By: Yarlini Vipulanandan, MD
Botulism is a rare illness caused by toxins (poison) produced by a certain bacteria. The botulism toxin attacks the body’s nerves, which can lead to muscle weakness, paralysis and difficulty breathing. Without prompt treatment, botulism can be life-threatening.
Types of botulism
Kids and adults can get botulism from swallowing or being exposed to the toxin made by
Clostridium botulinum (C. botulinum) and related bacteria. Different types of botulism include:
Foodborne botulism
Foodborne botulism can happen when food that isn't stored the right way and gets contaminated with spores from the bacteria. Improper storage allows the bacteria to grow and produce the toxin that makes people sick.
Outbreaks of this type of
botulism have occurred by eating not only homemade foods that were improperly canned, preserved or fermented, but also restaurant-prepared foods such as cheese sauce, baked potatoes wrapped in foil, and bottled garlic.
Wound botulism
Wound botulism can happen when the spores of the bacteria get into a wound or injured tissue. The bacteria then grow and produce toxins that get into the bloodstream and causes disease.
Infant botulism
Botulism can also happen when C. botulinum makes toxin in the intestines. This is known as infant botulism.
Infant botulism occurs mostly in babies younger than 6 months of age. This happens when the spores of the
C. botulinum bacteria are swallowed or breathed in by a baby. The germs grow in the intestines and produce toxin. The source of the spores is usually not known. Spores may be in soil or dust and then float into the air.
Honey is another source of botulism spores and should be avoided in babies under 12 months of age. The American Academy of Pediatrics (AAP) recommends that you do not give honey to a baby younger than 12 months. Honey is safe for children 1 year of age and older. Breastfeeding parents may eat honey.
Symptoms of foodborne botulism
Botulism that is caused by
contaminated food can get worse very quickly. Symptoms often begin with feelings of weakness and loss of muscle tone that start with the muscles of the face and spread downward throughout the body.
Symptoms in children include:
The toxin can cause paralysis of the muscles of the trunk, arms, legs, and respiratory system. In these food-borne infections, symptoms start soon after the contaminated food is eaten—typically within 12 to 48 hours but occasionally as long as 10 days later.
Preventing foodborne botulism
Food preparation and home canning can be made safer from botulism by following guidelines such as:
Use
recommended processes for home canning of food (ie. use a pressure cooker/canner, especially for low-acid foods such as vegetables or meat).
Boil home-processed, low acid canned foods for 10 minutes to destroy toxins. Additional time may be needed for higher altitudes.
Refrigerate all leftover and cooked foods within two hours after cooking.
Do not eat or feed your child any foods that appear to be spoiled.
- Discard any food containers that are bulging. They may contain gas produced by
C botulinum.
Symptoms of infant botulism
Signs of infant botulism may range from mild to severe, often beginning with:
Constipation
Difficulty feeding (inability to suck and swallow, pooling of milk or formula in mouth)
Poor head control
Drooping eyelids
Weak or different-sounding cry
Less facial movement
Overall weakness or floppiness
The typical time for symptoms of infant botulism to appear after exposure to the spores can range from 3 to 30 days.
How is botulism diagnosed?
A child's symptoms will help the doctor diagnose botulism. The diagnosis of foodborne botulism can be confirmed by finding toxin in a child's stool (poop), stomach contents, blood or the foods they ate. To diagnose wound botulism, tissue samples may be examined in the laboratory. Infant botulism is diagnosed by testing the baby's stool (poop).
How is botulism treated?
Botulism is considered a medical emergency and requires immediate treatment.
Antitoxin medication
Botulism is treated with
an antitoxin medicine that is given through a small tube placed into the vein. Antitoxin blocks the activity of the toxin in the bloodstream. It works best when it is given early in the course of illness. This is why antitoxin is given when the diagnosis of botulism is suspected. There is no need to wait for lab test results before starting the treatment.
Antibiotics are not helpful in treating most cases of botulism. They are usually only given when another infection is present.
Supportive care
Supportive care is an important part of the therapy for children with botulism. Since botulism toxic affects the muscles involved in breathing and eating, almost all children will need to be hospitalized so they can be monitored closely. If the illness is severe, your child may need help breathing with a mechanical ventilator. They may also need feeding tubes or intravenous (IV) nutrition until they can eat on their own.
Recovery from botulism
With treatment, most children recover fully from botulism. However, recovery can take several weeks or even months. If untreated, botulism may get worse and lead to respiratory failure (the breathing muscles become paralyzed). This can be deadly without respiratory support.
More information
About Dr. Vipulanandan
 Yarlini Vipulanandan, MD, is a combined Pediatric Infectious Disease and Pediatric Hospital Medicine Fellow at the University of Alabama in Birmingham (UAB) and is pursuing research in both congenital infections and osteoarticular infections. She completed her pediatric residency training at University of Texas Southwestern Medical Center in Dallas. Dr. Vipulanandan is a post-residency training member of the American Academy of Pediatrics. |
Editor's note:
Kristina Bryant, MD, FAAP, and
Jennifer Read, MD, MS, MPH, DTM&H, FAAP, also contributed to this article. |