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Highlights & Basics
- Botulism is a clinical syndrome characterized by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits or altered mental status.
- Diagnosis of botulism is clinical, confirmed by the detection of toxin in clinical samples.
- Treatment relies on a combination of aggressive supportive care and the swift administration of antitoxin in suspected cases.
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Definition
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Citations
World Health Organization. Botulism. Sep 2023 [internet publication].[Full Text]
Rao AK, Sobel J, Chatham-Stephens K, et al. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021 May 7;70(2):1-30.[Abstract][Full Text]
Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001 Feb 28;285(8):1059-70.[Abstract]
Centers for Disease Control and Prevention (CDC). Investigational heptavalent botulinum antitoxin (HBAT) to replace licensed botulinum antitoxin AB and investigational botulinum antitoxin E. MMWR Morb Mortal Wkly Rep. 2010 Mar 19;59(10):299.[Abstract][Full Text]
Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006 Feb 2;354(5):462-71.[Abstract][Full Text]
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2. Centers for Disease Control and Prevention. Botulism: national botulism surveillance. May 2025 [internet publication].[Full Text]
3. Koepke R, Sobel J, Arnon SS. Global occurrence of infant botulism, 1976-2006. Pediatrics. 2008 Jul;122(1):e73-82.[Abstract]
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5. Suen JC, Hatheway CL, Steigerwalt AG, et al. Genetic confirmation of identities of neurotoxigenic Clostridium baratii and Clostridium butyricum implicated as agents of infant botulism. J Clin Microbiol. 1988 Oct;26(10):2191-2.[Abstract][Full Text]
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7. World Health Organization. Botulism. Sep 2023 [internet publication].[Full Text]
8. Shaffer N, Wainwright RB, Middaugh JP, et al. Botulism among Alaska natives. The role of changing food preparation and consumption practices. West J Med. 1990 Oct;153(4):390-3.[Abstract][Full Text]
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10. Centers for Disease Control and Prevention (CDC). Botulism associated with commercially canned chili sauce - Texas and Indiana, July 2007. MMWR Morb Mortal Wkly Rep. 2007 Aug 3;56(30):767-9.[Abstract][Full Text]
11. UK Health Security Agency. Guidance: food botulism: outbreak in France involving British nationals. Sep 2023 [internet publication][Full Text]
12. Sobel J, Tucker N, Sulka A, et al. Foodborne botulism in the United States, 1990-2000. Emerg Infect Dis. 2004 Sep;10(9):1606-11.[Abstract]
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14. Health Protection Agency. Guidelines for action in the event of a deliberate release: botulism. 31 March 2009 [internet publication].[Full Text]
15. European Centre for Disease Prevention and Control: surveillance atlas of infectious diseases - botulism[Full Text]
16. American Academy of Pediatrics. Botulism and infant botulism (Clostridium botulinum). In: Kimberlin DW, Banerjee R, Barnett ED, eds. Red Book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024.
17. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): notes from the field: wound botulism outbreak among a group of persons who inject drugs - Dallas, Texas, 2020. Apr 2022 [internet publication].[Full Text]
18. Werner SB, Passaro D, McGee J, et al. Wound botulism in California, 1951-1998: a recent epidemic in heroin injectors. Clin Infect Dis. 2000 Oct;31(4):1018-24.[Abstract][Full Text]
19. Passaro DJ, Werner SB, McGee J, et al. Wound botulism associated with black tar heroin among injecting drug users. JAMA. 1998 Mar 18;279(11):859-63.[Abstract][Full Text]
20. Peak CM, Rosen H, Kamali A, et al. Wound botulism outbreak among persons who use black tar heroin - San Diego County, California, 2017-2018. MMWR Morb Mortal Wkly Rep. 2019 Jan 4;67(5152):1415-8.[Abstract][Full Text]
21. Centers for Disease Control and Prevention. Botulism: national botulism surveillance summary, 2021. May 2025 [internet publication].[Full Text]
22. Crowner BE, Brunstrom JE, Racette BA. Iatrogenic botulism due to therapeutic botulinum toxin A injection in a pediatric patient. Clin Neuropharmacol. 2007 Sep-Oct;30(5):310-3.[Abstract]
23. Chertow DS, Tan ET, Maslanka SE, et al. Botulism in 4 adults following cosmetic injections with an unlicensed, highly concentrated botulinum preparation. JAMA. 2006 Nov 22;296(20):2476-9.[Abstract][Full Text]
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25. UK Health Security Agency. UKHSA issues warning over botulism Aug 2025 [internet publication].[Full Text]
