Botulism

Overview

Botulism is a rare but serious illness caused by a poison called botulinum toxin. This toxin is made by bacteria called Clostridium botulinum. It attacks the nervous system and can cause muscle weakness and paralysis. People can get botulism in different ways, including eating contaminated food, through an infected wound, and in babies from swallowing spores that grow in the intestine.

No. Botulism is very rare in the United Kingdom and most other countries. Only a small number of cases are reported each year.

It can affect people of any age. Infants under one year old are at higher risk for infant botulism. Adults can get foodborne botulism from contaminated food or wound botulism, especially if they use injected drugs or have open wounds.

Symptoms

Common symptoms

• Drooping eyelids
• Blurred or double vision
• Slurred speech
• Difficulty swallowing
• Dry mouth
• Muscle weakness in the face, arms, or legs
• Feeling extremely tired

Symptoms in children

• Constipation, often the first sign in babies
• A weak cry
• Poor feeding or sucking
• A limp body
• Unusual tiredness or lack of energy
• Difficulty breathing or slow breathing

Symptoms in older adults

• The same symptoms as adults, but weakness and dizziness may be more severe
• Falls or trouble walking due to muscle weakness
• Difficulty swallowing that may cause choking or a wet-sounding cough

Causes

Main causes

• Foodborne botulism from eating contaminated food, especially home-canned or poorly preserved food
• Wound botulism when spores get into a cut, scrape, or deep wound
• Infant botulism when babies swallow spores (a dormant, protected form of the bacteria) that grow in their immature intestine
• Intestinal botulism in older children or adults with certain bowel conditions

Risk factors

• Eating home-canned food that was not processed properly
• Eating food from damaged, swollen, or leaking cans
• Using injected drugs, such as black tar heroin
• Having a deep wound that may be contaminated with soil or dirt
• Being under one year old
• Having Crohn's disease or other conditions that change the gut

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency symptoms listed above, call your local emergency number immediately.
• If you have weakness, double vision, or trouble swallowing that has come on suddenly

Book a routine appointment if:

• If you are concerned about food you have eaten that might have been improperly canned or preserved
• If you have a wound that looks infected and you feel generally unwell
• If you are a parent and worried about your baby's feeding, breathing, or energy level

Diagnosis

Doctors start with a detailed medical history and a physical examination. They will ask about what you have eaten recently, any injuries or wounds, and your symptoms. Because botulism is rare, it can be mistaken for other nerve and muscle conditions.

Tests that may be done

• Tests on blood, stool, or wound samples to look for the toxin or the bacteria
• A nerve test called electromyography to see how nerves and muscles are working
• A breathing test to check whether breathing muscles are affected
• A lumbar puncture (spinal tap) to look for other causes, if needed

What to expect at your appointment

If a doctor suspects botulism, you will likely be admitted to hospital for observation and testing. Several tests may be needed, and treatment often starts before the final test results come back.

Treatment

Botulism is treated in hospital. Early treatment is very important. The main goals are to stop the toxin from spreading, support your breathing, and help you recover strength.

Self-care at home

• Follow your care team's breathing and swallowing exercises if they suggest them
• Get plenty of rest and move gently as strength returns
• Do not try home remedies, herbal products, or over-the-counter treatments for botulism

Medical treatments

In hospital, doctors may give a medication called an antitoxin, which blocks the toxin in the blood. They may also provide supportive care such as fluids, physical therapy, and breathing support with a breathing machine (ventilator) if the breathing muscles are weak. For wound botulism, the wound is cleaned and treated carefully.

When is surgery considered?

For wound botulism, a doctor may need to perform a small procedure to clean the wound and remove any infected tissue. This is called surgical debridement.

Living with this condition

Recovery from botulism is slow. Muscle weakness can last for weeks or months. You will likely need physical therapy and support with daily activities while your nerves repair themselves.

Lifestyle tips

• Follow your physiotherapy plan to rebuild strength at a safe pace
• Drink plenty of fluids and eat soft foods if swallowing is difficult
• Accept help from family and friends with cooking, cleaning, and mobility
• Keep every follow-up appointment with your care team

Diet and exercise

If swallowing is a problem, you may need a soft or pureed diet until it improves. A speech therapist can suggest safe techniques. Exercise should be gentle and gradual, such as walking or stretching, guided by your physiotherapist.

Mental health and emotional wellbeing

Going through botulism can be frightening and stressful. Fear of getting worse or not recovering can cause anxiety or low mood. Talk to your care team about how you feel. Counselling or support groups can help.

Prevention

Yes, in many cases. Good food safety habits and proper wound care reduce the risk of botulism.

Vaccines

There is no public vaccine for botulism in general use. Vaccination is only used in special settings, such as for researchers who work with the toxin.

Screening programmes

There is no routine screening test for botulism in healthy people.

Complications

If left untreated

• Muscle weakness that spreads to the arms, legs, and chest
• Severe breathing difficulty requiring a breathing machine
• Pneumonia caused by inhaling food or liquid into the lungs
• Long-lasting nerve damage in some cases
• Death, in severe cases

Long-term outlook

With early hospital treatment, the outlook is very good. Most people recover fully, although it can take many months. Some people may continue to feel tired or weak for a long time. Rehabilitation and good medical support make a major difference in recovery.

Find support

External links open third-party websites. Ruqelo Health is not responsible for external content. Listing an organisation does not imply endorsement.