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About botulism

What is botulism?

The botulism neurotoxin is one of the most potent, lethal substances known.

  • Botulism is a disease caused by this neurotoxin (specifically A, B, E, or F type neurotoxin).
  • The neurotoxin is produced by bacteria called Clostridium botulinum.
  • The neurotoxin paralyzes muscles and can be deadly.
  • There are three major types of botulism that differ in how they are acquired: food-borne, wound, and infant botulism.
  • Food-borne botulism is usually caused by eating contaminated home-canned foods.
  • Never taste-test food that may have gone bad.
  • Wound botulism is due to Clostridium bacteria infecting a wound and releasing the neurotoxin.
  • In infant botulism, the baby consumes spores of the bacteria which then grow in the baby's intestine and release the neurotoxin.
  • Honey can contain spores of the bacteria and should not be fed to babies less than 1 year of age.
  • Early food-borne and wound botulism can be treated with an antitoxin to block the action of the neurotoxin.
  • Botulism neurotoxin is listed as a potential biological weapon.
  • Botulism neurotoxin is used in dilute concentration to treat medical and cosmetic conditions.

What is botulism?

Botulism is a serious illness that causes flaccid paralysis of muscles. It is caused by a neurotoxin, generically called botulinum toxin, produced by the bacterium Clostridium botulinum (and rarely by C. butyricum and C. baratii). There are seven distinct neurotoxins (types A-G) that Clostridium botulinum produces, but types A, B, and E (and rarely F) are the most common that produce the flaccid paralysis in humans. The other types mainly cause disease in animals and birds, which also develop flaccid paralysis. Most Clostridium species produce only one type of neurotoxin; however, the effects of A, B, E, or F on humans are essentially the same. Botulism is not transmitted from person to person. Botulism develops if a person ingests the toxin (or rarely, if it is inhaled or injected) or if the Clostridium spp. organisms grow in the intestines or wounds in the body and toxin is released.

The recorded history of botulism begins in 1735, when the disease was first associated with German sausage (food-borne disease or food poisoning after eating sausage). In 1870, a German physician by the name of Muller derived the name botulism from the Latin word for sausage. Clostridium botulinum bacteria were first isolated in 1895, and a neurotoxin that it produces was isolated in 1944 by Dr. Edward Schantz. From1949 to the 1950s, the toxin (named BoNT A) was shown to block neuromuscular transmissions by blocking the release of acetylcholine from motor nerve endings. Botulism toxin(s) are some of the most toxic substances known to man; while the toxin has been considered for use as a biological weapon, it has also been used to treat many medical conditions. In 1980, Dr. Scott used the toxin to treat strabismus (deviation of the eye), and in December 1989, BoNT-A (BOTOX) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of strabismus, blepharospasm, and hemifacial spasm in young patients. The use of BOTOX to treat glabellar lines (wrinkles and frown lines) was approved in 2002 by the FDA for cosmetic improvements; the FDA has approved many additional uses (for example, underarm sweating, and muscle pain disorders) since 2002.

What are the symptoms for botulism?

Foodborne botulism

Signs and symptoms of foodborne botulism typically begin between 12 and 36 hours after the toxin gets into your body. But, depending on how much toxin was consumed, the start of symptoms may range from a few hours to a few days. Signs and symptoms of foodborne botulism include:

Wound botulism

Signs and symptoms of wound botulism appear about 10 days after the toxin has entered the body. Wound botulism signs and symptoms include:

The wound may or may not appear red and swollen.

Infant botulism

If infant botulism is related to food, such as honey, problems generally begin within 18 to 36 hours after the toxin enters the baby's body. Signs and symptoms include:

  • Constipation, which is often the first sign
  • Floppy movements due to Muscle Weakness and trouble controlling the head
  • Weak cry
  • Irritability
  • Drooling
  • Drooping eyelids
  • Tiredness
  • Difficulty sucking or feeding
  • Paralysis

Certain signs and symptoms usually don't occur with botulism. For example, botulism doesn't generally increase blood pressure or heart rate, or cause Fever or confusion. Sometimes, however, wound botulism may cause fever.

