Botulism (Latin, ''botulus'', "sausage") also known as botulinus intoxication is a rare but serious paralytic illness caused by botulinum toxin, which is produced by the bacterium ''Clostridium botulinum''. The toxin enters the body in one of four ways: by colonization of the digestive tract by the bacterium in children (infant botulism) or adults (adult intestinal toxemia), by ingestion of toxin from foodstuffs (foodborne botulism) or by contamination of a wound by the bacterium (wound botulism).
All forms lead to paralysis that typically starts with the muscles of the face and then spreads towards the limbs. Infant botulism results from the ingestion of the ''C. botulinum'' spore and subsequent colonization of the small intestine. The infant gut may be colonized when the composition of the intestinal microflora (normal flora) is insufficient to competitively inhibit the growth of ''C. botulinum''.
Medical science does not yet completely understand all factors that make an infant susceptible to ''C. botulinum'' colonization. The growth of the spore releases botulinum toxin which is then absorbed into the bloodstream and taken throughout the body, causing paralysis by blocking the release of acetylcholine at the neuromuscular junction. Typical symptoms of infant botulism include constipation, lethargy, weakness, difficulty feeding and an altered cry often progressing to a complete descending flacid paralysis. Although constipation is usually the first symptom of infant botulism it is commonly overlooked.
Honey is the only known dietary reservoir of ''C. botulinum'' spores linked to infant botulism. For this reason honey should not be fed to infants less than one year of age. It is now sufficiently well known not to feed honey to babies. Due to the success of this public health message, fewer than 5% of recent infant botulism cases have been exposed to honey. The remaining 95% of infant botulism cases are thought to have acquired the spores from the natural environment. ''Clostridium botulinum'' is a ubiquitous soil-dwelling bacteria and is found in soils throughout the US. Many infant botulism patients have been demonstrated to live near a construction site or an area of soil disturbance.
Infant botulism has been reported in 49 of 50 US states.
An average of 110 cases of botulism are reported each year in the United States. Of these, approximately, 72% are infant botulism, and 3% are wound botulism. Outbreaks of foodborne botulism involving two or more persons occur most years and are usually caused by the consumption of home-canned foods. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black tar heroin, especially in California.
Complications
Infant botulism has no long-term side effects, but can be complicated by nosocomial adverse events. The case fatality rate is less than 1% for hospitalized infants with botulism.
Botulism can result in death due to respiratory failure. However, in the past 50 years, the proportion of patients with botulism who die has fallen from about 50% to 8% due to improved supportive care. A patient with severe botulism may require a breathing machine as well as intensive medical and nursing care for several months. Patients who survive an episode of botulism poisoning may have fatigue and shortness of breath for years and long-term therapy may be needed to aid their recovery.
Further Reading
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