Botulism Symptoms, Causes, Treatment - What are complications from botulism? on MedicineNet

Botulism (cont.)

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Medical Author:

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Medical Editor:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What are complications from botulism?

Botulism can result in death from respiratory failure. However, in the past 50 years, the rate of death from botulism has fallen from about 60% to 8%. Unfortunately, to survive, a patient with severe botulism may require not only a breathing machine but also intensive medical and nursing care for several months.

Patients who survive an episode of botulism poisoning may experience fatigue and shortness of breath for years, and long-term therapy may be needed to aid recovery.

Care providers should note that in 2009 the FDA increased its label precautions on the three available products: BOTOX, Dysport, and Myobloc. All three are different formulations of the toxin and are not interchangeable with regard to dosing. In addition, the FDA cautions that all the symptoms of botulism can occur if the treatments are inappropriately given, especially in high doses or if some of the solution seeps out of the localized area where it is injected. The FDA further warned care providers that suppliers of medical toxins that do not have FDA approval may supply faulty products that could harm individuals.

Can botulism be prevented?

Yes. Food-borne botulism has often come from improperly prepared home-canned foods such as asparagus, green beans, beets, and corn. However, there have been outbreaks of botulism from more unusual sources such as chopped garlic in oil, agave nectar, chili peppers, broccoli, tomatoes, tomato sauce, improperly handled baked potatoes wrapped in aluminum foil, and home-canned or fermented fish. People who do home canning should follow strict hygienic procedures to prevent or kill Clostridium bacteria, their spores, and neutralize its neurotoxin. Oils that are infused with garlic or herbs should be refrigerated. Potatoes that have been baked while wrapped in aluminum foil should be kept hot until served or refrigerated. Bacon should be cooked well since bacon preservatives (salts), which inhibit clostridial spores, have been reduced to have less salt. Because botulism neurotoxin is destroyed by high temperatures (85 degrees C for five minutes), people who eat home-canned foods should consider boiling the food for 10 minutes before eating it to help ensure that the food is safe to consume. Bulging cans or abnormal-smelling preserved foods should be discarded. Do not taste-test them or attempt to boil the food!

Because honey can contain spores of Clostridium botulinum and this has been a source of infection for infants, children less than 12 months old should not be fed honey. Honey is relatively safe for people 1 year of age and older.

Wound botulism can be prevented by promptly seeking medical care for infected wounds or skin cuts and avoiding injectable street drugs.

The FDA publishes recall lists of commercially produced foods that may contain botulinum toxin. The most recent large recall was Castleberry Food Company's hot dog chili sauces and dog food in 2007. In October 2009, Plumb Organics issued a recall of baby food (apple and carrot preparations) that may be tainted with botulinum toxin. Avoiding such potential sources of toxin can prevent botulism.

Vaccine development for the major human types of botulism neurotoxin is currently being investigated, but there is no vaccine commercially available or approved for public use by the FDA. However, in the United States, an investigational pentavalent (against neurotoxins A, B, C, D, and E) botulinum toxoid vaccine can be distributed by the CDC for laboratory workers at high risk of exposure to botulinum toxin and by the military for protection of troops against attack. Unfortunately, it takes several months to induce immunity. In 2009, a new research finding with molecules that mimic botulism toxin binding sites may provide another method to block toxin from binding to nerve tissues, but this approach is only in the research phase of development.

The herb milk thistle has been suggested by alternative medicine proponents (mainly in Europe) to treat food poisoning (especially mushroom poisoning) and to help detoxify the liver. There is no good data on its use in preventing or treating botulism.

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