failure caused by botulism can result in death.

Patients with severe symptoms may need a breathing machine and sometimes intensive medical and nursing care for several months. Fatigue and shortness of breath may linger for many years.

Other illnesses may develop as a result of the patient’s condition, and these are sometimes fatal.

A person who experiences paralysis may recover from botulism with the help of antitoxins, antibodies that can neutralize the toxin, but antitoxins will not cure any paralysis that has already occurred.

Diagnosis and Tests

Your doctor will likely start with a physical exam, looking for signs of botulism such as muscle weakness, a weak voice, or drooping eyelids. She might also ask you about foods you (or your baby) have eaten.

She may order a lab test to analyze either your blood or a stool sample to confirm her diagnosis. Other tests may be needed. If you happened to have saved it, you can also bring in the food you suspect caused the botulism for testing.

Lab tests may take a couple of days. In the meantime, your doctor may try to rule out other possible conditions. Botulism symptoms are similar to those for stroke and Guillain-Barre syndrome, in which your immune systemattacks your nerves, causing possible paralysis.

Tests for these conditions may be done while lab tests are being done.


Your doctor will have you admitted to a hospital, where there are several treatments that may be tried, depending on your case. They include:

Antitoxins: The main treatment for botulism is a medicationcalled an antitoxin. It interferes with the toxin your bloodstream. This medication can often help stop symptoms from getting worse.

Antibiotics: Sometimes these may work if your case is wound botulism. These bacteria-killing medications aren’t used for other types of botulism.

Breathing aid: If your case of botulism has seriously affected your muscles for breathing, you may need to be hooked up to a machine that helps you breathe. You may be on a mechanical ventilation machine for months if the illness is severe.

Therapy: You may need programs to help with your speech, swallowing, and other body functions as you start to get better.

Patients with botulism will need to be hospitalized.

Infants will be given Botulism Immune Globulin Intravenous-Human, also known as BIG-V or BabyBIG.

Those with respiratory problems will be on a ventilator, and they may need the ventilator for weeks or months, as well as intensive nursing. Over time, the paralysis may improve.

A patient with suspected botulism will immediately be given injections of antitoxins, even before diagnostic test results have returned.

If the infection results from a wound, the wound needs to be treated surgically. The area around the wound is removed, in a process known as debridement. Antibiotics may also be prescribed to prevent any secondary infection.


If you can your own food at home, make sure your hands, containers, and utensils are as clean as possible. Clean and store food carefully to lower the chance of tainting the food you’re canning.

The botulism toxin can be killed at high temperatures, so if you’re eating home-canned food, consider boiling it for 10 minutes to kill the bacteria. Proper refrigeration can help prevent the growth of C. botulinum, too.

Here are a few telltale signs of possible botulism contamination in canned foods:

  • The can has a bulge.
  • The container spurts out foam or liquid when you open it.
  • The contents smell unusual or foul.

If you ever see a bulge pushing out from a can or container, do not open it. Throw it away. If there is something wrong about the way food smells, don’t even taste it.

A couple of other things to remember:

  • Don’t give honey or corn syrup to a baby younger than 1 year old.
  • If you’re addicted to heroin, never share needles and don’t use black tar heroin. Seek out a doctor to help you with your addiction.

To reduce the risk of wound botulism, people are advised to seek urgent medical attention for any infected wounds and also to avoid injecting street drugs.

To ensure food safety, it is important to practice good food hygiene.

  • Follow any instructions carefully when canning food at home, or avoid canning food at home
  • Boil home-processed foods for at least 10 minutes before eating, even if no signs of food spoilage are evident
  • Do not taste canned food items to see if they are still good. Throw away any cans that are bulging, leaking, or appear damaged
  • Keep potatoes that have been baked in foil hot until eaten
  • Not give honey or corn syrup to infants under 12 months of age
  • Ensure all foods are well-cooked
  • Keep oils infused with garlic or herbs in a refrigerator

Boiling can destroy both the vegetative, or non-spore, form of the bacterium, and the toxin it produces.

However, while boiling for 10 minutes can kill the toxin, to destroy the spore form requires heating to at least 248 degrees Fahrenheit, or 120 degrees Celsius, under pressure, for at least 30 minutes in an autoclave or a pressure cooker.

This is because the spores are highly resistant to harsh environments, and they can remain viable even after several hours of normal boiling. The spores can be killed by very high temperatures such as those used in commercial canning.

The World Health Organization’s (WHO) “Five keys to safer food” stresses the importance of:

  • Keeping clean
  • Separating raw and cooked food
  • Cooking thoroughly
  • Keeping food at safe temperatures
  • Using safe water and raw materials

This is important when people are traveling, especially to countries where access to clean water, hygiene, and refrigeration facilities may be limited.

Botulism cannot always be prevented. The toxin may be present in house dust, even after cleaning. Parents should be aware of any signs that a child is sick, and take early action as appropriate.

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