Botulism
Botulism is a rare but serious illness caused by a powerful poison called botulinum toxin, which is produced by a bacteria. The toxin attacks the body’s nerves and can lead to difficulty breathing, muscle weakness or paralysis and even death. Botulism occurs if a person ingests the botulinum toxin or if the bacteria grow in a wound or in the intestines and release the toxin. People with botulism cannot give it to others.
In the U.S., there are an average of 110 cases of botulism reported each year. About 25% of cases are foodborne and about 70% are infant botulism. In New York City, there are typically four to seven infant botulism cases reported each year.
Types of Botulism
There are different types of botulism. Prevention strategies vary depending on the type.
Foodborne Botulism
This is caused by eating food contaminated with botulinum toxin. Common sources of foodborne botulism are homemade foods that have been improperly canned, preserved, fermented or refrigerated. Though uncommon, foods bought at a store can also be contaminated.
If you preserve, can, or ferment your own foods, you can reduce the chance of these foods giving you, your family or friends botulism by:
- Following safe home-canning instructions as recommended by the U.S. Department of Agriculture (USDA) in the USDA Complete Guide to Home Canning
- Following all instructions for washing, cleaning and sterilizing items used in canning
- Using pressure canners for low-acid foods like potatoes, most other vegetables, and meats
Everyone can reduce their chances of getting botulism by:
- Refrigerating any canned or pickled foods after you open them
- Refrigerating homemade oils infused with garlic or herbs and throwing away any unused oils after four days
- Keeping potatoes that have been baked while wrapped in aluminum foil hot (at temperatures above 140 degrees Fahrenheit) until they are served, or refrigerating them with the foil loosened
Infant Botulism
This is the most common type of Botulism. It can happen when an infant ingests spores (young bacteria) of the bacteria that cause Botulism. The spores are found naturally in soil or dust and inside homes on floors, carpet and countertops, even after cleaning. The spores can end up on the infant’s hands or objects that are then put in the infant’s mouth.
For almost all children and adults who are healthy, ingesting the bacteria that can cause botulism is not dangerous and will not cause botulism. In rare cases, infants get botulism when the spores grow into mature bacteria in their intestines, multiply, and produce botulinum toxin. It is most common in infants younger than 6 months old.
Although safe for children and adults, honey should not be fed to infants because it may contain spores that can cause infant botulism.
Wound Botulism
Wound botulism occurs when the bacteria that causes botulism gets into a wound, grows there, and produces botulinum toxin. Wound botulism has occurred in people after a traumatic injury, such as a motorcycle accident, or surgery. People who inject drugs can get botulism if the drug (such as black-tar heroin) is contaminated.
- Prevent wound botulism by keeping wounds clean. Check for signs of infection such as redness, swelling, pus and fever. If a wound looks infected, get medical care right away.
Iatrogenic Botulism
Iatrogenic botulism can happen after a botulinum toxin injection. Botulinum toxin products (commonly called “Botox”) are used for cosmetic reasons, such as for wrinkles, or medical reasons, such as for migraine headaches. Legitimate products contain purified toxin and are approved by the FDA. People are more likely to develop botulism following a botulinum toxin injection if the product is counterfeit or administered incorrectly.
Adult Intestinal botulism
This is the rarest type of botulism. Like infant botulism, adult intestinal botulism can happen when spores of the bacteria that cause botulism are ingested, grow into mature bacteria in the intestines, multiply, and produce botulinum toxin. People who have serious health conditions that affect the gut may be more likely to get sick.
Symptoms
With food-borne botulism, symptoms generally begin 18 to 36 hours after eating contaminated food. However, they can occur as soon as six hours or as many as 10 days after eating the contaminated food. For botulism caused by something other than food (such as botulinum toxin injections), symptoms may take days or weeks to develop.
