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Botulism

Technical Information

Clinical Features

A neuroparalytic illness characterized by symmetric, descending flaccid paralysis of motor and autonomic nerves, always beginning with the cranial nerves. Symptoms include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. If untreated, illness might progress to cause descending paralysis of respiratory muscles, arms and legs. Equine botulinum antitoxin (supplied by CDC through state health departments) can prevent progression of illness and shorten symptoms if administered early. Infant botulism can be treated with human-derived antitoxin (Baby-BIG) available from the California State Health Department.

Etiologic Agent

A potent neurotoxin produced from Clostridium botulinum, and rare strains of C. butyricum and C. baratii, which are anaerobic, spore-forming bacteria .

Incidence

In 2008, 153 cases of botulism were reported to the CDC. Of these, 18 were foodborne, 111 were infant botulism, 23 were cases of wound botulism, and one case was of unkown etiology. Additional information and annual tabulations of cases are available through the National Botulism Surveillance link on the Additional Information page.

Sequelae

Death can result from respiratory failure or the consequences of longterm paralysis. About 5% die. Recovery takes weeks to months. Those who survive may have fatigue and shortness of breath for years.

Transmission

Foodborne botulism follows ingestion of toxin produced in food by C. botulinum. The most frequent source is home-canned foods, prepared in an unsafe manner. Wound botulism occurs when C. botulinum spores germinate within wounds. Infant botulism occurs when C. botulinum spores germinate and produce toxin in the gastrointestinal tract of infants.

Risk Groups

All persons. Injection drug users are at increased risk for wound botulism.

Surveillance

In collaboration with state health departments, CDC maintains intensive surveillance for botulism in the United States. Every case of foodborne botulism is treated as a public health emergency because the responsible food, whether homemade or commercial, might still be available for consumption and could make unsuspecting persons ill. More

Trends

Vehicles of transmission typically are a variety of home canned vegetables , and fermented fish and other aquatic game foods in Alaska. Although botulism from commercial products is rare in the United States, in the first decade of the 21st century, two outbreaks occurred from commercially prepared products that were not mishandled at retail or by consumers. Wound botulism related to the use of black-tar heroin has increased, especially in California.

Challenges

Prompt recognition of clinical syndrome by physicians. Preparation for a possible attack on the United States with botulinum toxin.

Opportunities

Clinician education. Consumer education about home canning. Educating Alaska natives about proper fermentation techniques. Applying tools of molecular biology.

 
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