Table 1:
Characteristics of different forms of botulism
Type of botulism | Incidence | Risk factors | Incubation period | Laboratory diagnosis | Pathophysiology |
---|---|---|---|---|---|
Infant2–4 | 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).