UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Botulism

Authors
P Samuel Pegram, MD, FACP
Sean M Stone, MD
Section Editor
John G Bartlett, MD
Deputy Editor
Anna R Thorner, MD

INTRODUCTION

Botulism is a rare but potentially life-threatening neuroparalytic syndrome resulting from the action of a neurotoxin elaborated by the bacterium Clostridium botulinum. This disease has a lengthy history; the first investigation of botulism occurred in the 1820s with a case series about hundreds of patients with "sausage poisoning" in a southern German town [1]. Several decades later in Belgium, the association was demonstrated between a neuromuscular paralysis and ham infected by a spore-forming bacillus that was isolated from the ham. The organism was named Bacillus botulinus after the Latin word for sausage, botulus.

The microbiology, pathogenesis, epidemiology, clinical manifestations, diagnosis, and treatment of botulism will be discussed here.

TYPES OF BOTULISM

The modern syndrome of botulism occurs in several forms, differentiated by the mode of acquisition [2,3]:

Foodborne botulism – Ingestion of food contaminated by preformed botulinum toxin

Infant botulism – The ingestion of clostridial spores that then colonize the host's gastrointestinal (GI) tract and release toxin produced in vivo

                               

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Mar 07 00:00:00 GMT+00:00 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Kerner J. Neue Beobachtungen uber die in Wurtemburg so haufig vorfallen Vergiftung durch den Genuss gerauchter Wurst. Tubingen, 1820. In: Food Infections and Food Intoxications, Damon SR (Ed), Williams and Wilkins, Baltimore 1928. p.67.
  2. Abrutyn E. Botulism. In: Principles of Internal Medicine, 14th ed, Fauci AS, Isselbacher KJ, Braunwald E (Eds), McGraw-Hill, New York 1998. p.904.
  3. Yiannakopoulou E. Serious and long-term adverse events associated with the therapeutic and cosmetic use of botulinum toxin. Pharmacology 2015; 95:65.
  4. Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA 2001; 285:1059.
  5. Chertow DS, Tan ET, Maslanka SE, et al. Botulism in 4 adults following cosmetic injections with an unlicensed, highly concentrated botulinum preparation. JAMA 2006; 296:2476.
  6. Dowell VR Jr. Botulism and tetanus: selected epidemiologic and microbiologic aspects. Rev Infect Dis 1984; 6 Suppl 1:S202.
  7. Bleck TP. Clostridium botulinum (botulism). In: Principles and Practice of Infectious Diseases, 6th ed, Mandel, GL, Bennett JE, Dolin R (Eds), Churchill Livingstone, Philadelphia 2005. p.2822.
  8. Barash JR, Arnon SS. A novel strain of Clostridium botulinum that produces type B and type H botulinum toxins. J Infect Dis 2014; 209:183.
  9. Dover N, Barash JR, Hill KK, et al. Molecular characterization of a novel botulinum neurotoxin type H gene. J Infect Dis 2014; 209:192.
  10. Aureli P, Fenicia L, Pasolini B, et al. Two cases of type E infant botulism caused by neurotoxigenic Clostridium butyricum in Italy. J Infect Dis 1986; 154:207.
  11. Jin R, Rummel A, Binz T, Brunger AT. Botulinum neurotoxin B recognizes its protein receptor with high affinity and specificity. Nature 2006; 444:1092.
  12. Chai Q, Arndt JW, Dong M, et al. Structural basis of cell surface receptor recognition by botulinum neurotoxin B. Nature 2006; 444:1096.
  13. Black JD, Dolly JO. Interaction of 125I-labeled botulinum neurotoxins with nerve terminals. II. Autoradiographic evidence for its uptake into motor nerves by acceptor-mediated endocytosis. J Cell Biol 1986; 103:535.
  14. Sugiyama H. Clostridium botulinum neurotoxin. Microbiol Rev 1980; 44:419.
  15. Middlebrook JL. Relative lethality of selected toxins. In: Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning, 2nd ed, Ellenhorn MJ, Schonwald S, Ordog G, et al (Eds), Williams and Wilkins, Baltimore 1997. p.1055.
  16. Mcnally RE, Morrison MB, Berndt JE, et al. Effectiveness of medical defense interventions against predicted battlefield levels of botulinum toxin A, Science Applications International Corp, Joppa 1994.
