Botulism

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Organism
Botulism is caused by neurotoxins produced by Clostridium botulinum, an anaerobic, spore-forming bacterium.

Transmission
There are many forms of botulism. Modes of transmission for the three main kinds of botulism are described here:

• Infant botulism is caused by consuming the spores of the C. botulinum bacteria, which then grow in the intestines and release toxin.
• Wound botulism is caused by toxin produced from a wound infected with Clostridium botulinum. Wound botulism has been rare, but increasingly reported, especially in injectors of "black-tar" heroin under their skin (skin popping).
• Foodborne botulism is caused by ingesting foods that contain C. botulinum toxin. Most implicated foods are low acid, home-canned items inadequately processed during canning and not heated before consumption. Rarely, commercial products are implicated, usually after a breakdown in standard canning procedures. Foodborne botulism is considered a public health emergency, as action can be taken to prevent others from eating a contaminated food.

Botulism is not transmissible from person-to-person.

Symptoms
Symptoms in infants often include:

• Constipation
• Lethargy
• Generalized weakness (the “Floppy” baby syndrome)
• Poor feeding
• Poor head control
• Poor gag and sucking reflex

Symptoms in children and adults often include:

• Blurred or double vision
• Drooping eyelids
• Slurred speech
• Difficulty swallowing or speaking
• Dry mouth
• Muscle weakness
• Muscle paralysis, which may start with the face and progress down the body to the trunk, arms, and legs.
• All forms of botulism can be fatal and are considered medical emergencies.

Prevention
Infant botulism

• Honey can contain spores of Clostridium botulinum and may be a source of infection for infants therefore children less than 12 months old should not be fed honey (raw or otherwise).

Wound botulism

• Wound botulism can be prevented by promptly seeking medical care for infected wounds and by not using injectable street drugs.

Foodborne botulism

• Be sure to use proper techniques when canning foods at home to ensure that any botulism germs in the food are destroyed.
• Prepare and store food safely.
  • Don't eat preserved food if its container is bulging or if the food smells spoiled. However, taste and smell won't always give away the presence of C. botulinum. Some strains don't make food smell bad or taste unusual.
  • Oils infused with garlic, vegetables, fresh herbs or similar moist flavoring should be refrigerated to minimize risk.
  • Potatoes which have been baked while wrapped in aluminum foil should be kept hot or thoroughly re-heated before being served or refrigerated immediately.

Recent Texas Trends
Infant botulism, a type of botulism that affects children under 1-year of age, is the most common form of botulism reported in Texas. Over a five-year period (2016-2020), the average number of cases of infant botulism reported in Texas was 9 cases per year. During this time, reported case counts ranged between 7 in 2016 to 11 in 2018 and 2019.

Clostridium botulinum spores occur naturally in the environment, and can be found in dust, soil and water worldwide. The most common exposure identified in infant cases is exposure to dust. Raw honey and herbal tea can also be a source of exposure and should therefore not be given to children under one-year of age. In 2018, four cases of infant botulism were reported across multiple jurisdictions in Texas and were linked to honey pacifiers purchased in Mexico.

Foodborne botulism is less common in Texas. There was one outbreak with 4 cases reported in 2013 and it was linked to a home-pickled vegetable dish called Turshi. Over the last five years, there has been an increase in the number of wound botulism cases reported in Texas. These cases have been associated with the injection of illicit drugs, especially black tar heroin.

Health Advisories
Infant Botulism 2018