University at Albany Prevention Research Center

BOTULISM

Infectious Agent

A Gram positive spore-forming bacillus Clostridium Botulinium (C. Botulinium) and the toxin produced by it, Botulinum Toxin.
More Information On Infectious Agent at CIDRAP, NYSDOH & CDC
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Clinical Symptoms

Botulism is characterized by an acute, febrile, descending paralysis affecting the cranial nerves first and then causing muscle weakness. Severity ranges from mild cranial nerve dysfunction to complete flaccid paralysis. Death occurs due to airway obstruction or respiratory muscle paralysis.

Case Fatality - Before mechanical ventilation was available, it was 60%; now, 5-10% for food-borne and higher for wound botulism (15-44%).

Incubation Period - depends on the level of toxin exposure
- For food-borne botulism, it is 2hours to 8days
- For wound botulism, it is 4days to 14days
- for inhalational botulism, it is unknown, but estimated to be 24-36 hours

Symptoms - Nausea, Dry Mouth, Blurred Vision, Dysphonia, Dysphagia, Weakness, Fatigue, Dyspnea, Dysarthria, Double Vision, Dizziness, Vomiting, Constipation, Sore Throat, Abdominal Cramps or Pain, Diarrhea, Parasthesias.

Signs - Weakness of upper & lower extremities and extraocular muscles, Alert mental status, Ptosis, Diminished gag reflex, Facial nerve dysfunction, Dilated or fixed pupils, Nystagmus, Ataxia, Diminished or absent deep tendon reflexes in affected groups.

Complications - Respiratory failure, Aspiration pneumonia, Residual fatigue, dry mouth or eyes, dyspnea on exertion upto several years after initial presentation.
More Information On Clinical Symptoms at CIDRAP, NYSDOH & CDC
Images at CIDRAP

Epidemiology

Reservoir -

Soil. C. Botulinum is a natural contaminant of the soil throughout the U.S.

Modes of Transmission -
- Foodborne Botulism: Ingestion of food contaminated with preformed botulinum toxin and its absorption via the gastrointestinal tract.
- Wound Botulism: Infection of a contaminated wound with C. Botulinum and the subsequent absorption of the locally produced toxin. Exposure can occur following severe traumatic injury to the extremities or may occur even post-operatively. Cases have also been reported in intravenous drug addicts and with sinusitis in intranasal cocaine users.
- Inhalational Botulism: Inhalation of aerosolized preformed botulinum toxin with subsequent exposure through the lungs into the circulation.
- Infant Botulism: Ingestion of C. Botulinum spores which colonize the gastrointestinal tract, germinate, and produce toxin, that gets absorbed into the circulation.
- Intestinal Botulism in Adults: Same as infant botulism. Only a few cases have been reported and most have occurred post-operatively or in patients with underlying gastrointestinal pathology.
More Information On Epidemiology at CIDRAP & CDC

Botulinum Toxin as a Bioterrorism Agent

Botulinum toxin can be used as a lethal bioweapon with the likely modes of dissemination being -
- Deliberate contamination of food/beverages
- Dispersion of aerosolized toxin
- Contamination of water supply

A botulism outbreak following a deliberate toxin release will have the following features -
- Involvement of a large number of cases
- Multiple simultaneous outbreaks with or without an apparent source
- Common food exposure (for ingestional botulism) and common geographic location (for inhalational botulism as a result of an aerosol release) amongst cases during the week before symptom onset
More Information On Botulism as a Bioterrorism Weapon at CIDRAP & CDC

Click here for Information on

Prevention & Control at CIDRAP, NYSDOH & CDC
Laboratory Diagnosis at CIDRAP, NYSDOH & CDC
Treatment Information at CIDRAP, NYSDOH & CDC

Additional Sources of Information

- Visit the Centers for Disease Control & Prevention (CDC) Botulism Home Page
- Visit Infectious Disease Society of America (IDSA) for Botulism Information


Category A Anthrax Botulism Plague Smallpox Tularemia Viral Hemorrhagic Fevers Category B Brucellosis Glanders Melioidosis Psittacosis Q Fever Typhus Fever Viral Encephalitis Toxins Food Safety Water Safety Category C Nipah Hanta Virus Other Important Zoonotic Diseases Transmissible Spongiform Encephalopathy Rift Valley Fever Virus Handra Virus West Nile Fever	BOTULISM Infectious Agent A Gram positive spore-forming bacillus Clostridium Botulinium (C. Botulinium) and the toxin produced by it, Botulinum Toxin. More Information On Infectious Agent at CIDRAP, NYSDOH & CDC Images at CIDRAP Clinical Symptoms Botulism is characterized by an acute, febrile, descending paralysis affecting the cranial nerves first and then causing muscle weakness. Severity ranges from mild cranial nerve dysfunction to complete flaccid paralysis. Death occurs due to airway obstruction or respiratory muscle paralysis. Case Fatality - Before mechanical ventilation was available, it was 60%; now, 5-10% for food-borne and higher for wound botulism (15-44%). Incubation Period - depends on the level of toxin exposure - For food-borne botulism, it is 2hours to 8days - For wound botulism, it is 4days to 14days - for inhalational botulism, it is unknown, but estimated to be 24-36 hours Symptoms - Nausea, Dry Mouth, Blurred Vision, Dysphonia, Dysphagia, Weakness, Fatigue, Dyspnea, Dysarthria, Double Vision, Dizziness, Vomiting, Constipation, Sore Throat, Abdominal Cramps or Pain, Diarrhea, Parasthesias. Signs - Weakness of upper & lower extremities and extraocular muscles, Alert mental status, Ptosis, Diminished gag reflex, Facial nerve dysfunction, Dilated or fixed pupils, Nystagmus, Ataxia, Diminished or absent deep tendon reflexes in affected groups. Complications - Respiratory failure, Aspiration pneumonia, Residual fatigue, dry mouth or eyes, dyspnea on exertion upto several years after initial presentation. More Information On Clinical Symptoms at CIDRAP, NYSDOH & CDC Images at CIDRAP Epidemiology Reservoir - Soil. C. Botulinum is a natural contaminant of the soil throughout the U.S. Modes of Transmission - - Foodborne Botulism: Ingestion of food contaminated with preformed botulinum toxin and its absorption via the gastrointestinal tract. - Wound Botulism: Infection of a contaminated wound with C. Botulinum and the subsequent absorption of the locally produced toxin. Exposure can occur following severe traumatic injury to the extremities or may occur even post-operatively. Cases have also been reported in intravenous drug addicts and with sinusitis in intranasal cocaine users. - Inhalational Botulism: Inhalation of aerosolized preformed botulinum toxin with subsequent exposure through the lungs into the circulation. - Infant Botulism: Ingestion of C. Botulinum spores which colonize the gastrointestinal tract, germinate, and produce toxin, that gets absorbed into the circulation. - Intestinal Botulism in Adults: Same as infant botulism. Only a few cases have been reported and most have occurred post-operatively or in patients with underlying gastrointestinal pathology. More Information On Epidemiology at CIDRAP & CDC Botulinum Toxin as a Bioterrorism Agent Botulinum toxin can be used as a lethal bioweapon with the likely modes of dissemination being - - Deliberate contamination of food/beverages - Dispersion of aerosolized toxin - Contamination of water supply A botulism outbreak following a deliberate toxin release will have the following features - - Involvement of a large number of cases - Multiple simultaneous outbreaks with or without an apparent source - Common food exposure (for ingestional botulism) and common geographic location (for inhalational botulism as a result of an aerosol release) amongst cases during the week before symptom onset More Information On Botulism as a Bioterrorism Weapon at CIDRAP & CDC Click here for Information on Prevention & Control at CIDRAP, NYSDOH & CDC Laboratory Diagnosis at CIDRAP, NYSDOH & CDC Treatment Information at CIDRAP, NYSDOH & CDC Additional Sources of Information - Visit the Centers for Disease Control & Prevention (CDC) Botulism Home Page - Visit Infectious Disease Society of America (IDSA) for Botulism* Information*
Created by the School of Public Health University at Albany Updated July 2004