  17. Wannemacher RW Jr, Dinterman RE, Thompson WL, et al. Treatment for removal of biotoxins from drinking water. Fort Detrick, Frederick, MD: US Army Biomedical Research and Development Laboratory. Technical report 9120.
  18. Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA. Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med 1976; 295:770.
  19. Dodds KL. Worldwide incidence and ecology of infant botulism. In: Clostridium botulinum: Ecology and control in foods, Hauschild AHW, Dodds KL (Eds), Marcel Dekker, New York 1993. Vol 108.
  20. Werner SB, Passaro D, McGee J, et al. Wound botulism in California, 1951-1998: recent epidemic in heroin injectors. Clin Infect Dis 2000; 31:1018.
  21. Passaro DJ, Werner SB, McGee J, et al. Wound botulism associated with black tar heroin among injecting drug users. JAMA 1998; 279:859.
  22. Sam AH, Beynon HL. Images in clinical medicine: Wound botulism. N Engl J Med 2010; 363:2444.
  23. Yuan J, Inami G, Mohle-Boetani J, Vugia DJ. Recurrent wound botulism among injection drug users in California. Clin Infect Dis 2011; 52:862.
  24. Roblot F, Popoff M, Carlier JP, et al. Botulism in patients who inhale cocaine: the first cases in France. Clin Infect Dis 2006; 43:e51.
  25. Sobel J, Tucker N, Sulka A, et al. Foodborne botulism in the United States, 1990-2000. Emerg Infect Dis 2004; 10:1606.
  26. Mazuet C, Ezan E, Volland H, et al. Toxin detection in patients' sera by mass spectrometry during two outbreaks of type A Botulism in France. J Clin Microbiol 2012; 50:4091.
  27. Townes JM, Cieslak PR, Hatheway CL, et al. An outbreak of type A botulism associated with a commercial cheese sauce. Ann Intern Med 1996; 125:558.
  28. Centers for Disease Control and Prevention (CDC). Botulism associated with commercial carrot juice--Georgia and Florida, September 2006. MMWR Morb Mortal Wkly Rep 2006; 55:1098.
  29. Sheth AN, Wiersma P, Atrubin D, et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis 2008; 47:1245.
  30. Zhang S, Wang Y, Qiu S, et al. Multilocus outbreak of foodborne botulism linked to contaminated sausage in Hebei province, China. Clin Infect Dis 2010; 51:322.
  31. Centers for Disease Control and Prevention (CDC). Notes from the field: Botulism caused by consumption of commercially produced potato soups stored improperly--Ohio and Georgia, 2011. MMWR Morb Mortal Wkly Rep 2011; 60:890.
  32. Juliao PC, Maslanka S, Dykes J, et al. National outbreak of type a foodborne botulism associated with a widely distributed commercially canned hot dog chili sauce. Clin Infect Dis 2013; 56:376.
  33. Burke P, Needham M, Jackson BR, et al. Outbreak of Foodborne Botulism Associated with Improperly Jarred Pesto--Ohio and California, 2014. MMWR Morb Mortal Wkly Rep 2016; 65:175.
  34. Fagan RP, McLaughlin JB, Castrodale LJ, et al. Endemic foodborne botulism among Alaska Native persons--Alaska, 1947-2007. Clin Infect Dis 2011; 52:585.
  35. Austin JW, Leclair D. Botulism in the North: a disease without borders. Clin Infect Dis 2011; 52:593.
  36. Centers for Disease Control and Prevention (CDC). Botulism from home-canned bamboo shoots--Nan Province, Thailand, March 2006. MMWR Morb Mortal Wkly Rep 2006; 55:389.
  37. Kongsaengdao S, Samintarapanya K, Rusmeechan S, et al. An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory failure. Clin Infect Dis 2006; 43:1247.
  38. Centers for Disease Control and Prevention (CDC). Notes from the field: botulism from drinking prison-made illicit alcohol - Arizona, 2012. MMWR Morb Mortal Wkly Rep 2013; 62:88.
  39. Centers for Disease Control and Prevention (CDC). Botulism associated with home-fermented tofu in two Chinese immigrants--New York City, March-April 2012. MMWR Morb Mortal Wkly Rep 2013; 62:529.
  40. Gao QY, Huang YF, Wu JG, et al. A review of botulism in China. Biomed Environ Sci 1990; 3:326.
  41. McCarty CL, Angelo K, Beer KD, et al. Large Outbreak of Botulism Associated with a Church Potluck Meal--Ohio, 2015. MMWR Morb Mortal Wkly Rep 2015; 64:802.
  42. Sobel J. Botulism. Clin Infect Dis 2005; 41:1167.
