Botulism (Clostridium Botulinum)

What is botulism (Clostridium botulinum)?

Botulism is a serious illness caused by bacteria called Clostridium botulinum. The bacteria produce a poison (toxin) that can attack your body’s nervous system. If left untreated, botulism can be fatal.

Botulism poisoning is rare. But because it can cause death, you should call 911 or go to your nearest emergency room if you or your child develop botulism symptoms. Symptoms may include drooping eyelids and other signs affecting the muscles of your face, eyes and throat. It can eventually affect muscles related to breathing.

What happens if you get Clostridium botulinum?

Clostridium botulinum toxins attack your nerves. This can cause weakness and paralysis of your muscles, like those that help you move, talk and swallow. If the toxins attack the nerves that control your breathing, it can be fatal.

There are several different types of botulism. The most common kinds include foodborne botulism, infant botulism and wound botulism. Iatrogenic botulism and adult intestinal toxemia botulism are other rare forms of botulism.

Foodborne botulism

Foodborne botulism can happen when you eat foods contaminated with Clostridium botulinum spores. When food is stored improperly, bacteria can grow. As the bacteria grow, they release toxins into your food.

Foodborne botulism commonly occurs when homemade canned foods are improperly preserved or stored. Though rare, improperly canned store-bought foods can also cause botulism. Other sources of foodborne botulism include:

• Oils infused with herbs.
• Potatoes baked in aluminum foil.
• Canned cheese sauces.
• Bottled garlic.
• Canned tomatoes.
• Carrot juice.
• Foods kept warm or left unrefrigerated for too long.

Infant botulism

Botulism in babies can occur when Clostridium botulinum spores are ingested. When the spores reach your baby’s intestines, they grow and release the toxin. The source of the spores isn’t always known. But they’re commonly found in soil and dust. When the soil and dust become airborne, your baby may breathe them in.

The spores may also be present in honey. Ingesting botulinum spores doesn’t cause botulism in healthy older children and adults. But for reasons unknown, the toxin is released in infants younger than 12 months old. This is why experts advise that babies shouldn’t eat honey until they’re at least 1 year old.

Wound botulism

Wound botulism can develop when Clostridium botulinum spores get into a wound. When the spores get into a wound, they can grow and release toxins into your bloodstream.

Wound botulism most often occurs in people who use needles to inject drugs into their veins. In rare cases, it can also develop after surgery or a serious injury.

Iatrogenic botulism

Iatrogenic botulism can occur when you have too much botulinum toxin (Botox®) injected. Botox uses a purified and heavily diluted form of Clostridium botulinum. You may receive botulinum toxin treatments for cosmetic reasons, such as wrinkles. Or you may receive them for medical reasons, such as migraine headaches.

Botox botulism is rare. But you should only get botulinum toxin injections from a licensed medical professional. They’ll know the safest and correct amount to give you.

Adult intestinal toxemia botulism

Adult intestinal toxemia botulism is also known as adult intestinal colonization. It’s a very rare kind of botulism that can happen when Clostridium botulinum spores get into your intestines. The spores grow and produce toxins the same way they do in infants. If you have a serious health condition that affects your digestive system, you may be more likely to develop this form of botulism.

How common is botulism?

Botulism is rare. In 2018, 242 confirmed botulism cases were reported to the U.S. Centers for Disease Control and Prevention (CDC). Most of the cases involved infant botulism.

What are the signs and symptoms of botulism (Clostridium botulinum)?

Symptoms of infant botulism can range from mild to severe. They may develop anywhere from three to 30 days after exposure to Clostridium botulinum spores. Symptoms of infant botulism can include:

• Drooping eyelids (ptosis).
• Loss of facial expression.
• Drooling.
• Weakened cry.
• Slow or poor feeding.
• Reduced gag reflex.
• Constipation.
• Weakness or floppiness.
• Difficulty breathing.

Symptoms of botulism in older children and adults usually begin in the muscles of your face, eyes and throat. Without treatment, symptoms can spread to other parts of your body. Signs can appear from a few hours to several days after ingesting botulism spores. Symptoms include:

• Drooping eyelids (ptosis).
• Double or blurred vision.
• Dry mouth (xerostomia).
• Slurred speech.
• Difficulty swallowing (dysphagia).
• Difficulty breathing.
• Weakness or paralysis of your arms or legs.
• Nausea and vomiting.

What causes botulism?

