Botulism is usually the result of ingesting inadequately cooked contaminated foods, especially those with low acid content, such as home-canned fruits and vegetables, sausages, and smoked or preserved fish or meat. Honey and corn syrup may contain C. botulinum spores and shouldn’t be fed to infants. Rarely, botulism results from wound infection with C. botulinum.

Botulism occurs worldwide and affects more adults than children. Recently, findings have shown that an infant’s GI tract can become colonized with C. botulinum from some unknown source, and then the exotoxin is produced within the infant’s intestine. Incidence had been declining, but the current trend toward home canning has resulted in an upswing in recent years. Wound botulism occurs when open areas are infected with C. botulinum that secretes the toxin.

The disease usually manifests within 12 to 36 hours (range is 6 hours to 8 days) after the ingestion of contaminated food. The severity varies with the amount of toxin ingested and the patient’s degree of immunocompetence. Generally, early onset (within 24 hours) signals critical and potentially fatal illness. Initial signs and symptoms include dry mouth, sore throat, weakness, vomiting, and diarrhea.

The cardinal sign of botulism, though, is acute symmetrical cranial nerve impairment (characterized by ptosis, diplopia, and dysarthria), followed by descending weakness or paralysis of muscles in the extremities or trunk and dyspnea from respiratory muscle paralysis. Such impairment doesn’t affect mental or sensory processes and isn’t associated with fever.