Botulism: Clinical Description

Risk Groups

• All persons. Injection drug users are at increased risk for wound botulism.

Incubation

• Foodborne botulism: typically 12-36 hours after toxin ingestion, but in rare cases as early as 6 hours or as late as 10 days after ingesting toxin.
• Wound botulism and infant botulism: it is difficult to estimate incubation period because exposure times cannot be ascertained.
• Inhalational botulism: same as foodborne botulism.

Symptoms

• Foodborne Botulism
  • Symmetric cranial neuropathies such as diplopia, drooping eyelids, difficulty swallowing, dry mouth, altered voice, or difficulty speaking
  • Symmetric descending flaccid paralysis in a proximal to distal pattern.
  • Possibly but not necessarily:
    • Abdominal pain
    • Nausea
    • Vomiting
    • Diarrhea
  • May progress to respiratory dysfunction from respiratory muscle paralysis.
• Infant Botulism
  • Poor feeding
  • Diminished suckling and crying ability
  • Neck and peripheral weakness “floppy baby”
  • Constipation
  • Ventilatory failure
• Wound Botulism
  • Neurological findings are indistinguishable from food-borne botulism without gastrointestinal symptoms
  • Wounds may not be obviously or grossly infected but are usually deep and contain avascular areas.

For more information:

• Botulism: FAQ
• MMWR: Wound Botulism — California, 1995
• MMWR: Foodborne Botulism — Oklahoma, 1994
• MMWR: Wound Botulism Associated with Parenteral Cocaine Abuse — New York City