Botulism is a life-threatening condition of neuroparalysis that is caused by a potent neurotoxin produced by the spore-forming bacteria . Botulinum toxin blocks the release of acetylcholine from presynaptic axon terminals into the synaptic cleft, irreversibly inhibiting neurotransmission. There are three main types of botulism: foodborne botulism, infant botulism, and wound botulism. Foodborne botulism results from the ingestion of a food product already contaminated with botulinum toxin (typically home-canned foods). Infant botulism represents the majority of cases and is caused by the ingestion of spores (commonly from honey or soil), which then germinate and produce neurotoxins within the intestinal tract. In wound botulism, which typically occurs in IV drug users, C. botulinum spores germinate in contaminated wounds. All three types present with neuroparalysis, while foodborne and infant botulism are sometimes also associated with gastrointestinal symptoms (e.g., discomfort, nausea, constipation). Clinical suspicion of botulism may be confirmed by quickly identifying the toxin in bodily fluids (e.g., serum, vomit, gastric acid, stool) and/or food. Foodborne botulism is best treated with an antitoxin and medically-induced bowel emptying. Treatment of infant botulism consists of the administration of botulism immune globulin. Wound botulism requires surgical debridement in addition to antitoxin administration.
- Clostridium botulinum
- Botulinum toxin: protease that cleaves SNARE proteins and prevents fusion of transmitter-containing vesicles with the presynaptic membrane → inhibition of acetylcholine release from the presynaptic axon terminals 
- Neurological symptoms
- Gastrointestinal symptoms
4 D's of botulism: Dysarthria, Diplopia, Dysphagia, and Dyspnea.
- Secure airways.
- See the corresponding sections for specific treatment measures.
Therapeutic/cosmetic botulinum toxin use
- Local injection of botulinum toxin A (Botox) can be used to treat various conditions, including:
- Also used to reduce facial wrinkles
- Ingestion of preformed botulinum toxin via contaminated foods
- Incubation period: 12–36 hours
- Horse-derived heptavalent botulism antitoxin
- Eradication of toxin through bowel emptying (induced by medication)
- Sterilize food through autoclaving.
- Food should be boiled twice before being canned to kill spores that may have germinated after the first round of boiling.
Etiology: ingestion of spores
- Spores may be present in honey, juice, and contaminated soil.
- Germination of the spores in intestinal tract → synthesis of botulinum toxin
- Incubation period: days to 4 weeks
Clinical features: Infants may present with infantile hypotonia (see floppy infant syndrome below)
- Floppy movements
- General weakness
- Poor feeding (weak sucking)
- Differential diagnosis: floppy infant syndrome
|Differential diagnosis of floppy infant syndrome |
|Infant botulism|| || |
|Neonatal myasthenia gravis|| |
|Spinal muscular atrophy type 1|
|Myotonic dystrophy type 1|| |
|Trisomy 21|| |
- Specific treatment: IV human botulism immune globulin (BIG-IV)
- Prevention: Avoid exposure of < 1-year-old infants to potentially contaminated material (e.g., raw honey, dust, soil).
Treatment should not be delayed if there is a high clinical suspicion of infant botulism. 
- Etiology: germinating spores in contaminated wounds (most common among IV drug users)
- Incubation period: 10 days (ranges from 4–14 days)
- Specific treatment
- Government-sponsored sterile needle and syringe programs
- Avoidance of IV drug use
- Seek medical attention for infected wounds.
The differential diagnoses listed here are not exhaustive.