Botulism

Botulism is a rare but serious condition. A toxin that attacks the body's nerves causes it. A type of bacterium called Clostridium botulinum produces the toxin. The toxin is known as botulinum toxin. Botulism symptoms may be life-threatening.

Botulism can happen when the toxin gets into food or a wound. The condition also can happen when bacteria grow in the intestines of infants. Rarely, medical treatment or a bioweapon can cause botulism.

Three common forms of botulism are:

• Foodborne botulism. The harmful bacteria thrive and make a toxin in places that have little oxygen, such as in home-canned food.
• Wound botulism. If these bacteria get into a cut, they can cause a harmful infection when bacteria make the toxin.
• Infant botulism. This form of botulism begins after a baby takes in spores of C. botulinum bacteria. The bacteria grow in the baby's intestinal tract. Infant botulism mainly happens in babies age 2 to 8 months. Rarely, adults get this form of intestinal botulism.

Sometimes botulism happens when people get too much botulinum toxin for cosmetic or medical reasons. This rare form is called iatrogenic botulism. The term "iatrogenic" means an illness caused by medical exam or treatment.

Another rare form of botulism can happen from breathing in toxins. This may happen as the result of botulinum toxin used as a bioweapon.

All forms of botulism can be fatal. Anyone with botulism needs emergency medical help right away.

Foodborne botulism

Symptoms of foodborne botulism most often begin 12 to 36 hours after the toxin enters the body. But depending on how much toxin gets in, the start of symptoms may range from hours to days.

Symptoms of foodborne botulism include:

• Trouble swallowing or speaking.
• Dry mouth.
• Weakness on both sides of the face.
• Blurred or double vision.
• Drooping eyelids.
• Trouble breathing.
• Upset stomach, vomiting and stomach cramps.
• Not being able to move, called paralysis.

Wound botulism

Symptoms of wound botulism appear about 10 days after the toxin enters the body. Wound botulism symptoms include:

• Trouble swallowing or speaking.
• Weakness on both sides of the face.
• Blurred or double vision.
• Drooping eyelids.
• Trouble breathing.
• Not being able to move, called paralysis.
• Fever, often from infection of the wound.

The area around the wound may not always look swollen or show a change of color.

Infant botulism

Symptoms most often begin 18 to 36 hours after the toxin enters the baby's body.

Symptoms include:

• Trouble passing stool, called constipation. This often is the first symptom.
• Floppy movements due to muscle weakness and trouble holding up the head.
• Weak cry.
• Crankiness.
• Drooling.
• Drooping eyelids.
• Tiredness.
• Trouble sucking or feeding.
• Not being able to move, called paralysis.

Iatrogenic botulism

Iatrogenic botulism, in which someone gets the toxin from cosmetic or medical treatments, rarely causes serious side effects. Side effects may include headache, lack of facial movement, called paralysis, and muscle weakness.

When to see a doctor

Get medical care right away if you think that you have botulism. Fast treatment raises your chances of surviving and lowers your risk of complications.

Getting medical care quickly also can let public health officials know about foodborne botulism. They may be able to keep other people from eating tainted food. Keep in mind, though, that botulism can't spread from person to person.

Foodborne botulism

The source of foodborne botulism most often is homemade food that is poorly canned or preserved. Fruits, vegetables and fish often are the cause. Other foods, such as spicy chili peppers, foil-wrapped baked potatoes and oil that has garlic in it also may cause botulism.

Wound botulism

When C. botulinum bacteria get into a wound, they can multiply and make a toxin. This can happen even if the wound is a small cut.

Wound botulism has happened more often in recent years in people who use needles to take heroin. The heroin may have spores of the bacteria. This form of botulism is more common in people who use black tar heroin.

Infant botulism

Babies get infant botulism when the bacteria spores get into the intestinal tract. The bacteria make a toxin in the intestines.

Sometimes the source of infant botulism is honey. Don't feed honey or foods with honey in them to infants younger than 1 year. But infant botulism is more likely to happen after contact with soil tainted with the bacteria. Rarely, adults get this form of intestinal botulism.

Iatrogenic botulism

Rarely, botulism happens when too much botulinum toxin is given by shot for cosmetic reasons, such as removing wrinkles, or for medical reasons, such as treating migraines.

Inhaled botulism

If a group of people get botulism with no clear cause, the cause may be use of botulinum toxin as a bioweapon.

Risk factors for botulism include the following:

• For foodborne botulism, eating food that is poorly canned, preserved or stored.
• For wound botulism, using needles to take illicit drugs.
• For infant botulism, giving honey to babies younger than 1 year.

