Signs and Symptoms of Botulism


On Wednesday July 18, 2007, the Food and Drug Administration issued a warning to consumers about the risk of botulism poisoning from hot dog chili sauce marketed under a variety of brand names. The warning came after two Texas children and an Indiana couple who ate these products became ill with botulism and were hospitalized.

The manufacturer of the chili sauce, Castleberry Food Company of Augusta, Georgia, recalled 10 ounce cans of Castleberry’s Hot Dog Chili Sauce (UPC 3030000101), Austex Hot Dog Chili Sauce (UPC 3030099533), and Kroger Hot Dog Chili Sauce (UPC 1111083942) with “best by” dates from April 30, 2009 through May 22, 2009. Consumers unaware of the recall may still be in possession of the hot dog chili sauce.

While incidence of botulism is low, the disease is of considerable concern because of its high mortality rate if not treated immediately and properly.

Symptoms of botulism

Classic symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. These are all symptoms of the muscle paralysis caused by the bacterial toxin. If untreated, these symptoms may progress to cause paralysis of the arms, legs, trunk and respiratory muscles. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating a contaminated food, but can occur as early as 6 hours or as late as 10 days after consumption.

Botulinum toxin causes flaccid paralysis by blocking motor nerve terminals at the myoneural junction. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, and moving to the throat, chest and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and death from asphyxia results. Recommended treatment for foodborne botulism includes early administration of botulinal antitoxin (available from CDC) and intensive supportive care (including mechanical breathing assistance).

More about the Castleberry's botulism outbreak can be found in the Case News area of this site.

Botulism can result in death due to respiratory failure. However, in the past 50 years the proportion of patients with botulism who die has fallen from about 50% to 8%. The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks, plus intensive medical and nursing care. After several weeks, the paralysis slowly improves. If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. Good supportive care in a hospital is the mainstay of therapy for botulism.