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Botulism

Definition

Botulism is a rare but serious illness caused by Clostridium botulinum bacteria. The bacteria may enter the body through wounds, or they may live in improperly canned or preserved food.

Causes, incidence, and risk factors

Clostridium botulinum is found in soil and untreated water throughout the world. It produces spores that survive in improperly preserved or canned food, where they produce toxin. When eaten, even tiny amounts of this toxin can lead to severe poisoning.

The foods most commonly contaminated are home-canned vegetables, cured pork and ham, smoked or raw fish, and honey or corn syrup. Botulism may also occur if the organism enters open wounds and produces toxin there.

Infant botulism occurs when living bacteria or its spores are eaten and grow within the baby's gastrointestinal tract. The most common cause of infant botulism is eating honey or corn syrup.

Clostridium botulinum also occurs normally in the stool of some infants.

Approximately 110 cases of botulism occur in the U.S. per year. The majority are in infants.

Symptoms

Symptoms usually appear 8 - 36 hours after consuming contaminated food. There is NO fever with this infection.

In adults, symptoms may include:

• Abdominal cramps
• Breathing difficulty that may lead to respiratory failure
• Difficulty swallowing and speaking
• Double vision
• Dry mouth
• Nausea
• Temporary lack of breathing
• Vomiting
• Weakness with paralysis (equal on both sides of the body)

Symptoms in infants may include:

• Constipation
• Weakness, loss of muscle tone
• Weak cry
• Poor feeding and weak sucking
• Respiratory distress
• Alertness, despite weakness

Signs and tests

The doctor will perform a physical exam. There may be signs of:

• Absent or decreased deep tendon reflexes
• Absent or decreased gag reflex
• Eyelid drooping
• Muscle function/feeling loss
• Paralyzed bowel
• Speech impairment
• Urine retention with inability to urinate

Blood tests can be done to identify the toxin. A stool culture may also be ordered. Lab tests can be done on the suspected food to confirm botulism.

Treatment

Botulinus antitoxin is given.

Breathing trouble requires hospitalization. The health care team will establish a clear airway and provide supportive therapy. A tube may be inserted through the nose or mouth into the windpipe to provide an airway for oxygen. A breathing machine may be needed.

Intravenous fluids can be given when the patient has swallowing difficulties. A feeding tube may be inserted in the nose.

Cases of botulism are reported to state health authorities or the U.S. Centers for Disease Control and Prevention by health care providers so that the contaminated food can be removed from stores. Antibiotics are often given, but have not been shown to always be beneficial.

Support Groups

Expectations (prognosis)

Prompt treatment significantly reduces the risk of death.

Complications

• Aspiration pneumonia and infection
• Long-lasting weakness
• Nervous system problems for up to 1 year
• Respiratory distress

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you suspect botulism.

Prevention

NEVER give honey or corn syrup to infants younger than 1 year old -- not even just a little taste on a pacifier.

Prevent infant botulism by exclusively breastfeeding, if possible.

Always throw away bulging cans or foul-smelling preserved foods. Sterilizing home-canned foods by pressure cooking at 250 degrees Fahrenheit for 30 minutes may prevent botulism.

Keep foil-wrapped baked potatoes hot or in the refrigerator, not out in room temperature.

References

Bartlett JG. Clostridial infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier. 2007: chap 319.

Bleck TP. Clostridium botulinum (Botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2005: chap 243.

Long SS. Clostridium botulinum (Botulism). In: Long SS, Pickering LK, Prober CG. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.

Centers for Disease Control and Prevention (CDC). Diagnosis and management of foodborne illnesses: a primer for physicians and other health care professionals. MMWR Recomm Rep. 2004;53(RR-4):1-33.