Botulism Facts for Health Care Providers

Information and guidance for clinicians can be found on the Botulism: Clinical Guidance site.

Agent

Toxin produced by Clostridium botulinum, an encapsulated, anaerobe, gram-positive, spore-forming, rod-shaped (bacillus) bacterium

Disease

Botulism is a neuroparalytic (muscle-paralyzing) disease. There are three forms of naturally occurring botulism:

Foodborne botulism
Caused by ingestion of pre-formed toxin
Infant botulism
Caused by ingestion of C. botulinum which produces toxin in the intestinal tract
Wound Botulism
Caused by wound infection with C. botulinum that secretes the toxin

Botulinum Toxin as a Biological Weapon

Aerosolized botulinum toxin is a possible mechanism for a bioterrorism attack
Inhalational botulism does not occur naturally
Inhalational botulism cannot be clinically differentiated from the 3 naturally occurring forms
Indications of intentional release of a biologic agent may include:
- An unusual geographic clustering of illness (e.g., persons who attended the same public event or gathering)
- A large number of cases of acute flaccid paralysis with prominent bulbar palsies, especially if occurring in otherwise healthy persons

Transmission

Botulism is not transmissible from person-to-person

Incubation

Symptoms begin within 6 hours to 2 weeks after exposure (often within 12-36 hours)

Symptoms/
Signs

Difficulty swallowing or speaking, dry mouth
Diplopia (double vision), blurred vision, dilated or non-reactive pupils, ptosis (drooping eyelids)

Symmetric descending weakness respiratory dysfunction (requiring mechanical ventilation)
Descending flaccid paralysis
Intact mental state
No sensory dysfunction
No fever

Diagnosis/Lab/
Reporting

Clinicians should contact their state health departments to report suspected cases
Diagnosis: history and clinical exam
Laboratory confirmation:
- Demonstrating the presence of toxin in serum, stool, or food
- Culturing C. botulinum from stool, wound or food

Differential Diagnoses

Differential Diagnoses for Adults	Differential Diagnoses for Infants
Guillain-Barre syndrome Myasthenia gravis Cerebrovascular accident (CVA) Bacterial and/or chemical food poisoning Tick paralysis Chemical intoxication (e.g., carbon monoxide) Mushroom poisoning Poliomyelitis	Sepsis Meningitis Electrolyte-mineral imbalance Reye’s syndrome Congenital myopathy Werdnig-Hoffman disease Leigh disease

Treatment

Prompt diagnosis is essential
Antitoxin is effective in reducing the severity of symptoms, if administered early
A supply of antitoxin against botulism is maintained by the CDC
State health departments should contact CDC to arrange for a clinical consultation by phone, and (if indicated) the release of the antitoxin
Supportive care as needed, including mechanical ventilation

Prophylaxis

Botulism can be prevented by the administration of neutralizing antibody in the bloodstream
Passive immunity can be provided by equine botulinum antitoxin or by specific human hyperimmune globulin, while endogenous immunity can be induced by immunization with botulinum toxoid

Control Measures

Medical personnel caring for patients with suspected botulism should use standard precautions
Patients with suspected botulism do not need to be isolated
If meningitis is suspected in a patient with flaccid paralysis, medical personnel should use droplet precautions
Heating to an internal temperature of 85°C for at least 5 minutes will detoxify contaminated food or drink
When exposure is anticipated, some protection may be conferred by covering the mouth and nose with clothing such as an undershirt, shirt, scarf, or handkerchief
In contrast with mucosal surfaces, intact skin is impermeable to botulinum toxin
After exposure to botulinum toxin, clothing and skin should be washed with soap and water
Contaminated objects or surfaces should be cleaned with 0.1% hypochlorite bleach solution if they cannot be avoided for the hours to days required for natural degradation

For more information

For more information, please visit the Botulism Emergency Preparedness and Response page. You may also contact 1-800-CDC-INFO, or e-mail coca@cdc.gov.

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Emergency Preparedness and Response