Edit concept Create issue ticket

Botulism

Infantile Botulism

Botulism is an intoxication caused by botulinum toxin produced by the bacterium Clostridium botulinum.


Presentation

In all forms of botulism, the signs and symptoms are similar. However, in the food borne variety, gastrointestinal symptoms like vomiting and diarrhea may be present.

The most common presentation is the characteristic weakness of the muscles supplied by cranial nerves. Muscle paralysis starts from the face which manifests as loss of facial expressions, ptosis, diplopia, dyspnea, dysphagia and difficulty in talking [4].

The paralysis then symmetrically descends to involve the limbs causing weakness of the arms and legs. There may also be a diminishing or even a total absence of the reflexes. As the disease progresses, it may also cause paralysis of the muscles of respiration leading to respiratory arrest which can be life threatening.

Constipation is an early symptom in infant botulism which is most likely to be missed.

Stridor
Dyspnea
  • Muscle paralysis starts from the face which manifests as loss of facial expressions, ptosis, diplopia, dyspnea, dysphagia and difficulty in talking.[symptoma.com]
Malaise
  • Vomiting Dysphagia Diplopia Dilated/fixed pupils Extremely dry mouth unrelieved by drinking fluids Generally, botulism progresses as follows: Preceding or following the onset of paralysis are nonspecific findings such as nausea, vomiting, abdominal pain, malaise[emedicine.medscape.com]
  • Generally, botulism progresses as follows:Preceding or following the onset of paralysis are nonspecific findings such as nausea, vomiting, abdominal pain, malaise, dizziness, dry mouth, dry throat, and, occasionally, sore throat.[slideshare.net]
Constipation
  • The subject of this study was a three-month-old Costa Rican boy who was hospitalized because of poor suction and feeding, hypotonia, and constipation. Clinical history and physical examination findings suggested infant botulism.[ncbi.nlm.nih.gov]
  • The second case is particularly interesting, presenting with profound diarrhea following initial constipation, an unlikely symptom for an infant with botulism and possibly caused by Bacteroides fragilis.[ncbi.nlm.nih.gov]
  • This disease presents with symptoms such as constipation, weakness, and hypotonia and can lead to respiratory failure.[ncbi.nlm.nih.gov]
  • In June 2013, a male newborn aged 9 days (delivered after a full-term pregnancy) was brought to a hospital emergency department with a 2-day history of constipation, fussiness, and poor feeding.[ncbi.nlm.nih.gov]
  • Constipation and poor feeding in babies will almost certainly have another cause, but medical advice should always be sought for these symptoms.[health.govt.nz]
Vomiting
  • A blood, stool or vomit analysis may also be ordered. Treatment of foodborne or infant botulism typically includes ridding the body of the toxin by inducing vomiting or bowel movements. Wound botulism may be treated by removing the infected tissue.[livescience.com]
  • Symptoms often begin with blurred vision and difficulty in swallowing and speaking, but sometimes diarrhoea and vomiting can occur. The disease can go on to lead to further problems with vision, and paralysis.[patient.info]
  • The symptoms of botulism can range from mild, including transient nausea and vomiting , to severe cases that progress to heart and lung failure and, sometimes, death.[emedicinehealth.com]
  • Patient B presented with shortness of breath, vomiting, and stridor.[ncbi.nlm.nih.gov]
Nausea
  • The symptoms of botulism can range from mild, including transient nausea and vomiting , to severe cases that progress to heart and lung failure and, sometimes, death.[emedicinehealth.com]
  • On hospital day 2, the patient was transferred to the intensive care unit for progressive fatigable weakness with ptosis, dysphagia, dysarthria, and nausea.[ncbi.nlm.nih.gov]
  • Symptoms of botulism Common symptoms of botulism in infants, children and adults include: Nausea, vomiting and abdominal cramps Double or blurred vision Drooping eyelids Difficulty swallowing and speaking Difficulty breathing Dry mouth Muscle weakness[northwell.edu]