Because it affects muscle control throughout the body, botulinum toxin can cause many complications. The greatest danger is not being able to breathe. This is a common cause of death in people who get botulism. Other complications may include:

• Trouble speaking.
• Trouble swallowing.
• Long-lasting weakness.
• Shortness of breath.

People with these complications may need rehabilitation to rebuild their strength or help with speaking, swallowing or breathing.

Foodborne botulism

Make sure to destroy botulism germs when canning or preserving foods at home. And prepare and store food safely.

• Pressure-cook home-canned foods at 250 degrees Fahrenheit (121 degrees Celsius) for 20 to 100 minutes depending on the food.
• Boil home-canned foods for 10 minutes before serving them.
• Don't eat preserved food if the container bulges or the food smells bad. But taste and smell won't always give away the presence of C. botulinum. Some strains of C. botulinum don't make food smell or taste bad.
• If you wrap potatoes in foil before baking, eat them hot. To store the potatoes, loosen the foil and put the potatoes in the refrigerator. Don't keep them at room temperature.
• Store homemade oils that have garlic or herbs in them in the refrigerator. Throw them out after four days.
• Put canned foods in a container and store in the refrigerator after you open them.

Wound botulism

To prevent wound botulism and other serious bloodborne diseases, never breathe in street drugs or use a needle to take them. Keep wounds clean to prevent infection. If you think a wound is infected, seek medical help right away.

Infant botulism

To lower the risk of infant botulism, don't give any honey to babies younger than 1 year.

Iatrogenic botulism

To prevent iatrogenic botulism, be sure to go to a licensed healthcare professional for any cosmetic or medical procedure that uses botulinum toxin. Types include onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport) and others.

To diagnose botulism, your healthcare professional checks for muscle weakness or lack of muscle movement, called paralysis. Tell your healthcare professional about foods you've eaten in the past few days and if you have a wound that might be infected.

For possible infant botulism, a healthcare professional may ask if your child has eaten honey, is having trouble passing stool, called constipation, or has been less active than usual.

A study of blood, vomit, stool or the suspected food to look for the toxin may help confirm a diagnosis of infant or foodborne botulism. But getting these test results may take days. So a physical exam is the main way to diagnose botulism.

For foodborne botulism, a healthcare professional may cause you to vomit or give you medicine to help you pass stool. This is to clear the toxin from your body. If you have wound botulism, a surgeon may need to remove infected tissue.

Symptoms related to getting botulinum toxin for cosmetic or medical reasons most often get better with time.

Antitoxin

If you're diagnosed early with foodborne or wound botulism, you may get a shot of antitoxin to lower the risk of complications. The antitoxin attaches itself to toxin that's moving through your bloodstream and keeps it from harming your nerves.

The antitoxin can't reverse damage that's already been done. But nerves can repair themselves. Many people recover fully. But recovery may take up to a year. And most people need rehabilitation therapy.

Healthcare professionals may use another type of antitoxin to treat infants. This is called human-derived botulism immune globulin.

Antibiotics

Antibiotics most often treat wound botulism when the wound is infected. But antibiotics don't treat other forms of botulism because the medicines can speed up the release of toxins in the body.

Breathing aid

If you have trouble breathing, you may need to use a machine called a mechanical ventilator for up to several weeks while your body fights the toxin's effects. The ventilator forces air into your lungs through a tube in your nose or mouth.

Rehabilitation

As you get better, you also may need therapy to rebuild your strength or help with speaking, swallowing or other functions botulism affects.

You may start by seeing your main healthcare professional. Or you may need to go to a hospital for treatment right away. At the hospital, you may see several healthcare professionals. They may include doctors who specialize in conditions that affect the brain and nerves, called neurologists, and specialists in infectious diseases.

What you can do

Make a list of:

• Your symptoms and when they began.
• Key personal information, including major stresses, recent life changes and family medical history.
• All medicines, vitamins, and other supplements you take, including dosages.
• Questions to ask your healthcare professional.

Take a family member or friend along, if possible, to help you remember the information you get.

For botulism, basic questions to ask include:

• How did I get botulism?
• What treatment do you suggest?
• Will I have lasting damage?
• How can I keep this from happening again?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional may ask you questions, such as:

• Are your symptoms constant or do they come and go?
• How bad are your symptoms?
• Have you or your child eaten any home-canned food recently?
• If your infant is ill, has your infant eaten honey?
• Did anyone else eat the food that might have made you ill?