Botulism and Botulinum Toxin: What to Know

While botulism is a relatively rare condition, it does represent a serious illness that can have life-threatening consequences if not treated immediately. Whether it's from contaminated food or an infected wound, it is crucial to understand both the signs and how to prevent botulism. Let’s dive into what botulism is, how it spreads, and what you can do to stay safe.

What is Botulism? 

Botulism is a rare but serious illness that affects the muscles and nervous system in the human body. It occurs when food or wounds are contaminated. Symptoms of botulism include muscle weakness and paralysis. The condition can be life-threatening if it is not diagnosed and treated in time with an anti-toxin.

Botulism is a rare but serious illness. According to the 2017 national botulism survey, 182 laboratory-confirmed cases were reported to the Centers for Disease Control and Prevention (CDC). Among these cases, 141 were classified as infant botulism, making up the majority, accounting for 77% of the total cases. 

Botulinum toxin is one of the most dangerous substances known to mankind. A very small dose (1 nanogram per kilogram of body weight) can be lethal. 

What Causes Botulism?  

Botulism is usually caused by Clostridium botulinum (C. botulinum) bacteria that produce lethal botulinum toxins. Clostridium botulinum produces spores that are heat-resistant and widely present in the environment. In a low-oxygen or anaerobic environment (no oxygen), the botulinum spores germinate (grow) and produce toxins that can contaminate soil, food, and wounds, leading to the symptoms of botulism.  

Besides C. botulinum, Clostridium baratii and Clostridium butyricum can sometimes cause human botulism. 

Notably, the non-toxic strains of Clostridium butyricum (C. butyricum) are being used as probiotics in some Asian countries, particularly in China, Korea, and Japan. However, certain strains of C. butyricum have been associated with serious health conditions such as infant botulism and necrotizing enterocolitis in preterm neonates. 

Clostridium butyricum's dual nature highlights the need to differentiate beneficial strains from harmful ones. Therefore, further research is essential to better understand the role of C. butyricum in gut health.

What Does Botulinum Toxin Do To The Body?

Toxins produced by Clostridium botulinum block the functioning of the body’s nerves and muscles. They produce these effects by blocking the release of a substance called acetylcholine at the junctions between nerve and muscle cells. This leads to paralysis of skeletal muscles (muscles that we use to breathe, swallow, and move). Botulinum toxin production can eventually affect respiratory (breathing) muscles and be fatal without treatment. 

Is Botulinum Toxin The Same As Botox?

Yes, the medicine in Botox is the same neurotoxin that causes botulism. Botox is a commonly known brand name of botulinum toxin type A. However, it contains very small doses and is used for medical and cosmetic reasons. Botox works by causing muscle paralysis and is used to treat wrinkles and certain health conditions such as excessive sweating, chronic migraines, and overactive bladder.

What Are The Common Causes of Botulism?  

Foodborne Botulism

Food borne botulism occurs by eating contaminated food that contains spores of Clostridium botulinum bacteria. When food is improperly stored, the spores reproduce and release toxins into the food.

The most common cause of foodborne botulism is homemade canned foods that are improperly canned, preserved, or fermented. Less commonly, store-bought canned foods can also cause botulism.

What Foods Contain Botulism?

Potential causes of foodborne botulism include:

• Foods kept unrefrigerated or warm for too long

• Low cooking temperatures

• Low acid foods

• Canned tomatoes

• Bottled garlic

• Homemade oils (herb-infused oils)

• Potatoes baked in aluminum foil

• Carrot juice

• Canned cheese sauces

Wound Botulism

Wound botulism occurs when Clostridium botulinum spores enter the human body through a wound and release toxins into the bloodstream. People who inject drugs (illicit drugs such as black tar heroin) are at the highest risk of wound botulism. Rarely, it can also occur after a serious traumatic injury or surgery.

Infant Botulism

Spores produced by Clostridium botulinum are found in contaminated soil and dust and can become airborne. A baby can ingest these spores (exactly how this happens is unclear). Once in the baby’s intestines, the spores can grow and release toxins. Honey and corn syrup are also proven sources of the C. botulinum bacteria and can cause botulism in infants under 1 year of age.

Honey and corn syrup are two of the most common sources of botulism in infants. If adults and older children ingest honey containing botulinum spores, they don’t release the toxin and don’t cause botulism illness. For reasons that are unclear, younger children are more at risk of developing the illness. This may be related to the lack of competing bacteria in a young child’s digestive system and a relatively underdeveloped immune system. Due to the risk of infant botulism, experts do not advise that anyone feed honey or processed foods containing honey to children under 1 year of age. 

Iatrogenic Botulism

Iatrogenic botulism is rare. It occurs if you have too much botulinum toxin injected for cosmetic or medical reasons. Purified and extremely diluted toxin from Clostridium botulinum is used for a variety of purposes, including decreasing the appearance of wrinkles and treating chronic migraine headaches, overactive bladder, cervical dystonia or spasmodic torticollis (painful involuntary contractions of neck muscles), and blepharospasm (involuntary blinking of the eyes).

What Are 3 Reasons Botulinum Toxin Should Not Be Used?

Three reasons not to use botulinum toxin for cosmetic reasons are serious adverse effects such as allergic reactions, dysphagia (difficulty swallowing), and muscle weakness. 

Remember that botulinum toxin (Botox, other brand names) is safe when the injections are performed by a licensed medical professional. However, you should avoid Botox injections at spas, salons, and other facilities where the injections may not be performed by trained professionals. 

Adult Intestinal Toxemia Botulism

Also known as adult intestinal botulism or adult intestinal colonization, this is a very rare type of botulism. It occurs when Clostridium botulinum spores enter the intestines of adults and release toxins, similar to infant botulism. People with digestive disorders are at an increased risk of this type of botulism.