  • However, to be extra cautious, we advise patients with Crohn’s disease to consult a medical professional immediately if any of the following symptoms occur: vomiting, diarrhea, nausea, fatigue, muscular weakness or the more severe neurological symptoms[badgut.org]
  • The first symptoms are nausea, vomiting and diarrhoea. Later symptoms are paralysis of the eyes, mouth, and throat, and then progressively other muscles. Botulism can also develop when a wound is infected with the bacteria.[health.govt.nz]
Food Poisoning
  • Often-fatal food poisoning caused by presence of a toxin (called botlinus toxin or botulin) produced by the bacteria clostridium botulinum .[businessdictionary.com]
  • […] noun bot·u·lism \ ˈbä-chə-ˌli-zəm \ See What's Trending Now See More Trending Words What's Trending Now More Trending Words Definition of botulism : acute food poisoning that is caused by botulinum toxin produced in food by a bacterial clostridium ( Clostridium[merriam-webster.com]
  • Botulism : An uncommon, but potentially very serious illness, a type of food poisoning , that produces paralysis of muscles via a nerve toxin called botulinum toxin (" botox ") that is manufactured by bacteria named Clostridium botulinum .[emedicinehealth.com]
  • It should be considered as a food poisoning. See also clostridial diseases for additional information. Symptoms These are seen 4-48 hours or so after the toxin has been eaten. All Pigs Muscle paralysis.[thepigsite.com]
Dysphagia
  • Initial symptoms included blurred vision, slurred speech, muscle weakness, ptosis, and dysphagia. All patients received heptavalent botulinum antitoxin, seven required mechanical ventilation, and all survived.[ncbi.nlm.nih.gov]
  • He suffered from mild dysarthria, diplopia, dysphagia and ptosis since two days. The CT-scan of the cerebrum and the liquor were without any pathological results.[ncbi.nlm.nih.gov]
  • Presenting symptoms included dysphagia, diplopia, dysarthria, and weakness. The median time to symptom onset was 54.5 hours (interquartile range [IQR] 49-88 hours) postingestion.[ncbi.nlm.nih.gov]
  • On hospital day 2, the patient was transferred to the intensive care unit for progressive fatigable weakness with ptosis, dysphagia, dysarthria, and nausea.[ncbi.nlm.nih.gov]
  • By history, the most common symptoms were dysphagia (66%), proximal muscle weakness of upper and lower extremity (60%), neck flexor muscle weakness (33%), ophthalmoplegia (53%), bilateral ptosis (46%), dysarthria (53%), double vision (40%), blurred vision[ncbi.nlm.nih.gov]
Drooling
  • Later symptoms include: trouble swallowing saliva, which causes excessive drooling generalised muscle weakness breathing difficulties. These symptoms can develop over about a week. Infant botulism is a very rare condition.[health.govt.nz]
  • The following could all be indications of infant botulism: The first sign of this illness if usually constipation Muscle weakness will lead to limp movements or inability to control the head Drooling Droopy eyelids Irritability Fatigue Issues with feeding[availclinical.com]
  • Symptoms in an infant include lethargy, poor appetite, constipation, drooling, drooping eyelids, a weak cry, and paralysis. Long-Term Effects of Botulism The majority of botulism patients never fully recover their pre-illness health.[foodborneillness.com]
Muscle Weakness
  • By history, the most common symptoms were dysphagia (66%), proximal muscle weakness of upper and lower extremity (60%), neck flexor muscle weakness (33%), ophthalmoplegia (53%), bilateral ptosis (46%), dysarthria (53%), double vision (40%), blurred vision[ncbi.nlm.nih.gov]
  • Slurred speech, drooping eyelids, double vision, dry mouth and muscle weakness are among botulism 's symptoms. But even if the botulism explanation is true, the toxin cannot live in the body for a year.[merriam-webster.com]
  • It also causes persistent fatigue or lassitude due to muscle weakness that always first affects shoulders and upper arms and progressively affect lower parts of the body.[businessdictionary.com]
  • On discharge 3 months after admission he still had muscle weakness and required feeding by a nasogastric tube.[poison.org]
