Botulism natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.
Overview
If botulism left untreated it may cause respiratory failure and even death. Common complications of botulism include, respiratory failure, difficult swallowing, speech difficulties, fatigue, and death. Botulism's prognosis depends on the amount of the ingested toxins and prompt treatment.
Natural History
The symptoms of foodborne botulism often develop few days after ingestion of toxin produced in food by C. botulinum. The most frequent source is home-canned foods, prepared in an unsafe manner. Wound botulism occurs when C. botulinum spores germinate within wounds. Infant botulism occurs when C. botulinum spores germinate and produce toxin in the gastrointestinal tract of infants. If botulism left untreated it may cause respiratory failure and even death.
Complications
Infant botulism has no long-term side effects, but can be complicated by nosocomial adverse events. The case fatality rate is less than 1% for hospitalized infants with botulism.
Important complications of botulism include:
- Respiratory muscle weakness and impending respiratory failure
- Long-lasting weakness
- Difficult swallowing
- Speech difficulties
- Fatigue
- Death from botulism mainly occurs from a few reasons:
- Respiratory failure, possibly due to a delayed diagnosis.
- Complications in the hospital such as a nosocomial infection, mostly due to pneumonia.
Prognosis
The prognosis depends upon the particular case. The amount of botulinum toxin an individual is exposed to will play a role in the overall prognosis, but early treatment will significantly decrease the chance of death.
There are in fact 7 different forms of the toxin, and type A generally causes the most severe form of Botulism. An overall mortality rate of approximately 5-10% is suspected for the foodborne form of Botulism. Patients that are much older (older than 60) and young patients have a higher mortality rate than the average 5-10%.
Wound botulism is, on average, more fatal than foodborne botulism. Wound botulism carries a mortality rate of approximately 15%.
The mortality rate of infant botulism is much lower; usually less than 1%.
The recovery period for botulism is fairly long. It ranges from approximately 30 to around 100 days. Sometimes patients need to stay on a ventilator for a long period of time to assist with breathing. There can also be a period of generalized weakness for up to a year after recovery from botulism.