26. Smith LD. Botulism: the organism, its toxins, the disease. Springfield, IL: Charles C. Thomas; 1977.
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29. Black JD, Dolly JO. Interaction of 125I-labeled botulinum neurotoxins with nerve terminals. II. Autoradiographic evidence for its uptake into motor nerves by receptor-mediated endocytosis. J Cell Biol. 1986;103:535-544.[Abstract][Full Text]
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34. Schiavo G, Santucci A, Dasgupta BR, et al. Botulinum neurotoxins serotypes A and E cleave SNAP-25 at distinct COOH-terminal peptide bonds. FEBS Lett. 1993;335:99-103.[Abstract]
35. Sheth AN, Wiersma P, Atrubin D, et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis. 2008 Nov 15;47(10):1245-51.[Abstract]
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37. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR): notes from the field: wound botulism outbreak among a group of persons who inject drugs - Dallas, Texas, 2020. Apr 2022 [internet publication].[Full Text]
38. Kalka-Moll WM, Aurbach U, Schaumann R, et al. Wound botulism in injection drug users. Emerg Infect Dis. 2007 Jun;13(6):942-3.[Abstract]
39. Brett MM, Hallas G, Mpamugo O. Wound botulism in the UK and Ireland. J Med Microbiol. 2004 Jun;53(Pt 6):555-61.[Abstract][Full Text]
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45. Rao AK, Sobel J, Chatham-Stephens K, et al. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021 May 7;70(2):1-30.[Abstract][Full Text]
46. Centers for Disease Control and Prevention. Botulism: clinical overview of botulism. Apr 2024 [internet publication].[Full Text]
47. Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med. 1998 Aug 1;129(3):221-8.[Abstract]
48. Hughes JM, Blumenthal JR, Merson MH, et al. Clinical features of types A and B food-borne botulism. Ann Intern Med. 1981 Oct;95(4):442-5.[Abstract]
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50. Istre GR, Compton R, Novotny T, et al. Infant botulism: three cases in a small town. Am J Dis Child. 1986 Oct;140(10):1013-4.[Abstract]
51. Long SS. Botulism in infancy. Pediatr Infect Dis. 1984 May-Jun;3(3):266-71.[Abstract]
52. Centers for Disease Control and Prevention. Botulism: clinical overview of infant botulism. Apr 2024 [internet publication].[Full Text]
53. Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001 Feb 28;285(8):1059-70.[Abstract]
54. Cai S, Singh BR, Sharma S. Botulism diagnostics: from clinical symptoms to in vitro assays. Crit Rev Microbiol. 2007 Apr-Jun;33(2):109-25.[Abstract][Full Text]
55. Dowell VR Jr, McCroskey LM, Hatheway CL, et al. Coproexamination for botulinal toxin and Clostridium botulinum: a new procedure for laboratory diagnosis of botulism. JAMA. 1977 Oct 24;238(17):1829-32.[Abstract]
56. Centers for Disease Control and Prevention. Botulism: submit a specimen for testing. Apr 2024 [internet publication].[Full Text]
57. BC Centre for Disease Control. Better health through promotion, protection & prevention. 2025 [internet publication].[Full Text]
58. Gutmann L, Bodensteiner J, Gutierrez A. Electrodiagnosis of botulism. J Pediatr. 1992 Nov;121(5 Pt 1):835.[Abstract]
59. Roman MG, Humber JY, Hall PA, et al. Amplified immunoassay ELISA-ELCA for measuring Clostridium botulinum type E neurotoxin in fish fillets. J Food Prot. 1994 Nov;57(11):985-90.[Abstract][Full Text]
60. Shone C, Wilton-Smith P, Appleton N, et al. Monoclonal antibody-based immunoassay for type A Clostridium botulinum toxin is comparable to the mouse bioassay. Appl Environ Microbiol. 1985 Jul;50(1):63-7.[Abstract][Full Text]
61. Del Torre M, Stecchini ML, Peck MW. Investigation of the ability of proteolytic Clostridium botulinum to multiply and produce toxin in fresh Italian pasta. J Food Prot. 1998 Aug;61(8):988-93.[Abstract]
62. Rodriguez A, Dezfulian M. Rapid identification of Clostridium botulinum and botulinal toxin in food. Folia Microbiol (Praha). 1997;42(2):149-51.[Abstract]
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66. Pascuzzi RM, Fleck JD. Acute peripheral neuropathy in adults: Guillain-Barre syndrome and related disorders. Neurol Clin. 1997 Aug;15(3):529-47.[Abstract]
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68. Francisco AM, Arnon SS. Clinical mimics of infant botulism. Pediatrics. 2007 Apr;119(4):826-8.[Abstract]
69. Mercuri E, Finkel RS, Muntoni F, et al. Diagnosis and management of spinal muscular atrophy: part 1: recommendations for diagnosis, rehabilitation, orthopedic and nutritional care. Neuromuscul Disord. 2018 Feb;28(2):103-15.[Abstract][Full Text]
70. Health Canada. Botulism - guide for healthcare professionals. Apr 2022 [internet publication]. [Full Text]
71. World Health Organization. Foodborne disease outbreaks: guidelines for investigation and control. 2008 [internet publication].[Full Text]
72. Centers for Disease Control and Prevention (CDC). Investigational heptavalent botulinum antitoxin (HBAT) to replace licensed botulinum antitoxin AB and investigational botulinum antitoxin E. MMWR Morb Mortal Wkly Rep. 2010 Mar 19;59(10):299.[Abstract][Full Text]
73. Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006 Feb 2;354(5):462-71.[Abstract][Full Text]
74. Chalk CH, Benstead TJ, Pound JD, et al. Medical treatment for botulism. Cochrane Database Syst Rev. 2019 Apr 17;(4):CD008123.[Abstract][Full Text]
75. Santos JI, Swensen P, Glasgow LA. Potentiation of Clostridium botulinum toxin aminoglycoside antibiotics: clinical and laboratory observations. Pediatrics. 1981 Jul;68(1):50-4.[Abstract]
76. Gangarosa EJ, Donadio JA, Armstrong RW, et al. Botulism in the United States, 1899-1969. Am J Epidemiol. 1971;93:93-101.[Abstract]
77. Varma JK, Katsitadze G, Moiscrafishvili M, et al. Signs and symptoms predictive of death in patients with foodborne botulism - Republic of Georgia, 1980-2002. Clin Infect Dis. 2004;39:357-362.[Abstract][Full Text]
78. Glauser TA, Maguire HC, Sladky JT. Relapse of infant botulism. Ann Neurol. 1990;28:187-189.[Abstract]
79. Centers for Disease Control and Prevention. Botulism: home-canned foods. Apr 2024 [internet publication].[Full Text]
