| Botulism is a serious but rare type of food poisoning that causes progressive muscular paralysis and nervous system disturbances. Toxins produced by the bacteria Clostridium botulinum affect the transmission of nerve impulses. Muscles such as those in the throat and those that control breathing become paralyzed. Death may result from respiratory failure.
The most common form of human botulism throughout the world is caused by eating contaminated food. Even minute amounts can lead to severe poisoning. Because the bacteria, which can survive under adverse conditions, can only multiply in the absence of air (anaerobic), they thrive in preserved or canned food that has been contaminated during preparation. Foods most commonly infected with the toxin are spiced, smoked, vacuum-packed, or home-canned foods that are eaten without cooking. In the US, foodborne botulism has been associated primarily with home-canned food, particularly vegetables, fruit, and condiments, and less commonly with meat and fish.
One sign of contaminated food is a can with a bulging lid or sides; contaminated foods may look and taste normal. Boiling food for at least 20 minutes can destroy the toxin.
Botulism bacteria are also found in the soil. Wound botulism can occur if these bacteria enter skin broken during an injury and if the bacteria then produce toxin.Risk: In the US, the geographic distribution of cases by toxin type parallels the distribution of organism types found in the environment. Type A predominates west of the Mississippi River; type B, although widely distributed, is more common in the East; and type E is found in the Pacific Northwest, Alaska, and the Great Lakes area.
Native peoples have the highest rates of botulism in the world. Men have higher rates of wound botulism than females. Food botulism affects men and women equally (Chan-Tack). Incidence and Prevalence: There are an average of 110 new cases of botulism in the US each year. Of these, an estimated 25% are from food and about 3% are wound botulism. Although wound botulism is very rare, most of the documented cases have been found in the US. Botulism occurs in animals with a much higher incidence ("Botulism"). Botulism is widespread. Type A or B toxins have been found worldwide, although B is more commonly found in Europe (Chan-Tack). |
Source: Medical Disability Advisor
| History: Symptoms usually appear between 18 and 36 hours after eating contaminated food but can appear as early as 6 hours or as late as 10 days. They may include difficulty swallowing or speaking, dry mouth, nausea, vomiting, abdominal cramps, diarrhea, slurred speech, and blurred or double vision. As paralysis of the nervous system progresses, symptoms include weakness of upper and lower extremities, dizziness, difficulty walking, and difficulty breathing. Physical exam: The exam may reveal dilated, fixed pupils, drooping eyelids (ptosis), decreased gag reflex or tongue weakness, partial paralysis of face, weakness of upper and lower extremities, poor muscular coordination (ataxia), and decreased, absent, or increased deep tendon reflexes. Pulse is rapid and weak. Tests: Bacterial culture or toxin analysis (assays) may be done on blood (serum), stool, wound, or remnants of suspected food. Other tests may include a brain scan, spinal fluid examination, and a test for myasthenia gravis. Nerve studies may be done by recording the electrical activity in the muscles through electromyography (EMG) or by skin testing. |
Source: Medical Disability Advisor
| Maintenance of airway and breathing is crucial. Respiratory paralysis may lead to death unless mechanical assistance (respirator) is provided. Botulinum antitoxin is given to adults. Although the antitoxin cannot undo the damage, it may slow or stop further damage, allowing the body to heal itself over the next few months. Antitoxin is most effective if given within 72 hours of symptom onset. Drugs (purgatives) and wound débridement may be used to remove any unabsorbed toxin. Intravenous fluids may be given to prevent dehydration.
Wounds may require surgical treatment to remove the toxin-producing bacteria. |
Source: Medical Disability Advisor
| Botulism is a life-threatening condition. Suffocation due to paralysis of the respiratory muscles results in death in about 70% of untreated cases. Prompt treatment with an antitoxin reduces the risk of death to less than 25%.
In the past 50 years, the percentage of patients who have died from botulism has fallen from about 50% to 8%. |
Source: Medical Disability Advisor
Source: Medical Disability Advisor
| Work accommodations may include a temporary transfer to sedentary duties and elimination of duties that require heavy lifting. The individual's work area may need to be relocated nearer to the entrance/exit in order to decrease the amount of walking required, or the employer may need to support a worker's ability to move from the parking lot to the work area (e.g., avoid stairs). |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Has individual eaten any potentially contaminated food?
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Does individual have a cut that was exposed to soil?
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How long after exposure did the symptoms appear?
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Does individual have difficulty swallowing or speaking? Dry mouth? Does individual have symptoms of nausea, vomiting, diarrhea, or abdominal cramps? Is vision blurred or double? Does individual have dilated fixed pupils? Ptosis? Is individual having trouble walking? Breathing?
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Is there a decreased gag reflex, tongue weakness, or partial paralysis of face? Does individual have weakness of the extremities and ataxia? Were deep tendon reflexes decreased, absent, or increased?
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Is the pulse rapid and weak?
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Were blood, stool, and wound tests performed? Was the suspected food tested? Were nerve conduction studies done?
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Have conditions with similar symptoms been ruled out?
Regarding treatment:
- Was a respirator necessary?
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Was the individual given botulinum antitoxin? Within 72 hours?
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Were purgatives used?
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Was the wound debrided?
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Were IV fluids needed?
Regarding prognosis:
- Can individual's employer accommodate any necessary restrictions?
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Does individual have any conditions that may affect ability to recover?
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Did complications arise such as aspiration pneumonia or abscess?
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Does individual have neurological impairment or persistent psychological problems?
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Source: Medical Disability Advisor
| "Botulism ." Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. 16 Sep. 2004 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/botulism_g.htm#How%20common%20is%20botulism>.Chan-Tack, Kirk M., and John Bartlett. "Botulism." eMedicine. Eds. David H. Shepp, et al. 10 Mar. 2004. Medscape. 16 Sep. 2004 <http://emedicine.com/med/topic238.htm>. |
Source: Medical Disability Advisor
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