Botulism is a foodborne illness that is caused by a type of bacteria,
Clostridium botulinum (C. botulinum) which releases a toxin that is poisonous to the nervous system. Botulism is not common but it can be fatal.
Botulism is most commonly caused by home-canned fruits and vegetables which are non-acidic and have not been processed for a long enough period of time. It can also be caused by commercial canning or improperly preserved fish, seafood and meat products.
Other Types of Botulism
In addition to foodborne illness caused by botulism, there are other ways to get it including:
- Inhalation botulism – Caused by breathing in the botulin toxin. It is rare but has been theorized for use as a biological weapon by aerosolizing the toxin and spreading it into the air.
- Wound botulism – occurs when spores of botulinum get into open wounds, reproduce and create toxins. Wound botulism is mainly associated with IV drug users who inject tainted drugs like heroin into the skin and not in the veins.
- Infant botulism – occurs in babies under 6 months to 1 year who swallow botulinum spores which grow into bacteria to release the toxin. Botulinum spores are present in dust and soil but most commonly come from unpasteurized or “raw” honey. As children age, they develop a resistance to botulinum bacteria in their intestines and are no longer susceptible. Children under 12 months of age should not be allowed to eat raw honey.
What Types of Food Causes Botulism?
Botulism is present in soil and contaminated water but is killed by proper cooking or processing. The main sources of botulism good poisoning are caused by inadequate food processing for storage. Home canning is a primary source of botulism, along with fermented fish or foods held for extended periods at warm temperatures.
Botulism develops in preserved foods which:
- Are in low or no oxygen (anaerobic) storage like canning
- Are low acidity such as foods that are not preserved in vinegar
- Are low sugar
- Are low salt
- Not processed at high enough heat
- Do not contain an adequate amount of water
Foods which are not held at “hot” temperatures have also resulted in botulism poisoning including foil-wrapped potatoes, oil infused with garlic and cooked chile peppers.
Native Alaska foods which have not been well-preserved, have been responsible for hundreds of deaths since 1950. Alaska native foods that have caused botulism poisoning include:
- Fermented fish heads
- Fermented fish eggs
- Fermented seal flipper
- Fermented walrus flipper
- Fermented whale
- Fermented beavertail
- Dried, unsalted fish
- Seal oil
In addition to foods, a home-brew alcohol beverage called “Pruno” has been responsible for hundreds of food poisoning events. Pruno is made from fermented fruits, sugar, candy or even ketchup or milk. The fermenting process starts with the addition of bread, which supposedly provides yeast for the fermentation to begin.
Pruno also goes by other names including prison wine, toilet wine, homebrew, and jailhouse hooch. It is primarily a problem that originated in prison and can be made with a minimum of equipment but may also be made in remote villages and communities.
Notable Botulism Food Poisoning Events
Though botulism can be deadly, it does not occur as often as other types of food poisoning.
Notable events which resulted in deaths due to botulism toxin include:
- 1971 – a New York man died from canned soup
- 1977 – 59 individuals became sickened after consuming improperly canned peppers and hot sauce at a Mexican restaurant
- 1978 – 34 people were sickened, and two people died after eating potato salad or 2-bean salad at a restaurant in New Mexico
- 1983 – 28 people were sickened and 1 died after consuming sautéed onions at a restaurant in Illinois
- 1994 –30 people were sickened after consuming vegetable dips made from baked potatoes at a Greek restaurant
- 2002 – 8 Alaskans who ate “muktuk” or whale blubber from a beached whale were sickened
- 2007 – 8 people who consumed canned foods from Castleberry’s Food Company in Georgia were poisoned
- 2015 – Between 21 and 31 people were sickened after consuming potato salad made from canned potatoes from a church potluck
- 2017 – 10 people were sickened and 1 person died from nacho cheese sauce consumption at a gas station in California
Alaska is responsible for up to half of all botulism cases in the U.S. due to fermented seafood and homebrew contamination. More than 300 deaths may have occurred since 1950 due to botulism food poisoning in Alaska.
Pruno has been responsible for a number of botulism outbreaks in prisons around the country, including native Alaskan villages.
Symptoms of Botulism
No matter how a person gets botulism, the symptoms are similar. The primary symptom which separates botulism from other types of food poisoning is due to the toxin attacking nerve tissue. In most case, weakness begins on the sides of the face, travels down to the neck and on to the rest of the body. Other symptoms mainly include nerve damage as well including:
- Drooping eyelids
- Blurred or double vision
- Difficulty swallowing
- Shortness of breath
- Slurred speech
Many of those affected by botulism toxin also experience vomiting, abdominal pain, and diarrhea. If the disease progresses, severe constipation and difficulty urinating may develop. Untreated botulism may progress to paralysis of the extremities (arms and legs) and to the diaphragm (the muscle used for breathing).
Infant botulism has symptoms that may be less obvious and include:
- Muscle weakness in head and neck, moving downward
- Poor feeding
- Weak cry
- Eye drooping
Diagnosis and Treatment of Botulism
Symptoms of botulism poisoning usually appear within 6 to 36 hours of eating contaminated food. Rarely, they may be delayed for up to 10 days. Botulism is diagnosed through physical exam but also include laboratory or stool sample to check for botulism bacteria and toxin.
Once other illnesses which have similar symptoms like Epstein Barre virus are ruled out through laboratory testing, the primary treatment for botulism is the administration of anti-toxin to inactivate the poison. Patients who have had significant effects on the breathing muscles may also require supportive treatment with a ventilator to breathe for them until the toxin is eliminated.
After the toxin has been inactivated or eliminated, therapy may be needed to help restore body functions such as speech, swallowing, and movements.
Preventing Botulism Food Borne Illness
While botulism may be tasteless and odorless, it produces gas when in closed environments like canned foods. Opening a product which has been contaminated with botulism will often produce a hissing sound as gas is expelled or released from the container or contents of the can may spurt or foam. Some cans or containers may be deformed by gas formation and should not be used. Food that smells unusual or foul should also not be used.
Because botulism mostly occurs in preserved foods, proper procedures are the best method for prevention. Proper food preservation procedures vary from food to food and may involve processing in a water bath if the food is acidic or sweetened with a high concentration of sugar or may require pressure cooker processing. If possible, food should be boiled for at least 10 minutes prior to serving.
For other types of food, potatoes or vegetables that have been cooked in foil should be eaten hot or loosened and stored in the refrigerator. Oils infused with garlic or other herbs should be stored in the refrigerator. Do not use potatoes or other vegetables that have been allowed to sit at room temperature for any length of time.
To reduce the risk of infant botulism, children under the age of 1 year should not be given honey or corn syrup as it may have been improperly pasteurized.
Though botulism is rare and mainly caused by home canning, it can be a result of improper processing at a commercial manufacturing facility or improper handling at a restaurant. In these cases, the business that is responsible for the outbreak may be liable for costs and damages associated with the injury. Patients who have become ill or the loved ones of those who have died may be eligible for compensation for medical costs, future medical costs, lost wages, and pain and suffering or in the event of a death, for wrongful death.
People or loved ones of those who have been injured or who died due to botulism food poisoning should seek legal advice. They may be eligible for compensation.