Botulism is a rare but severe descending flaccid paralysis caused by botulinum neurotoxin (BoNT) produced by spore-forming Clostridium spp., usually C. botulinum, and rarely other Clostridial species. When the clostridial spores germinate and produce BoNT, the BoNT irreversibly binds to the neuromuscular junction, resulting in a descending flaccid paralysis. Botulism occurs in several forms, defined by the method of acquisition including wound, foodborne, intestinal toxemia (rare outside the infant population), and through iatrogenic exposures.
Botulism is a medical emergency, and rapid clinical diagnosis is essential to ensure appropriate treatment. High index of suspicion is necessary to consider the diagnosis; patients presenting with signs and symptoms of botulism have had delayed or missed diagnoses at initial presentation, likely resulting in more severe outcomes. However, confirmatory diagnosis requires a specialized public health laboratory test and may takes weeks to finalize. Therefore, treatment should be based on clinical diagnosis and not be delayed for laboratory confirmation of botulism.
Treatment for botulism includes administering botulinum antitoxin (or BabyBIG for infant botulism) as soon as possible. Antitoxin does not reverse paralysis but arrests its progression by binding to free botulinum toxin, which prevents it from being internalized further in the neuromuscular junction.
Additional intensive care, which may include mechanical ventilation, may be necessary for botulism patients; neurology and infectious disease consultation is recommended. Death can result from respiratory failure or the consequences of extended paralysis.
Healthcare providers can request the antitoxin 24/7 through their local health department (LHD).
For infant botulism, contact the CDPH Infant Botulism Treatment and Prevention Program directly at (510) 231-7600 (24/7/365) to obtain the licensed human botulinum antitoxin, BabyBIG, which is available only for infants (generally under 15 months old).
If unable to reach the LHD, providers may contact the CDPH Duty Officer at (916) 328-3605.
CDC video guide on preparing and administering antitoxin for the treatment of botulism: