Botulism
Basic Information
Definition
Botulism is a neuroparalytic illness characterized by symmetric, descending, flaccid paralysis of motor and autonomic nerves caused by intoxication with botulinum toxin. Three forms of the disease are recognized:
• Classic botulism or foodborne botulism is caused by the ingestion of preformed botulinum toxin in contaminated foods.
• Infant botulism is caused by colonization of the gastrointestinal (GI) tract with the organism Clostridium botulinum, followed by absorption of the neurotoxin produced in the GI tract.
Epidemiology & Demographics
• Approximately 150 cases of botulism are reported in the United States each year; 60% are infant botulism.
• Wound botulism increased in 1995 and 1996 primarily among injecting drug users (possibly associated with black tar heroin).
• Foodborne botulism outbreaks have been associated with both restaurant and home-prepared foods of all types, including the consumption of commercially prepared foods which have been stored improperly (toxin types A and B).
• Alaska has the highest incidence of foodborne botulism primarily due to the consumption of improperly prepared Alaskan native foods of fish or marine origin (toxin type E).
• Infant botulism occurs with increased frequency in California, Utah, and southern Pennsylvania (toxin types A and B).
Clinical Presentation
• Patients with foodborne botulism can present with GI disturbances such as nausea, vomiting, diarrhea, and abdominal pain, followed by neurologic symptoms.
• Common neurologic symptoms are dry mouth, blurred vision, diplopia, dysphonia, dysphagia, cranial nerve paralysis, and descending weakness, including the muscles of respiration.
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