Botulism
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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 bacteria enter open wounds and produce toxins there.
Infant botulism occurs when a baby eats living bacteria or its spores and they grow in 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.
About 110 cases of botulism occur in the U.S. per year. Most of the cases are in infants.
References
Arnon SS. Botulism (Clostridium botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.
Reddy P, Bleck TP. Clostridium botulinum (botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 245.
Long SS. Clostridium botulinum (Botulism). In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.
National Center for Home Food Preservation. USDA Complete Guide to Home Canning, 2009 revision. Accessed July 5, 2011.
Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Symptoms
Symptoms usually appear 8 - 36 hours after you eat contaminated food. There is NO fever with this infection.
In adults, symptoms may include:
Symptoms in infants may include:
- Constipation
- Poor feeding and weak sucking
- Respiratory distress
- Weak cry
- Weakness, loss of muscle tone
Signs and tests
The health care provider will perform a physical exam. There may be signs of:
- Absent or decreased deep tendon reflexes
- Absent or decreased gag reflex
- Eyelid drooping
- Loss of muscle function/feeling
- 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.
References
Arnon SS. Botulism (Clostridium botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.
Reddy P, Bleck TP. Clostridium botulinum (botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 245.
Long SS. Clostridium botulinum (Botulism). In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.
National Center for Home Food Preservation. USDA Complete Guide to Home Canning, 2009 revision. Accessed July 5, 2011.
Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Treatment
You will get botulinus antitoxin.
For breathing trouble, you will have to stay in a hospital. The health care team will clear your airway and provide treatment. A tube may be inserted through the nose or mouth into the windpipe to provide an airway for oxygen. You may need a breathing machine.
Patients who have trouble swallowing may getintravenous fluids. A feeding tube may be inserted.
Health care providers report cases of botulism to state health authorities or the U.S. Centers for Disease Control and Prevention so that the contaminated food can be removed from stores.
Some people receive antibiotics, but they may not always help.
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.
References
Arnon SS. Botulism (Clostridium botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.
Reddy P, Bleck TP. Clostridium botulinum (botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 245.
Long SS. Clostridium botulinum (Botulism). In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.
National Center for Home Food Preservation. USDA Complete Guide to Home Canning, 2009 revision. Accessed July 5, 2011.
Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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 breastfeeding only, if possible.
Always throw away bulging cans or foul-smelling preserved foods. Sterilizing home-canned foods by pressure cooking them at 250 degrees Fahrenheit for 30 minutes may reduce the risk for botulism.
Keep foil-wrapped baked potatoes hot or in the refrigerator, not at room temperature.
References
Arnon SS. Botulism (Clostridium botulinum). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 202.
Reddy P, Bleck TP. Clostridium botulinum (botulism). In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2009: chap 245.
Long SS. Clostridium botulinum (Botulism). In: Long SS, ed. Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Philadelphia, Pa: Churchill Livingstone Elsevier; 2008: chap 189.
National Center for Home Food Preservation. USDA Complete Guide to Home Canning, 2009 revision. Accessed July 5, 2011.
Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 8/24/2011
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.