  • Initial symptoms included blurred vision, slurred speech, muscle weakness, ptosis, and dysphagia. All patients received heptavalent botulinum antitoxin, seven required mechanical ventilation, and all survived.[ncbi.nlm.nih.gov]
Blurred Vision
  • Symptoms include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Treatment may include antitoxins, intensive medical care, or surgery of infected wounds.[fpnotebook.com]
  • Initial symptoms included blurred vision, slurred speech, muscle weakness, ptosis, and dysphagia. All patients received heptavalent botulinum antitoxin, seven required mechanical ventilation, and all survived.[ncbi.nlm.nih.gov]
  • The following could indicate foodborne botulism: Dry mouth Drooping eyelids Trouble speaking or swallowing Difficulty breathing Weakness in the muscles of the face Blurred vision or seeing double Abdominal cramping, nausea, and vomiting Paralysis Wound[availclinical.com]
  • A 60-year-old man was hospitalized with blurred vision, diplopia, and dysarthria. On hospital day 2, the patient was transferred to the intensive care unit for progressive fatigable weakness with ptosis, dysphagia, dysarthria, and nausea.[ncbi.nlm.nih.gov]
Diplopia
  • He suffered from mild dysarthria, diplopia, dysphagia and ptosis since two days. The CT-scan of the cerebrum and the liquor were without any pathological results.[ncbi.nlm.nih.gov]
  • Presenting symptoms included dysphagia, diplopia, dysarthria, and weakness. The median time to symptom onset was 54.5 hours (interquartile range [IQR] 49-88 hours) postingestion.[ncbi.nlm.nih.gov]
  • A 60-year-old man was hospitalized with blurred vision, diplopia, and dysarthria. On hospital day 2, the patient was transferred to the intensive care unit for progressive fatigable weakness with ptosis, dysphagia, dysarthria, and nausea.[ncbi.nlm.nih.gov]
  • Clinical features include abdominal pain, vomiting, acute PARALYSIS (including respiratory paralysis), blurred vision, and DIPLOPIA. Botulism may be classified into several subtypes (e.g., food-borne, infant, wound, and others).[fpnotebook.com]
  • Muscle paralysis starts from the face which manifests as loss of facial expressions, ptosis, diplopia, dyspnea, dysphagia and difficulty in talking.[symptoma.com]
Urinary Retention
  • Initial symptoms include blurry vision (accommodation defects, diplopia) with bilateral ptosis, followed by dysautonomic symptoms (dry mouth and eyes, mydriasis, dysphagia, dysarthria, urinary retention and constipation).[orpha.net]
  • Later complications include paralytic ileus, severe constipation , and urinary retention. Wound botulism results when wounds are contaminated with C botulinum spores.[emedicine.medscape.com]
  • The toxin's main focus is on the nervous system and the neurological symptoms with the disease include blurred vision, dilated pupil, inability to swallow, speech impairment, urinary retention, respiratory paralysis and skeletal weakness.[microbewiki.kenyon.edu]
  • Later complications include paralytic ileus, severe constipation, and urinary retention 7. Wound botulism results when wounds are contaminated with Cbotulinum spores.[slideshare.net]
Bladder Distention
  • distention advancing to urinary retention Orthostatic hypotension Reduced salivation Reduced lacrimation Other neurologic findings include the following: Changes in deep tendon reflexes, which may be either intact or diminished Incoordination due to[emedicine.medscape.com]
  • The autonomic nervous system is also involved.Manifestations of this include the following:1 Paralytic ileus advancing to severe constipation2 Gastric dilatation3 Bladder distention advancing to urinary retention4 Orthostatic hypotension5 Reduced salivation6[slideshare.net]
Flaccid Paralysis
  • Within a 3-month period, two infants presented non-specifically to hospital and rapidly progressed developing flaccid paralysis. Both children were diagnosed with infant botulism.[ncbi.nlm.nih.gov]
  • Infant botulism is caused by the ingestion of Clostridium botulinum spores and leads to a life-threatening descending motor weakness and flaccid paralysis in infant children.[ncbi.nlm.nih.gov]
  • It is characterized by symmetric cranial nerve palsy, commonly followed by symmetric, descending, flaccid paralysis of involuntary muscles, which may result in respiratory compromise and death. ( 1 ) The sensorium remains intact because the botulism toxin[pedsinreview.aappublications.org]
