New Hampshire Department of Health and Human Services Fact Sheet Division of Public Health Services

Botulism

What is ? Botulism is a rare but serious paralytic illness botulism. Outbreaks of foodborne botulism caused by a that is produced by involving two or more persons occur most the bacterium botulinum. There years and are usually caused by eating are three main kinds of botulism. Foodborne contaminated home-canned . The number botulism is caused by eating that of cases of foodborne and infant botulism has contain the botulism toxin. Wound botulism is changed little in recent years, but wound caused by toxin produced from a wound botulism has increased because of the use of infected by C. botulinum. Infant botulism is black-tar heroin, especially in California. caused by consuming the of the botulinum , which then grow in the Why is a potential intestines and release toxin. All forms of bioweapon? botulism can be fatal and are considered Botulinum toxin is considered a bioweapons medical emergencies. Foodborne botulism threat because it is extremely potent and can be especially dangerous because eating a lethal. It is also easy to produce, transport, contaminated food can numerous and misuse. It can either be aerosolized into people. the air or used as a contaminant in food. Also a number of countries are known to have Where is developed botulinum toxin as a biological found? weapon. Aum Shinrikyo, the group that was Clostridium botulinum is the name of a group responsible for releasing sarin gas in the of bacteria commonly found in . These Tokyo subway system, tried botulinum toxin rod-shaped organisms grow best in low- first but failed to perfect its use. conditions. The bacteria form spores, which allow them to survive in a dormant What are the symptoms of botulism? state until exposed to conditions that can The classic symptoms of botulism include support their growth. There are seven types of double vision, blurred vision, drooping botulism toxin designated by the letters A eyelids, slurred speech, difficulty , through G; only A, B, E, and F cause illness dry mouth, and muscle weakness. Infants with in humans. botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor How common is botulism? muscle tone. These are all symptoms of the In the United States an average of 110 cases muscle caused by the bacterial toxin. of botulism are reported each year. Of these, If untreated, these symptoms may progress to approximately 25% are foodborne, 72% are cause paralysis of the arms, legs, trunk, and infant botulism, and the rest are wound respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours

29 Hazen Drive ‹ Concord, NH 03301 ‹ 603-271-4496 ‹ www.dhhs.nh.gov

after eating a contaminated food, but they can occur as early as 6 hours or as late as 10 days. How can botulism be prevented? Foodborne botulism has often been from How is botulism diagnosed? home-canned foods with low acid content, Physicians may consider the diagnosis if the such as , green , beets, and patient’s history and physical examination corn. However, outbreaks of botulism from suggest botulism. However, these clues are more unusual sources such as improperly usually not enough to allow a diagnosis of handled chopped in oil, chili peppers, botulism. Other can appear similar to and tomatoes have occurred. Persons who do botulism, such as , but special tests can home should follow strict hygienic exclude these other conditions. The most procedures to reduce contamination of foods. direct way to confirm the diagnosis is to Oils infused with garlic or herbs should be demonstrate the presence of botulinim toxin refrigerated. Because high temperatures in the patient’s system. destroy the botulism toxin, persons who eat home-canned foods should consider boiling How can botulism be treated? the food for 10 minutes before eating it to The and paralysis that ensure safety. Instructions on safe home occur with severe botulism may require a canning can be obtained from county patient to be on a breathing machine extension services or from the US Department (ventilator) for weeks, plus intensive medical of Agriculture. Because can contain and nursing care. After several weeks the spores of Clostridium botulinum and this has paralysis slowly improves. If diagnosed early, been a source of in infants, children foodborne and wound botulism can be treated younger than 12 months should not be fed with an which blocks the action of honey. Honey is safe for persons 1 year of age toxin circulating in the blood. This can or older. Wound botulism can be prevented prevent patients from worsening, but recovery by promptly seeking medical care for infected still takes many weeks. Physicians may try to wounds and by not using injectable street remove contaminated food still in the drugs. If you suspect that you may have been digestive tract if the toxin was foodborne. exposed to botulinum toxin in any manner, Wounds should be treated, usually surgically, seek medical help immediately. to remove the source of the toxin-producing bacteria. Good supportive care in a hospital is the mainstay of therapy for all forms of For specific concerns about botulism, call botulism. Currently, antitoxin is not routinely the New Hampshire Department of Health given to treat infant botulism. and Human Services, Bureau of Infectious Control at 603-271-4496 or 800- Are there complications from 852-3345 x4496. For further information, botulism? refer to the Centers for Disease Control and Prevention website at www.cdc.gov Botulism can result in death due to respiratory or the New Hampshire Department of failure. However, in the past 50 years, the Health and Human Services website at proportion of patients with botulism who die www.dhhs.nh.gov . has fallen from about 50% to 8%. Patients who survive an episode of botulism poisoning may have and for years and long-term therapy may be needed to aid recovery.

29 Hazen Drive ‹ Concord, NH 03301 ‹ 603-271-4496 ‹ www.dhhs.nh.gov