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Botulism

What You Need to Know

  • Botulism is a rare but serious disease caused by a toxin (poison) that attacks the nervous system and causes paralysis in children and adults.

  • There are different forms of botulism, including foodborne botulism, wound botulism, and infant botulism. Botulism doesn't spread from person to person.

  • People with botulism usually have weakness or paralysis that starts from the head and face and spreads down to the rest of the body.

  • Without treatment, botulism can lead to death. If you or someone you know has symptoms of botulism, call 911 or go to the emergency room immediately.

  • You can help reduce your risk of botulism by properly storing and preserving food, and by not injecting street drugs (like black tar heroin). To help reduce the risk of botulism in babies, do not feed babies honey.

  • If you are a healthcare provider and suspect your patient (non-infant) may have botulism, please contact the local health department (LHD). If unable to reach the LHD, providers may contact the CDPH Duty Officer at (916) 328-3605.


What is botulism?

Botulism is a rare but serious disease caused by a toxin (poison) that is made by bacteria called Clostridium botulinum (C. botulinum). This botulinum toxin attacks the nervous system and causes paralysis in children and adults.

People who become sick with botulism may have:

      • Droopy eyelids
      • Double or blurry vision
      • Muscle weakness in the face
      • Trouble swallowing
      • Slurred speech or trouble speaking
      • Weakness in the arms and legs

Botulism can also weaken the muscles that control breathing. Without treatment, botulism can lead to death.

Babies younger than 15 months old may get infant botulism and may appear tired, show little facial expression, have a weak cry or poor head control, and appear "floppy" because they can't control their muscles. 

If you or someone you know has symptoms of botulism, call 911 or go to the emergency room immediately.

Botulism symptoms include trouble swallowing, droopy eyelids, blurry vision, slurred speech, weak muscles, and trouble breathing

How can a person get botulism? 

The bacteria that cause botulism, called C. botulinum, are found naturally in the environment, including in the soil and dust. Most of the time, C. botulinum bacteria do not make people sick.
Under certain conditions (especially in low-oxygen, low-acid, and low-sugar environments), the bacteria can grow and produce the botulinum toxin which causes paralysis.

A person can get botulism in different ways. The different types of botulism are determined by how a person is infected:

Botulism is not contagious, which means it cannot be spread from person to person.


  • Foodborne botulism is caused by eating or drinking something that is contaminated with the botulinum toxin.
    • Foods that aren't processed, preserved, or stored (especially refrigerated) properly can create the right environment for C. botulinum bacteria to grow and make the botulinum toxin. 
      Home-canned foods

      Risky foods can include: 
      • Homemade or home-canned foods, especially meat or vegetables (that aren't properly preserved)
      • Store-bought foods that aren't properly refrigerated

 

  • Wound botulism is caused by C. botulinum bacteria entering a wound or opening in the skin and producing the botulinum toxin.
    • People who inject street drugs like black tar heroin are more likely to get wound botulism than people who do not because C. botulinum bacteria can get in through the injection site and produce the botulinum toxin.
    • Rarely, a traumatic injury (like an open fracture) where dirt or soil gets into the wound can cause wound botulism.

  • Infant botulism is caused by C. botulinum bacteria that get into an infant's intestines and grow and produce the botulinum toxin.
    • Honey can contain C. botulinum bacteria and is not safe for babies under 15 months old to eat.

  • Adult intestinal toxemia (adult intestinal colonization) is similar to infant botulism and is caused by C. botulinum bacteria that get into an adult's intestines and grow and produce the toxin.
    • People with severe gut illnesses or past intestinal surgery are more at risk for this type of botulism, but it is very rare.

  • Iatrogenic botulism is caused by accidentally injecting too much botulinum toxin for cosmetic or medical reasons.
    • Botulinum toxin can sometimes be used for medical treatment or cosmetic reasons (like for wrinkle treatment or headaches). In rare cases, injections of too much botulinum toxin can cause symptoms of botulism. 

​Although botulism is rare, all forms of botulism can cause death and are considered medical emergencies.

What can happen if someone has botulism?

If not treated quickly, paralysis from botulism usually moves from the head and continues down the body, causing breathing problems, full paralysis, and even death. About 1 in 20 people who get botulism die from respiratory failure or the result of long-term paralysis.

Symptoms of foodborne botulism usually begin about 18 to 36 hours after eating or drinking something that is contaminated with the botulinum toxin, but symptoms can occur as early as 6 hours or as late as 10 days after.

People with wound botulism may not have symptoms until several days after the wound is infected with the bacteria or after injecting drugs contaminated with the bacteria.

How is botulism treated?

Botulism is a very serious disease that can be deadly if not treated. If caught early, botulism can be treated with botulinum antitoxin, which blocks the toxin from causing more harm in the body. But the antitoxin can't undo any muscle paralysis that has already happened, so it can take weeks or even months for a person to get better. A person with severe botulism may need help breathing and may need to be on a breathing machine (ventilator) for weeks with intensive medical care.

Botulinum antitoxin for patients 15 months of age and older in California is available by working with the local public health department, CDPH, and the U.S. Centers for Disease Control and Prevention (CDC). If the diagnosis of botulism is suspected, healthcare providers can ask for the botulinum antitoxin through their local health department, which will work with CDPH and CDC to release the antitoxin. For infant botulism, healthcare providers should contact the CDPH Infant Botulism Treatment and Prevention Program to obtain the licensed human botulinum antitoxin, BabyBIG. 

How can I reduce my risk of getting botulism?

To help reduce your risk of foodborne botulism, it's important to properly store and preserve food to help keep C. botulinum bacteria from growing and producing botulinum toxin:

    • Always follow label instructions for proper handling or storage of food (ex: "Keep refrigerated").
Keep Refrigerated
    • Never eat food that is moldy or smells bad or "sour" – this can be a sign that the food is contaminated with germs that can make you sick. Remember: When in doubt, throw it out!

      Moldy Food Jar     A person smelling bad food


Home canning supplies

 


Syringe needle on the ground

To reduce your risk of wound botulism, do not inject street drugs. Learn more on the CDC Injection Drug Use and Would Botulism webpage.


You can also help reduce the risk of wound botulism by keeping all wounds clean. If you start to see any signs of infection (like fever, redness, or pain around a wound), see a healthcare provider right away.



To help reduce the risk of infant botulism, do not feed honey to babies less than 15 months old. For information on infant botulism, visit the CDPH Infant Botulism Treatment and Prevention Program webpage.


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