  • Botulism should be considered among prisoners with cranial nerve palsies and descending, symmetric flaccid paralysis.[ncbi.nlm.nih.gov]
Guillain-Barré Syndrome
  • Both botulism and Miller-Fisher variant of Guillain-Barré syndrome were initial diagnostic considerations, and she was treated with intravenous immunoglobulin and botulinum antitoxin.[ncbi.nlm.nih.gov]
  • Differential diagnosis Differential diagnosis includes myasthenia gravis, Guillain-Barré syndrome (Miller-Fisher syndrome), Lambert-Eaton syndrome, and foodborne and adult intestinal botulism (see these terms).[orpha.net]
  • Physicians must be careful when diagnosing botulism because it may cause symptoms similar to diseases such as Guillain-Barré syndrome, myasthenia gravis, Lambert-Eaton syndrome, and strokes.[aanem.org]
  • Differential diagnosis Differential diagnosis, depending on the disease form, in adults or infants, includes myasthenia, Guillain-Barré syndrome (and Miller Fisher syndrome), Lambert-Eaton syndrome (see these terms), bacterial and chemical food poisoning[orpha.net]
  • These include Guillain-Barré syndrome, stroke, and myasthenia gravis. To definitively diagnose botulism, the botulinum toxin must be identified in the patient's serum, stool, or gastric aspirate.[toxipedia.org]
Stroke
  • Physicians must be careful when diagnosing botulism because it may cause symptoms similar to diseases such as Guillain-Barré syndrome, myasthenia gravis, Lambert-Eaton syndrome, and strokes.[aanem.org]
  • These include Guillain-Barré syndrome, stroke, and myasthenia gravis. To definitively diagnose botulism, the botulinum toxin must be identified in the patient's serum, stool, or gastric aspirate.[toxipedia.org]
  • Botulism symptoms are similar to those for stroke and Guillain -Barre syndrome, in which your immune system attacks your nerves, causing possible paralysis. Tests for these conditions may be done while lab tests are being done.[webmd.com]
  • In all other forms, the diagnosis of botulism can be based on the patient’s history and physical examination; however, the signs and symptoms may mimic other diseases like Guillain-Barré syndrome, stroke and myasthenia gravis.[symptoma.com]
Descending Paralysis
  • Clostridium botulinum is known to cause descending paralysis in infants throughout the world. The subject of this study was a three-month-old Costa Rican boy who was hospitalized because of poor suction and feeding, hypotonia, and constipation.[ncbi.nlm.nih.gov]
  • A 47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans.[ncbi.nlm.nih.gov]
  • Botulism is characterized by symmetrical descending paralysis that may progress to respiratory arrest. The standard confirmatory test for botulism is a mouse bioassay to prove the presence of botulinum neurotoxin.[ncbi.nlm.nih.gov]
  • Symptoms include: blurred or double vision, drooping eyelids, slurred speech, difficulty swallowing, and descending paralysis. If left untreated, infection may lead to respiratory arrest and even death.[publichealthontario.ca]
  • paralysis (3) bilateral symptoms (4) no fever (5) clear sensorium (6) lack of sensory findings Food-borne toxin absorbed from small intestine home-canned fruit and vegetable ingestion symptoms within 12-36 hrs GI distress - neuro symptoms parasympathetic[lifeinthefastlane.com]
Dizziness
  • These long-term effects most often include fatigue, weakness, dizziness, dry mouth, and difficulty performing strenuous tasks. Patients also report a generally less happy and peaceful psychological state than before their illness.[foodborneillness.com]
  • Summarizing its finding, the study concluded that: Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and[botulismblog.com]
  • The poisoned person becomes tired and may complain of headache and dizziness. The muscles of the eyelid may be paralyzed , a sign that may appear within hours of eating the food. The vision is often blurred, and the affected person may see double.[britannica.com]
  • Symptoms such as weakness, dizziness, dry mouth etc. can occur as soon as 18 hours after an infection.[microbewiki.kenyon.edu]

