Botulism is a rare paralytic illness caused by a toxin from Clostridium botulinum that blocks the release of acetylcholine at nerve endings. It can come from improperly home-canned food, infected wounds often linked to injection drug use, or spores that grow in an infant's gut, and it can stop breathing within hours.
Key symptoms
- Double vision, blurred vision and drooping eyelids
- Trouble swallowing and slurred speech
- Weakness that spreads downward from the face to the arms, trunk and legs
- Dry mouth and constipation
- Infants: constipation, weak cry, poor feeding and floppiness
What you find on exam
- Cranial nerve palsies: ptosis, dilated or sluggish pupils, facial weakness
- Symmetric descending flaccid weakness with reduced reflexes
- Normal sensation and a clear mind
- No fever; check breathing strength and vital capacity
Tests
- Clinical diagnosis; do not wait for tests to treat
- Call the state health department and CDC to get antitoxin and testing
- Toxin testing of serum, stool or the suspected food
- Nerve conduction studies; rule out Guillain-Barre syndrome and myasthenia gravis
Treatment basics
- Antitoxin as early as possible: heptavalent antitoxin for adults, BabyBIG for infants
- Close airway monitoring; intubation and ventilation for respiratory failure
- Wound botulism: debridement, and penicillin after antitoxin
- Supportive care: feeding, prevention of clots and pressure injuries
- Avoid aminoglycosides, which can worsen weakness
Red flags
- Falling vital capacity or weak cough: respiratory failure
- Pooling of saliva or inability to protect the airway
- Several people sick after the same meal: possible outbreak
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Related guides
Sources: NCCPA PANCE Content Blueprint; NASEMSO National Model EMS Clinical Guidelines; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.