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. 2012 Nov 20;184(17):1919–1922. doi: 10.1503/cmaj.120340

Table 1:

Characteristics of different forms of botulism

Type of botulism Incidence Risk factors Incubation period Laboratory diagnosis Pathophysiology
Infant24 Canada: 1/yr
United States: 100/yr
Age < 12 mo; exposure to contaminated dust/soil and honey Unknown Toxin or spores in feces (toxin in serum is rarely detected but would also confirm diagnosis) Ingestion and subsequent growth of spores, with toxin production in gastrointestinal tract
Foodborne2,3 Canada: 10/yr*
United States: 20/yr*
Ingestion of contaminated food 12–72 h Toxin in serum, feces, gastric aspirate or implicated food; or culture of gastric aspirate or feces and clinical presentation consistent with botulism Ingestion of preformed toxin
Wound2,3 Canada: None reported
United States: ~30/yr
Injection of illicit drugs; nasal or sinus lesions due to chronic cocaine sniffing; deep wounds 7 d Toxin in serum; or culture of tissue from the wound Germination of spores in wound, with toxin production in vivo
Adult enteric3,5 Canada: 5 reported Crohn disease; long-term antimicrobial therapy Unknown Repeated positive culture of feces, toxin in feces, or both Similar to infant botulism
Iatrogenic6 Rare Overdose of injected botulinum toxin for medical or cosmetic purposes Days Toxin in serum Intramuscular injection of toxin
Inhalational3 Very rare (none reported in Canada) Laboratory worker or bioterrorism 12–80 h Toxin detection from nasal swab (toxin not usually detected in serum or feces) Inhalation of aerosolized toxin
*

Foodborne botulism is usually seen in outbreaks; numbers are average estimates over 10-year period.

Prolonged breastfeeding and change in diet are potential risk factors, but they are still controversial (see text for details).