Botulism is a neurological condition characterized by paralysis due to the effects of a toxin called botulinum toxin. The bacterium Clostridium botulinum synthesizes and releases the toxin which binds to receptors on muscles and subsequently paralyzes them. There are several types and I will cover the two main ones:
- Food-borne is often found in issues with poor canning of foods which provides a permissive environment for the Clostridium botulinum bacterium. The bacteria make the toxin that causes the symptoms. Symptoms typically begin within six hours to two weeks. The typical timeframe for the development of symptoms is 12-36 hours and include muscle weakness that descends down the body beginning in the shoulders then upper and lower arms and then in the thighs and calves. The most dangerous aspect of this is paralysis of the diaphragm and other respiratory muscles requiring intubation and mechanical ventilation. Other symptoms include blurred vision, double vision, drooping eyelids, slurred speech, and difficulty swallowing.
- Wound botulism occurs when a wound is infected with the Clostridium bacterium. In my entire career I saw one case of botulism. A young man who was a landscaper came in with the typical descending weakness and then was unable to breathe and was placed on a ventilator which he remained on for approximately three months. It is extremely serious and although the CDC has a supply of antitoxin, it must be delivered early in the disease. In the case of the patient I observed, it was too late. He eventually recovered but being paralyzed for so long required an extensive and prolonged course of physical therapy as his muscles atrophied. It was determined that he had a wound that was infected with Clostridium botulinum bacteria.
Additional information about the disease is it cannot be transferred from person to person. In the case of the food-borne type it is a public health emergency as depending on the source, more people can become infected.
Fortunately, Botox, Dysport, Xeomin and Juveau do not cause botulism. They contain an extremely miniscule amount of the botulinum toxin. However, in training I was informed that there were two instances where people tried to synthesize the toxin themselves. The result was a gross miscalculation of dose and patients developed botulism.