When to see a doctor

Seek urgent medical care if you suspect that you have botulism. Early treatment increases your chances of survival and lessens your risk of complications.

Seeking medical care promptly may also alert public health authorities. They may then be able to keep other people from eating contaminated food. Botulism isn't contagious from person to person.

What are the causes for botulism?

Foodborne botulism

The source of foodborne botulism is often home-canned foods that are low in acid, such as fruits, vegetables and fish. However, the disease has also occurred from spicy peppers (chiles), foil-wrapped baked potatoes and oil infused with garlic.

When you eat food containing the toxin, it disrupts nerve function, causing paralysis.

Wound botulism

When C. botulinum bacteria get into a wound — possibly caused by an injury you might not notice — they can multiply and produce toxin. Wound botulism has increased in recent decades in people who inject heroin, which can contain spores of the bacteria. In fact, this type of botulism is more common in people who inject tar heroin.

Infant botulism

Babies get infant botulism after consuming spores of the bacteria, which then grow and multiply in their intestinal tracts and make toxins. The source of infant botulism may be honey, but it's more likely to be exposure to soil contaminated with the bacteria.

Are there benefits to botulinum toxin?

You might wonder how something so toxic could ever be beneficial, but scientists have found that the paralyzing effect of botulinum toxin makes it useful in certain circumstances.

Botulinum toxin has been used to reduce facial wrinkles by preventing contraction of muscles beneath the skin and for medical conditions, such as eyelid spasms and severe headaches. However, there have been rare occurrences of serious side effects, such as muscle paralysis extending beyond the treated area, with the use of botulinum toxin for medical reasons. Be sure to use a licensed doctor for any cosmetic or medical procedures using onabotulinumtoxinA (Botox).

What are the treatments for botulism?

For cases of foodborne botulism, doctors sometimes clear out the digestive system by inducing vomiting and giving medications to induce bowel movements. If you have botulism in a wound, a doctor may need to remove infected tissue surgically.


If you're diagnosed early with foodborne or wound botulism, injected antitoxin reduces the risk of complications. The antitoxin attaches itself to toxin that's still circulating in your bloodstream and keeps it from harming your nerves.

The antitoxin cannot, however, reverse the damage that's been done. Fortunately, nerves do regenerate. Many people recover fully, but it may take months and extended rehabilitation therapy.

A different type of antitoxin, known as botulism immune globulin, is used to treat infants.


Antibiotics are recommended for the treatment of wound botulism. However, these medications are not advised for other types of botulism because they can speed up the release of toxins.

Breathing assistance

If you're having trouble breathing, you'll probably need a mechanical ventilator for as long as several weeks as the effects of the toxin gradually lessen. The ventilator forces air into your lungs through a tube inserted in your airway through your nose or mouth.


As you recover, you may also need therapy to improve your speech, swallowing and other functions affected by the disease.

What are the risk factors for botulism?

The CDC reports that 65 percent of botulism cases occur in infants or children younger than 1 year of age. Infant botulism is typically the result of exposure to contaminated soil, or by eating foods that contain botulism spores. Honey and corn syrup are two examples of foods that can have contamination. These spores can grow inside the intestinal tract of infants, releasing the botulism toxin. Older children and adults have natural defenses that prevent the bacteria from growing.

According to the CDC, around 15 percent of botulism cases are foodborne. These can be home-canned foods or commercially canned products that didn’t undergo proper processing. The World Health Organization (WHO) reports that botulism toxin has been found in:

  • preserved vegetables with low acid content, such as beets, spinach, mushrooms, and green beans
  • canned tuna fish
  • fermented, smoked, and salted fish
  • meat products, such as ham and sausage

Wound botulism makes up 20 percent of all botulism cases, and is due to botulism spores entering an open wound, according to the CDC. The rate of occurrence for this type of botulism has risen in recent years due to drug use, as the spores are commonly present in heroin and cocaine.

Botulism isn’t passed from person to person. A person must consume the spores or toxin through food, or the toxin must enter a wound, to cause the symptoms of botulism poisoning.

Is there a cure/medications for botulism?

Antitoxin should be administered for mild cases, while more severe cases should use a ventilator to support breathing.

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