Workup

Most of the cases of infant botulism should be diagnosed on clinical grounds. Confirmation can be made by stool or enema specimen with the mouse bioassay.

In all other forms, the diagnosis of botulism can be based on the patient’s history and physical examination; however, the signs and symptoms may mimic other diseases like Guillain-Barré syndromestroke and myasthenia gravis [5].

Confirmation of diagnosis can be made if botulinum toxin is identified in the food, stomach contents, vomitus and/or feces of the patient. In peracute cases, the toxin can be found in blood as well. The detection of toxin in various specimens can be carried out by different tests such as:

  • Enzyme-linked Immunosorbent Assays (ELISA)
  • Electrochemiluminiscence (ECL) [6]
  • Mouse inoculation tests

Treatment

The primary treatment consists of administration of antitoxin and the provision of supportive care [7].

In case of respiratory paralysis, the patient may require a ventilator for weeks or months. Food borne and wound botulism, if diagnosed early, can be treated with passive immunity and antibiotics [8].

Two types of antitoxins are available:

  • trivalent antitoxin (effective against the toxin types A, B and E) [9]
  • heptavalent antitoxin (effective against all the toxin types from A to G) [10]

Infant botulism is harder to manage. Currently, a drug named Botulism Immune Globulin Intravenous (Human) is the only suitable option to manage this form of botulism.

Prognosis

Untreated botulism may be fatal in as many as 60% of the cases. However, if diagnosed early, the disease can be successfully treated with no complications.

The recovery however, may still take some weeks. Before the development of artificial respirators, mortality due to botulism was very high, but in 1990s it dropped to as low as 2%.

Etiology

Botulism is caused by the toxin produced by the bacterium Clostridium botulinum and not by infection with the bacterium itself. The organism produces toxin in anaerobic conditions. The toxin enters the bloodstream and acts on the nervous system causing flaccid paralysis of voluntary muscles which may progress to paralysis of respiratory muscles leading to respiratory arrest.

The disease in humans in mostly caused by three toxin types A, B and E. The lethal doses for causing disease in a man of 70 kg weight are estimated to be 0.09 to 0.15 micrograms intravenously, 0.80 to 0.90 micrograms through inhalation and 70 micrograms orally.

Food borne Botulism

This form of botulism occurs when food containing botulinum toxin is consumed. In conditions of environmental stress, the bacteria form spores which are resistant to cooking. Later, when they receive a favorable environment (e.g. one that has an alkaline pH and a low salt & sugar content), they produce botulinum toxin. This mostly occurs in improperly preserved foods.Symptoms appear 12 to 36 hours after eating such contaminated food.

Infant Botulism

This is the type of botulism which occurs due to colonization of the bacteria in the intestines. The bacteria produce toxins which are absorbed from the intestinal wall into the bloodstream. It most commonly occurs in infants of the ages of 2 to 3 months. This is because by that age, their normal intestinal flora have not been fully established. Normally, the intestinal flora compete with Clostrodium botulinum, preventing it from actively colonizing the intestine. Honey consumption in infants is regarded as the most common cause of infant botulism [2].
Adult form of infant botulism is termed as adult intestinal toxemia but it is exceedingly rare.

Wound Botulism

Wound botulism occurs as a result of contamination of a wound by either the bacteria or its spores. The toxin produced by them then enters the bloodstream. Nowadays, intravenous drug use is a very common cause of this form of botulism [3].

Inhalation Botulism

It is a very rare kind of botulism. Some cases have been reported due to the accidental inhalation of Clostridium botulinum spores by laboratory workers.

Epidemiology

Globally, botulism is not a very common disease. Most of the cases are sporadic, although sometimes outbreaks have occurred in certain areas of the United States and the United Kingdom.

The Centers for Disease Control USA has documented 263 individual cases during the years 1990 to 2000; 163 of which happened to be of the food borne variety. The average number of cases of food borne botulism in the United States is estimated to be 24 cases per year - most of which occur in Alaska [1].

There are about 80 to 100 cases of infant botulism annually in United States, making it the most common form of botulism. About 20% of these occur due to the consumption of honey in children below one year of age.The largest incidence of infant botulism has been found to be in Philadelphia and Pennsylvania.