Signs and symptoms might include:
- Difficulty swallowing
- Muscle weakness
- Double vision
- Drooping eyelids
- Blurry vision
- Slurred speech
- Difficulty breathing
- Difficulty moving the eyes
Possible signs and symptoms in foodborne botulism might also include:
- Vomiting
- Nausea
- Stomach pain
- Diarrhea
Signs and symptoms in an infant might include:
- Constipation
- Poor feeding
- Drooping eyelids
- Pupils that are slow to react to light
- Face showing less expression than usual
- Weak cry that sounds different than usual
- Difficulty breathing
- Floppy arms, legs or head
People with botulism might not have all these symptoms at the same time.
The symptoms result from muscle paralysis caused by the botulinum toxin. If untreated, the disease may progress and symptoms may worsen to cause full paralysis of some muscles, including those used in breathing and those in the arms, legs and torso.
If you or someone you know has symptoms of botulism, immediately go to a health care provider or emergency room. If you have difficulty walking, swallowing or breathing, call 911.
Diagnosis and Treatment
Botulism is usually diagnosed by finding the toxin in blood, stool, or skin (if wound botulism). Sometimes it can be found in contaminated food (if foodborne botulism).
If diagnosed early, botulism can be treated with a drug called an antitoxin, which prevents the botulinum toxin from causing any more harm. Antitoxin can only be given in a hospital. Antitoxin is not used to treat infant botulism; however, giving intravenous antibodies may be effective.
Severe botulism can cause respiratory failure and paralysis, which may require a patient to be on a breathing machine (ventilator) for weeks to months and may require intensive care. Depending on the severity of the illness, the paralysis can slowly improve over the course of weeks to months.
Botulinum Toxin Injection Safety
Getting botulinum toxin (“Botox”) from unlicensed people or from people using counterfeit or fake products can pose serious health risks.
Since 2024, cases of severe reactions, including the rare and sometimes fatal disease botulism, have been linked to unlicensed botulinum toxin administration, do-it-yourself” injections, and counterfeit botulinum toxin products in NYC. These severe reactions have led to hospitalizations and intensive care admissions.
To protect your health, receive botulinum toxin injections only from licensed medical professionals authorized to prescribe and administer these treatments.
Safety Tips
If you are considering a botulinum toxin injection for a medical condition or cosmetic reason (such as for wrinkles):
- Ask your provider if they are licensed and trained to give the injection.
- Do not accept injections from unlicensed providers.
- Ask if the botulinum toxin product being used is approved by the Food and Drug Administration (FDA) and obtained from a reliable source.
- Botulinum toxin injections are available under brands like Botox, Daxxify, Dysport, Jeuveau, and Xeomin.
- Ask to see the medication vial used for the injection.
- Avoid suspicious businesses advertising botulinum toxin injections at unusually low prices or outside medical settings.
- When in doubt, do not get the injection.
After getting a botulinum toxin injection:
- See your healthcare provider or go to the emergency room immediately if you have any symptoms of botulism, including:
- Blurry or double vision
- Drooping eyelids
- Difficulty swallowing
- Difficulty breathing
- Muscle weakness
- Report suspected counterfeit botulinum toxin products to the FDA at 800-551-3989 or through FDA’s criminal activity reporting form.
- Report harmful reactions related to any medication, including suspected counterfeit medication, to the FDA MedWatch Safety Information and Adverse Event Reporting Program.
Who Can Prescribe and Administer Botulinum Toxin Injections
Under New York state law, Botox and other botulinum toxin injections may be given only by trained, licensed professionals who regularly perform this type of care. To confirm that the person giving your injection is a licensed professional, go to the New York State Professional Verification Search online. Select “Search by Name” and select the provider’s profession to find their license information.
To confirm that the person giving your injection is a licensed professional, go to the New York State Professional Verification Search online. Select “Search by Name” and select the provider’s profession to find their license information.
The following providers (license codes in parentheses) are licensed to give botulinum toxin injections:
- Physicians (060)
- Physician assistants (023)
- Nurse practitioners (029)
- Dentists (050)
- Podiatrists (070)
- Registered nurses (022)
- Licensed practical nurses (010)
Aestheticians and cosmetologists are not licensed to practice medicine. Administering botulinum toxin injections likely constitutes the practice of medicine under New York law. Engaging in the practice of medicine without a medical license can result in criminal charges, including felony penalties.