Botulism

Botulism is a potentially deadly illness caused by a toxin produced by bacteria called Clostridium botulinum. These bacteria are found in the soil and at the bottom of lakes, streams, and oceans. The intestinal tracts of fish, mammals, crabs, and other shellfish may contain C. botulinum and its spores. The bacteria's spores can survive in improperly prepared foods.

Causes

A very small amount of the Botulism toxin can cause illness. People come in contact with this toxin in one of three ways:
  • Eating food contaminated with the toxin, such as:
  • Home-canned goods
  • Sausage
  • Meat products
  • Seafood
  • Canned vegetables
     
  • An infant swallowing the bacteria's spores, which grow in the baby's body and produce the toxin. Honey is a prime source of infant Botulism . Other sources include soil and dust.
  • A wound becomes infected with the bacteria (rare in the US). The toxin then travels to other parts of the body through the bloodstream.
In some cases, the source of the bacteria is unknown.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
  • Eating improperly canned foods
  • Honey consumption in infants
  • IV drug use (rare)

Symptoms

Symptoms begin in the face and eyes, and progress down both sides of the body. If left untreated, muscles in the arms, legs, and torso, as well as those used in breathing become paralyzed. Death can occur.

Symptoms can range from mild to severe and include:

In adults:
  • Muscle weakness
  • Dizziness
  • Double or blurred vision
  • Droopy eyelids
  • Trouble swallowing
  • Dry mouth
  • Sore throat
  • Slurred speech
  • Difficulty breathing
  • Constipation
In babies:
  • Constipation
  • Not eating or sucking
  • Little energy
  • Poor muscle tone
  • Feeble cry
When food is the cause of botulism, symptoms usually start within 36 hours of eating the contaminated food. Some people notice symptoms within a few hours. Others may not develop symptoms for several days. Some people experience nausea, vomiting, and diarrhea. When a wound is the cause of botulism, symptoms start within 4-14 days.

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. Blood, stool, and stomach contents will be tested for the toxin. Stool will also be tested for the C. botulinum itself. Samples of questionable food may also be tested for the toxin and bacteria. A wound culture will be done if wound botulism is suspected.

Tests to rule out other medical conditions may include:
  • Blood work
  • MRI scan – a test that uses magnetic waves to make picture of the inside of the brain
  • Spinal fluid analysis
  • Nerve conduction tests

Treatment

Supportive Care

The most serious complication is respiratory failure. Treatment aims to maintain adequate oxygen supply, which may require a ventilator and close monitoring in an intensive care unit. Feeding through a tube may also be necessary.

Antitoxin

If treatment begins early, an antitoxin can stop the paralysis from progressing and may shorten symptoms. It does not reverse the disease process.

Ridding the Body of Toxins

Methods to eliminate the toxin include:
  • Enemas
  • Suctioning of stomach contents
  • Medication to stimulate vomiting
  • Surgery to clean a wound
  • Antibiotics to treat a wound infection

Prevention

High temperatures can destroy the botulism toxin. Strategies to prevent Botulism include:
  • Do not feed honey to children less than 1 year old.
  • Refrigerate oils that contain garlic or herbs.
  • Bake potatoes without foil. If potatoes are wrapped in foil, keep them hot until served or refrigerate them.
  • Do not taste foods that appear spoiled.
  • Do not eat food from a can that is bulging.
  • Boil home-canned foods for 10 minutes before eating.
  • Practice good hygiene when canning. Follow government recommendations.
  • Seek medical care for wounds. Return to the doctor if a wound looks infected (redness, warmth, pus, tenderness).
  • Do not inject illicit drugs.