Botulism

Botulism, a paralytic illness, is rare, but it can cause serious, paralyzing symptoms and may be fatal. The disease is caused by a nerve toxin formed from a bacterium (germ), called Clostridium botulinum, which is found in soil.

There are seven known botulism toxins (poisons), but only toxins type A, B, E, and F are harmful to humans. There are three kinds of botulism, characterized differently on the basis of their means of exposure:

• Foodborne botulism - This type of botulism is caused by eating food contaminated with a botulism toxin. Foodborne botulism can affect a great number of people who eat contaminated food. The World Health Organization (WHO) considers botulism one of the four most likely agents to be used in biological warfare (a state in which infectious agents or toxic chemicals are being used as a weapon of mass destruction).
• Wound botulism - This type of botulism is caused by a botulism toxin that is produced from a wound that was contaminated with Clostridium botulinum.
• Infant botulism - This type of botulism occurs when infants consume spores of Clostridium botulinum, which then release toxins in the intestines.

How prevalent is botulism?

On average, only 110 cases of botulism are reported in the United States each year. Of these:

• 25 percent are foodborne botulism.
• 72 percent are infant botulism.
• 3 percent are wound botulism.

Infant botulism is a very rare disorder in the Chicago area.

What are the symptoms of botulism?

The symptoms of foodborne botulism usually occur 18 to 36 hours after eating contaminated food. However, symptoms may occur as early as six hours or as late as 10 days following exposure. The following are generally the most common symptoms of botulism. However, individuals may experience symptoms differently.

Symptoms may include:

• Double vision or blurred vision
• Drooping eyelids
• Slurred speech
• Difficulty swallowing
• Dry mouth
• Muscle weakness

Infants with botulism may seem lethargic, feed poorly, experience constipation, and have a weak cry and appear floppy. If left untreated, symptoms may progress to paralysis of the arms, legs, trunk, and breathing muscles. The symptoms of botulism may resemble other medical conditions or problems. Always consult your physician for a diagnosis. How is botulism diagnosed? The patient's history and physical examination may lead to a diagnosis of botulism. However, since botulism resembles other diseases, other diagnostic testing may be necessary, including the following:

• Computed tomography scan (Also called a CT or CAT scan) - This diagnostic procedure that uses a combination of x-rays and computer technology to produce cross-sectional pictures of the body. A CT scan can show detailed images of any part of the body, including the brain, bones, muscles, fat, and organs. CT scans are more detailed than routine x-rays.
• Spinal tap (Also called a lumbar puncture) - A small amount of fluid can be removed and sent for testing to determine if there are signs of an infection or other problems.
• Electromyogram (EMG) - This test measures the electrical activity of a muscle or a group of muscles. An EMG can detect abnormal electrical muscle activity.
• Test for botulism toxin poisons in the patient's serum or stool.

What is the treatment for botulism?

Specific treatment for botulism will be determined by your physician based on:

• Your child's age, overall health, and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures, or therapies

Treatment may include:

• Antitoxin treatment for foodborne and wound botulism (when diagnosed early)
• Removal of contaminated food in the gut through induced vomiting or enemas in food botulism
• Surgical treatment for infected wounds (to remove the source of the toxin) in wound botulism
• Respiratory assistance (ventilator) for patients who need this
• Intensive medical and supportive care including antibiotics

Recovery from botulism may take many weeks. Fatigue and shortness of breath may persist for years.

Preventing botulism

Most foodborne botulism is caused by home-canned foods with low acid content, such as asparagus, beets, corn, and green beans. More unusual sources of foodborne botulism have included the following:

• chopped garlic in oil
• chili peppers
• tomatoes
• improperly handled baked potatoes in aluminum foil
• home-canned or fermented fish

To reduce contamination, home-canning should be done following strict hygienic procedures set by county extension services or by the US Department of Agriculture. Botulism spores are killed by high temperatures. It is advisable to boil home-canned foods for 10 minutes before eating.

Other preventive measures should include the following:

• Garlic and other herbs in oils should be refrigerated.
• Potatoes baked in aluminum foil should be kept hot until served or refrigerated.
• Children under the age of 12 months should not be fed honey, because it can contain botulism spores.
• Seek prompt medical care for infected wounds.
• Do not use injectable street drugs.

Always consult your physician for more information.