Botulism

Kelly J Baldwin MD (Dr. Baldwin of Geisinger Medical Center has no relevant financial relationships to disclose.)
Tyler R West DO (Dr. West of Geisinger Medical Center has no relevant financial relationships to disclose.)
Karen L Roos MD FAAN, editor. (Dr. Roos of Indiana University School of Medicine has no relevant financial relationships to disclose.)
Originally released December 7, 1993; last updated January 22, 2017; expires January 22, 2020

This article includes discussion of botulism, food-borne botulism, iatrogenic botulism, inhalational botulism, and wound botulism. The foregoing terms may include synonyms, similar disorders, variations in usage, and abbreviations.

Overview

In this article, the authors review the clinical manifestations, diagnostic tests, and management of patients who present with 5 types of botulism: foodborne, wound, adult intestinal toxemia, iatrogenic following medical or cosmetic administration, and inhalational botulism. Recent information on wound and foodborne botulism is presented, along with diagnostics and treatments.

Key points

 

• All symptoms of botulism result from botulinum toxin blocking acetylcholine transmission across cholinergic synapses of the peripheral nervous system.

 

• Most cases of foodborne botulism come from improperly home-canned vegetables and meats that fail to destroy C botulinum spores.

 

• There has been a rise in wound botulism in people who inject drugs such as heroin. Infections often occur through skin infections caused by a practice known as “skin popping” whereby users inject the contaminated heroin subcutaneously under their skin or into muscle.

 

• The definitive diagnosis of botulism is made by demonstrating the presence of botulinum toxin in serum, stool, or suspected food, or isolation of C botulinum from a wound site.

 

• Repeated measurements of vital capacity are recommended; if the vital capacity falls below 30% of predicted, one should consider elective intubation and mechanical ventilation.

 

• The Centers for Disease Control and Prevention recommends administration of trivalent (types A, B, E) botulism antitoxin as soon as possible.

Historical note and terminology

The clinical features of botulism were recognized as far back as the time of Hippocrates. However, it remained a puzzling illness until 1897 when van Ermengem clearly described the clinical, toxicological, and bacteriological features of an outbreak of foodborne botulism. He demonstrated that botulism was not due to an infection but to an intoxication produced by a gram-positive bacillus called Clostridium botulinum. Later it was discovered that wounds could become infected with C botulinum that then produced toxin to cause botulism. In the 1970s, it was recognized that infants could develop botulism ("infantile botulism") with paralysis following C botulinum colonization of the gastrointestinal tract with release of botulinum toxin into the gut. The botulinum neurotoxin comes from 6 groups of bacteria: Clostridium botulinum I-IV, C baratii, and C butyricum (Peck 2009).

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