  43. Sobel J, Malavet M, John S. Outbreak of clinically mild botulism type E illness from home-salted fish in patients presenting with predominantly gastrointestinal symptoms. Clin Infect Dis 2007; 45:e14.
  44. David WS, Temin ES, Kraeft JJ, Hooper DC. Case records of the Massachusetts General Hospital. Case 3-2015. A 60-year-old woman with abdominal pain, dyspnea, and diplopia. N Engl J Med 2015; 372:364.
  45. Varma JK, Katsitadze G, Moiscrafishvili M, et al. Signs and symptoms predictive of death in patients with foodborne botulism--Republic of Georgia, 1980-2002. Clin Infect Dis 2004; 39:357.
  46. Hughes JM, Blumenthal JR, Merson MH, et al. Clinical features of types A and B food-borne botulism. Ann Intern Med 1981; 95:442.
  47. Mechem CC, Walter FG. Wound botulism. Vet Hum Toxicol 1994; 36:233.
  48. Nystrom SC, Wells EV, Pokharna HS, et al. Botulism toxemia following laparoscopic appendectomy. Clin Infect Dis 2012; 54:e32.
  49. O'Suilleabhain P, Low PA, Lennon VA. Autonomic dysfunction in the Lambert-Eaton myasthenic syndrome: serologic and clinical correlates. Neurology 1998; 50:88.
  50. Roland EH, Ebelt VJ, Anderson JD, Hill A. Infant botulism: a rare entity in Canada? CMAJ 1986; 135:130.
  51. Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 2006; 354:462.
  52. Fagan RP, McLaughlin JB, Middaugh JP. Persistence of botulinum toxin in patients' serum: Alaska, 1959-2007. J Infect Dis 2009; 199:1029.
  53. Padua L, Aprile I, Monaco ML, et al. Neurophysiological assessment in the diagnosis of botulism: usefulness of single-fiber EMG. Muscle Nerve 1999; 22:1388.
  54. Wheeler C, Inami G, Mohle-Boetani J, Vugia D. Sensitivity of mouse bioassay in clinical wound botulism. Clin Infect Dis 2009; 48:1669.
  55. Schreiner MS, Field E, Ruddy R. Infant botulism: a review of 12 years' experience at the Children's Hospital of Philadelphia. Pediatrics 1991; 87:159.
  56. Centers for Disease Control and Prevention (CDC). Investigational heptavalent botulinum antitoxin (HBAT) to replace licensed botulinum antitoxin AB and investigational botulinum antitoxin E. MMWR Morb Mortal Wkly Rep 2010; 59:299.
  57. FDA news release. FDA approves first botulism antitoxin for use in neutralizing all seven known botulinum nerve toxin serotypes. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345128.htm (Accessed on March 25, 2013).
  58. BAT, Botulism antitoxin heptavalent (A, B, C, D, E, F, G) - (equine) sterile solution for injection. http://www.fda.gov/downloads/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/UCM345147.pdf (Accessed on February 06, 2015).
  59. United States Centers for Disease Control and Prevention. Botulism in the United States 1899-1996: Handbook for Epidemiologists, Clinicians & Laboratory Workers, 1998. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/files/botulism.pdf (Accessed on April 12, 2010).
  60. Tacket CO, Shandera WX, Mann JM, et al. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med 1984; 76:794.
  61. Sellin LC. Botulism--an update. Mil Med 1984; 149:12.
  62. American Academy of Pediatrics. Botulism and infant botulism (Clostridium botulinum). In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.294.
  63. Santos JI, Swensen P, Glasgow LA. Potentiation of Clostridium botulinum toxin aminoglycoside antibiotics: clinical and laboratory observations. Pediatrics 1981; 68:50.
  64. Hodowanec A, Bleck TP. Botulism (Clostridium botulinum). In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, 8th ed, Bennett JE, Dolin R, Blaser MJ (Eds), Elsevier Saunders, Philadelphia 2015. p.2763.
  65. Centers for Disease Control and Prevention. How can botulism be prevented? http://www.cdc.gov/nczved/divisions/dfbmd/diseases/botulism/#prevent (Accessed on February 06, 2015).
  66. Centers for Disease Control and Prevention (CDC). Notice of CDC's discontinuation of investigational pentavalent (ABCDE) botulinum toxoid vaccine for workers at risk for occupational exposure to botulinum toxins. MMWR Morb Mortal Wkly Rep 2011; 60:1454.
  67. Gottlieb SL, Kretsinger K, Tarkhashvili N, et al. Long-term outcomes of 217 botulism cases in the Republic of Georgia. Clin Infect Dis 2007; 45:174.