Bacteria called Clostridium botulinum causes botulism. Sometimes, Clostridium butyricum or Clostridium baratii bacteria cause botulism. You can come in contact with the bacteria or its spores without getting sick. But under certain conditions, the spores can develop and grow.

These mature bacteria then release the toxins. When the toxins are released, they quickly spread into your bloodstream and attach to your nerves. Botulism develops when those nerves no longer work. Conditions that allow spores to develop and grow include:

• Low oxygen or lack of oxygen.
• Low acidity, sugar or salt.
• Cooking temperatures that are too low (even boiling may not destroy the spores).
• Certain amounts of water.
• Storage temperatures that are too warm.

How do you get botulism (Clostridium botulinum)?

You can get Clostridium botulinum from an infected wound or from eating contaminated food. But the bacteria release toxins that can make you sick if they get into your body through your mouth or a break in your skin.

What is Clostridium botulinum commonly found in?

The spores of Clostridium botulinum bacteria are commonly found in soil but only rarely make you sick. It’s sometimes found in preserved vegetables, fish or meats. Foods preserved by home canning methods are more likely to be contaminated than foods found in grocery stores. Infants under a year old can get Clostridium botulinum toxins from honey.

How is botulism (Clostridium botulinum) diagnosed?

To diagnose botulism, your healthcare provider will perform a physical examination. They’ll ask you about your symptoms and check for weak or paralyzed muscles.

Botulism can resemble symptoms of other conditions including stroke, meningitis and Guillain-Barré syndrome. So, your healthcare provider may need to do more testing to confirm a diagnosis of botulism.

What tests will be done to diagnose botulism?

To confirm the diagnosis of botulism, your healthcare provider can conduct a test that shows the toxin is present in your blood, stool or vomit. Suspected food samples can also be tested for the toxin.

Other tests your healthcare provider may use include:

• Brain scan.
• Spinal fluid exam.
• Nerve and muscle function tests (electromyography).

The test results can take several days. So, your healthcare provider may begin treatment right away if botulism is suspected.

How is botulism (Clostridium botulinum) treated?

Depending on the cause and severity of your botulism, your healthcare provider may use a variety of treatment options. In the most common treatment, your healthcare provider will give you a medication called an antitoxin. Antitoxins block the toxin’s activity in your bloodstream. This prevents the toxins from causing any more damage. But antitoxin can’t heal what’s already been damaged. You may need to stay in the hospital for weeks or months while you heal.

If you have breathing problems, your healthcare provider may place you on a breathing machine (ventilator). A ventilator is a machine that helps you breathe. You’ll be on a ventilator until any paralysis affecting your breathing goes away.

If you have wound botulism, you may need an operation to remove the contaminated part of your wound surgically. After the operation, you may take antibiotics to keep the infection from coming back.

Can botulism be cured?

No specific treatment will cure botulism, though mild nerve damage can heal. Antitoxins can stop further damage from the toxin.

What are the complications or side effects of botulism?

Botulism can paralyze the muscles that help you swallow and breathe. While antitoxins can help in many cases, some people do die of breathing problems and infections. In addition, health issues that may result from botulism include:

• Extreme tiredness (fatigue).
• Long-term weakness.
• Shortness of breath (dyspnea).
• Aspiration pneumonia and infection.
• Nervous system issues.

What can I expect after treatment for botulism?

Depending on the severity of your case, recovery from botulism can take weeks, months or even years. Most people who receive prompt treatment recover completely in fewer than two weeks.

How can I prevent botulism?

You can take steps to prevent the most common types of botulism.

Foodborne botulism

• Refrigerate foods within two hours after cooking. Proper refrigeration prevents the bacteria from producing spores.
• Cook food thoroughly.
• Avoid food containers that appear damaged or bulging. (These can be signs of gas produced by the bacteria.)
• Sterilize home-canned foods in a pressure cooker at 250°F (121°C) for 30 minutes.
• Throw away foul-smelling preserved foods.

Infant botulism

• Don’t give honey to babies under one year old.
• Breastfeed your baby to slow the onset of illness if botulism develops.

Wound botulism

• Don’t abuse injectable drugs.
• Seek medical treatment for a wound with signs of infection including redness, tenderness, swelling or pus.
• Clean wounds contaminated by dirt and soil thoroughly.

Iatrogenic botulism

• Only get Botox injections from licensed medical professionals.

What is my outlook if I have botulism?

Botulism can be fatal if left untreated. But most people who receive a prompt diagnosis and treatment can make a full recovery from the illness. They return to normal functioning throughout their lives.