What Are the Symptoms of Botulism?  

Symptoms of Infant Botulism

Infant botulism symptoms can develop 3 to 30 days after exposure to Clostridium botulinum spores. They can range in severity from mild to severe and may include:

• Ptosis (drooping eyelids)

• Decreased facial expressions

• Drooling

• Poor feeding

• Weak cry

• Decreased gag reflex

• Flaccid paralysis (weak or floppy muscles) 

• Constipation

• Trouble breathing

Symptoms in Adults and Older Children

Symptoms of botulism in adults and older children usually begin in the face, eye, and throat muscles. The symptoms can develop anywhere from a few hours to several days after exposure to Clostridium botulism spores. Without proper diagnosis and treatment, the symptoms can spread to the breathing muscles and be fatal.

• Ptosis (drooping eyelids)

• Vision problems, such as double vision or blurred vision

• Xerostomia (dry mouth)

• Slurred speech

• Dysphagia (difficulty swallowing)

• Difficulty breathing

• Weakness of arm or leg muscles

• Nausea and vomiting

When to Seek Emergency Help  

Seek medical treatment immediately if you suspect botulism. As mentioned, Clostridium botulinum toxins attack the nerves and muscles. These toxins cause weakness and paralysis of muscles that you need to breathe, swallow, talk, and move. If the toxins affect the nerves and muscles needed for breathing, it can result in fatal respiratory failure. For this reason, botulism illnesses are medical emergencies.

Diagnosis and Treatment of Botulism  

Tests and Indicators  

Healthcare providers can diagnose botulism based on history, symptoms, physical examination, and diagnostic tests. 

A diagnosis of botulism can be confirmed by looking for the botulinum toxin in a sample of blood, stool, or vomit. A food sample can also be tested. 

Additional diagnostic tests may include a CT scan (CAT scan) or an MRI of the brain, a lumbar puncture (spinal tap), and electromyography (test of nerve and muscle function). The results of testing for botulism can take several days to come back. If your healthcare provider suspects botulism, they may start treatment immediately.

What Can Botulism Look Like?

Botulism symptoms can resemble other conditions such as meningitis, stroke, and Guillain-Barre syndrome. Diagnostic tests can help your healthcare provider confirm the diagnosis. The presence of botulinum toxin in a sample of your blood, stool, or vomit is diagnostic of the condition. 

Treatment Options: From Antitoxin to Supportive Care  

Treatment for botulism consists of botulinum antitoxin, a medicine that blocks the effects of the toxin produced by C. botulinum. This medicine is given by intravenous (IV) infusion. It inactivates unbound toxins present in the bloodstream but not toxins that have already attached to neuromuscular junctions. 

Botulinum antitoxin works better the earlier it is administered. It can stop further damage but does not reverse the damage that has already occurred. Therefore, it is important to seek medical care as soon as possible for suspected botulism. There is a limited quantity available, and the CDC stores botulinum antitoxin at quarantine stations at major US airports. 

Other treatments for botulinum depend on the type and severity of the illness. Some patients need to spend weeks to months in the hospital to recover. For example, those who develop breathing problems may need to be placed on a breathing machine (ventilator) until the breathing muscles’ paralysis improves. 

For wound botulism, doctors may recommend surgical treatment to remove contamination and prescribe antibiotics to prevent re-infection.

Recovery Outlook: Can You Survive Botulism?  

Yes, you can survive botulism. However, the botulism antitoxin cannot reverse the damage that has already occurred. Therefore, recovery from botulism may require weeks or months of hospitalization. 

Prevention and Safety Measures  

Safe Food Practices to Prevent Foodborne Illness  

Improperly canned food at home is one of the main sources of botulism. The best way to prevent food borne botulism is to follow USDA guidelines for home canned foods and to use only USDA-recommended recipes. 

Public health officials advise that homed canned low-acid foods are the most common cause of human botulism outbreaks in the US. Therefore, it is important to be especially careful while canning low-acid foods such as tomatoes, figs, fresh vegetables, poultry, fish, seafood, and meats. 

Here are some additional tips to prevent botulism:

• Pressure canning using a pressure canner is the only recommended method for canning low-acid foods. Boiling water or electric multi-cooker appliances with a canning function do not protect against botulism from low-acid foods.

• Store canned food in a clean, cool, dark place between 50°F and 70°F. Do not store canned food in direct sunlight, uninsulated attics, or near furnaces, hot pipes, or cooking ranges.

• Put labels and dates on home canned food and store only as much food as you can use within one year. 

• Before you eat food that was home-canned, boil it to destroy botulinum toxin. 

• Food handlers should take precautions to prevent bacterial growth and food-borne illnesses.

How To Detect Botulism In Canned Food?

According to the Centers for Disease Control and Prevention (CDC), signs that home-canned or store-bought canned food might be contaminated with toxins or germs include:

• A leaking or bulging container.

• A damaged or cracked container.

• A container that spurts foam or liquid when opened.

• Foul-smelling preserved foods.

• Food that appears discolored or moldy.

Prevention Strategies

Botulism is a serious health condition. Learning about botulism is the first step in keeping yourself and your family safe. 

Improperly canned and preserved foods at home are the main source of foodborne botulism. Follow the above-listed recommendations carefully to prevent illness caused by foodborne botulism. 

Take precautions to prevent infant botulism, such as not giving honey to babies under 1 year of age.

To prevent wound botulism, keep wounds clean and get medical care immediately if a wound looks infected (red, swollen, warm, painful, or oozing pus).

To prevent iatrogenic botulism, always get botulinum toxin injections from a licensed medical professional who knows the correct and safe dosage.