Definition

Botulism is a rare, but life-threatening illness that needs urgent care.

Causes

Toxins made by certain bacterial spores cause botulism. The spores are found:

• In the soil
• At the bottom of lakes, rivers, and streams
• In fish, mammals, and shellfish

Spores live in poorly cooked foods. A very small amount of the toxin can cause illness. You can get sick by eating foods that carry the bacteria or toxin. This occurs with:

• Home-canned goods
• Sausage
• Meat products
• Seafood
• Canned vegetables
• Honey

If a baby swallows the spores, they will grow and make the toxin. Unlike adults and older children, babies become sick from toxins growing in their bowels. Honey is a prime source of infant botulism. Other sources are soil and dust.

Wound infection in the US is rare, but it can happen. The toxin travels to other parts of the body through the bloodstream.

In some cases, the cause is unknown.

Botulism toxin is also a potential bioterrorism agent.

Risk Factors

Botulism risk is higher:

• If you eat poorly preserved, cooked, or canned foods
• For babies who eat honey
• If you have a dirty or infected wound (rare)
• Use IV drugs (rare)

Symptoms

Symptoms start in the face and eyes, then move down both sides of the body. Without care, muscles in the arms, legs, and torso will not move. This involves muscles that help you breathe. Botulism can be deadly.

Symptoms range from mild to serious.

In adults:

• Constipation
• Vision problems
• Droopy eyelids
• Fatigue
• The feeling of spinning while standing still— vertigo
• Sore throat
• Swallowing problems
• Dry mouth
• Slurred speech
• Breathing problems

In babies:

• Constipation
• Not eating or sucking
• Little energy
• Floppy muscles
• Weak cry

The time people notice muscle- or nerve-related problems depends on how the toxin got into the body:

• Food—12-36 hours, but can be up to 10 days
• Inhalation—within 6 hours
• Wound—often within 2 weeks

Diagnosis

The doctor will ask about your symptoms and health history. It’s vital to know how you got sick or what you were eating.

You may also have:

• A physical exam
• Blood tests
• Stool tests
• Tests on any stomach contents or food
• Tests on your muscles and nerves
• A swab of the wound

Public health officials will work quickly to find the source of botulism to set up testing and care.

Treatment

Care will start right away, even if your test results aren’t ready. This may involve:

• An antitoxin—it will stop the spread of paralysis, but cannot reverse it
• Supportive care in an intensive care unit
• Breathing support with a ventilator
• Surgery to clean out your wound
• Antibiotics if the wound is infected

Intubation to Help Breathing

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Prevention

To lower your chances of botulism, learn how to properly can and cook food. Also:

• Don’t feed honey to children under 1 year old.
• Refrigerate oils that have garlic or herbs.
• Don’t eat food from a can that is bulging.
• Practice good hygiene when canning.
• Seek care for wounds, especially if they become infected.
• Avoid using IV drugs.