Botulism: Types, Causes, Symptoms, Treatment, Pathophysiology, Prevention

One of the most fatal conditions that can happen to a person is botulism. Whether it is an infection or some kind of poisoning is a matter of deep insight, but the fact is that it can be both. Botulism, which is an acute neurologic disorder can cause life-threatening neuroparalysis and needs to be treated well for potential survival.


Definition of Botulism:

Caused by the toxins that are produced by Clostridium botulinum bacteria, botulism is a rare but potentially fatal condition.

The Clostridium botulinum bacteria is found worldwide and survives in water, guts of animals, fish and mammals or even shellfish and also in soil. It is not an organism and hence, it does not live in the human body. It enters the body by accident and weakens or paralyzes the bodily muscles and can even lead to death. The toxins that are released by these bacteria are some of the most dangerous and powerful toxins that science knows and it can almost immediately cause paralysis of the muscles by affecting the nervous system – that includes the nerves, spinal cord and brain.

Types and Causes of Botulism:

There are different types of botulism and it all depends on the way in which the bacteria enter the body or the cause of the infection.

    1. Intestinal Botulism (Infant botulism): This is the most common type of botulism and it occurs in children, who are less than 12 months of age. It occurs as the spores of the bacteria gets into the infant’s body and releases toxins in the intestine. When the babies become more than 1 year old, they develop a defense against the bacteria and hence, do not occur in elder children.

However, adults, who have gastrointestinal problems, are also susceptible to Botulism. When these people consume foods like honey, corn syrup or something that is contaminated with soil and dust that contains this bacteria, this condition occurs. But when the condition is incubated, is not clearly known. Whereas honey has been a persistent cause of developing this condition in American. Australian honey has not yet been found with contamination of these bacteria.

  1. Food Borne Botulism: Canned foods are sometimes found with the contamination of the Clostridium botulinum bacteria. Although with time the bacteria die, the toxin released from them stays within the food and consuming this causes Botulism. If proper storage measures are not taken or if there is not enough of cooking, the bacteria can get into the body through foods.
  2. Wound Botulism: When the Clostridium botulinum bacteria infect a wound or a cut, this type of botulism occurs. Usually the reason for this type of botulism to develop is using contaminated injections that are used for pushing heroin and other drugs into the muscle and not in the veins.

Signs and Symptoms of Botulism:

Common or General Symptoms of Botulism

Within 18 to 36 hours of the attack of the bacteria, the symptoms of Botulism start to appear. However, it can occur within as fast as 6 hours and also the appearance of the symptoms may delay for up to 10 days. The symptoms vary in different types of Botulism. However, the most common or general symptoms of Botulism are –

In the babies or infants, who suffer from Botulism, the symptoms are –

  • Weakness of muscles
  • Weakened cry
  • Constipation and drooling
  • Weak sucking
  • Poor feeding
  • Breathing difficulties
  • Reduced movements
  • Choking and gagging

Epidemiology and Prognosis of Botulism:

Botulism is a fairly rare condition. On an average, 145 cases of botulism are reported in the entire United States of America, whereas between 1980 and 2013, there were only 36 cases of botulism registered in the UK, including England and Wales. In the case reports of American botulism patients, 65% are stated to be suffering from infant botulism, 15% suffer from food borne botulism and 20% suffer from wound botulism. The reported cases in the UK included 26 cases that took place because of consuming one brand of hazelnut yogurt, in the year of 1989, just before the onset of symptoms. The yogurt was reportedly contaminated with the bacteria.

The fatality of botulism is 5 to 10%. The infant botulism mortality rate is as low as 1%, for those infants, who are admitted to the hospital.

Pathophysiology of Botulism:

The mechanism of Botulism is a complex one in which the toxins released by these bacteria blocks the neuromuscular transmission in cholinergic nerve fibers. This function is accomplished by the toxins as it inhibits the acetylcholine release at the presynaptic clefts of myoneural junctions. Not only by the inhibition of acetylcholine, but also by binding acetylcholine to itself, the toxins block this transmission.

If the toxins are not denatured by the digestive enzymes, they get absorbed by the small intestine and stomach. As a result, they block neuromuscular transmission in cholinergic nerve fibers and are hematogenously disseminated. This predominantly affects the gastrointestinal, nervous, metabolic, and endocrine systems. The motor end plate plays the role of responding to acetylcholine. Since the toxin disturbs this mechanism, it results in hypotonia and descends into symmetric flaccid paralysis.

Diagnosis of Botulism:

Diagnosis of Botulism is very important in order to start treating it. However, there are some diseases such as Guillain-Barré syndrome, stroke, and myasthenia gravis that look quite similar to botulism. Hence, the diagnostic tests that are run to assure if the Clostridium botulinum bacteria is present in the body or not, includes the blood and stool test to check for the presence of this toxin in the body.

The more useful tests are of course the physical examination that includes –

  • Drooping eyelid
  • Blurred vision
  • Absent or decreased gag reflex and deep tendon reflexes
  • Loss of muscle function
  • Paralyzed bowel movement
  • No fever
  • Urine retention or inability to urinate
  • Speech impairment.

Treatment for Botulism:

The basic line of treatment for botulism is removing the toxins from the body. If you have wound botulism, the doctor will surgically remove the affected and infected tissue, in order to prevent it from spreading.

  1. Treating Botulism with Antitoxins:

    Botulism is best treated with the antitoxins as they can nullify the impact of the toxins that are generated by the Clostridium botulinum bacteria. The faster it is given, the sooner and faster will be the recovery from Botulism.

  2. Antibiotics to Treat Botulism:

    Only if the botulism is wound botulism, antibiotics are given to treat it. Other types of botulisms are not treated, rather the release of toxins are hastened with the use of antibiotics in most other cases.

  3. Treating Infant Botulism:

    Since this type of botulism is less severe, it can be treated faster. The infants are assisted in breathing and they are kept in the warm atmosphere of the incubator to prevent them from further infection. Fluids are given through IV for those, who have difficulty in swallowing. Botulinum immunoglobulin medicine is given to the infants to introduce infant botulism-immune antibodies in the child that are extracted from human blood.

Prevention of Botulism:

The best way to prevent the Clostridium botulinum bacteria from getting inside the body is by preventing it from contaminating your food and bodily wounds. Hence, you must –

  • Be careful while canning foods at home. Sterilize the cans and bottles and throw away the unsterilized and foul-smelling cans and bottles.
  • Do not offer honey or corn syrup to infants. Prevent infant botulism by feeding infants only with breast milk.
  • See the doctor immediately when wound occurs.

Preventing the Clostridium botulinum bacteria is the best way to avoid this disease. However, even if it occurs, with fast diagnosis and treatment, it can be treated well.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 18, 2019

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