Wound botulism occurs due to trauma and its incidence is on the rise since 1990s due to increased use of intravenous drugs and skin popping.

Sex distribution
Age distribution

Pathophysiology

The bacterium Clostridium botulinum produces eight types of toxins (A, B, C1, C2, D, E, F, and G). These toxins are serologically different but produce similar symptoms in the patients. The toxin types A, B and E cause disease in humans.

In all forms of botulism the toxin affects the nervous system. Once it is absorbed in the bloodstream it is carried to the peripheral cholinergic synapses specially that of the neuromuscular junctions where it inhibits the release of acetylcholine from the nerve terminals by irreversibly binding to the acetylcholine receptors.

This neurotransmitter produces a bridge between synapses where dendrites and axons connect with each other. The toxin enzymatically blocks acetylcholine release from the motor nerve endings which results in paralysis.

Prevention

There are no guidelines for prevention of Botulism.

Summary

Botulism is a rare but potentially lethal condition caused by a spore-producing gram positive bacterium Clostridium botulinum that naturally occurs in the soil. The organism produces botulinum toxin which causes neuromuscular flaccid paralysis.

Depending upon the route of entry of the bacteria or its toxin, botulism can be divided into several types; namely food-borne botulism, infant botulism, wound botulism, and the less common, inhalation botulism.

The disease begins with fatigue, blurring of vision and diplopia followed by the weakness of motor function throughout the body and difficulty in breathing.

If diagnosed early, it can be treated by providing passive immunity, although complete recovery may take weeks to months.

Patient Information

Botulism is a rare but fatal disease caused by a bacterium that is normally found in the soil. It is characterized by paralysis of the muscles of the face, arms, legs and chest (including the muscles required for breathing).

It usually results from eating food that is contaminated with the toxin. This condition is treated by the injection of appropriate antitoxins. In cases that are diagnosed early, the prognosis is quite good.

References

Article

  1. Shaffer N, Wainwright, RB, Middaugh, JP, et al. Botulism among Alaska Natives. The role of changing food preparation and consumption practices. West J Med. 1990;153(4):393-393.
  2. Grant KA, McLauchlin J, Amar C. Infant botulism: advice on avoiding feeding honey to babies and other possible risk factors. Community practitioner : the journal of the Community Practitioners' & Health Visitors' Association. Jul 2013;86(7):44-46.
  3. Passaro DJ, Werner SB, McGee J, Mac Kenzie WR, Vugia DJ. Wound botulism associated with black tar heroin among injecting drug users. JAMA : the journal of the American Medical Association. Mar 18 1998;279(11):859-863.
  4. Khakshoor H, Moghaddam AA, Vejdani AH, Armstrong BK, Moshirfar M. Diplopia as the primary presentation of foodborne botulism. Oman journal of ophthalmology. May 2012;5(2):109-111.
  5. Forss N, Ramstad R, Backlund T, Lindstrom M, Kolho E. Difficulties in diagnosing food-borne botulism. Case reports in neurology. May 2012;4(2):113-115.
  6. Sachdeva A, Singh AK, Sharma SK. An electrochemiluminescence assay for the detection of bio threat agents in selected food matrices and in the screening of Clostridium botulinum outbreak strains associated with type A botulism. Journal of the science of food and agriculture. Mar 15 2014;94(4):707-712.
  7. Werner SB, Chin J. Botulism--diagnosis, management and public health considerations. California medicine. May 1973;118(5):84-88.
  8. Chalk CH, Benstead TJ, Keezer M. Medical treatment for botulism. The Cochrane database of systematic reviews. Feb 20 2014;2:CD008123.
  9. Alizadeh AM, Zamani N. Treatment of foodborne botulism in current clinical toxicology. Pediatric reports. Apr 2 2012;4(2):e22.
  10. Hill SE, Iqbal R, Cadiz CL, Le J. Foodborne botulism treated with heptavalent botulism antitoxin. The Annals of pharmacotherapy. Feb 2013;47(2):e12.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!