What is botulism, a rare condition that can quickly turn life-threatening?

Unlike typical food poisoning, botulism can cause paralysis and breathing failure. Experts explain causes, symptoms, and why awareness in India remains critical for prevention

From canned foods to street snacks, most of us rarely think about the hidden risks in what we eat. However, recent cases in Italy have brought fresh attention to botulism, a rare but life-threatening illness caused by toxins from the bacterium Clostridium botulinum. The disease can progress quickly, making urgent medical care essential. Experts emphasise that recognising early symptoms and following preventive measures are vital to reducing risks.

 

What is Botulism?

 

Botulism is a rare but potentially deadly disease caused by the bacterium Clostridium botulinum. "It differs from typical food poisoning because it’s not just about digestive system being upset, but about a powerful neurotoxin that affects the nervous system," said Dr Dip Narayan Mukherjee, senior consultant for clinical microbiology and infectious diseases at The Calcutta Medical Research Institute (CMRI).

 

 

The bacteria produces botulinum toxin under anaerobic (low-oxygen) conditions, such as in improperly canned foods or contaminated wounds. When this toxin enters the body, it blocks the release of acetylcholine, a neurotransmitter essential for muscle contraction. "Without acetylcholine, muscles, including those controlling breathing, become paralyzed. This paralysis of cranial nerves and respiratory muscles can lead to severe breathing difficulties and death if untreated," said Dr Mukherjee.

 

Unlike other food poisoning, which usually causes vomiting and diarrhoea, botulism primarily causes muscle paralysis, making it far more dangerous and difficult to manage without prompt medical intervention, he explained.

 

Prevalence of botulism

 

Globally, around 1,000 cases are reported annually, but India sees very few. “This may partly be due to underreporting, but also because food here is usually cooked thoroughly, which destroys the bacteria,” said Dr Mukherjee. The last reported outbreak in India dates back to the 1990s, when ladoos caused illness.

 

Types of botulism

 

• Foodborne botulism – from eating contaminated or improperly preserved foods.
• Wound botulism – when spores infect a cut or injury and release toxins.
• Infant botulism – affecting babies under one year old, often linked to spores in honey or soil.
• Inhalation botulism – extremely rare, caused by breathing in the toxin (mainly in lab accidents).
• Iatrogenic botulism – linked to incorrect or excessive use of botulinum toxin in medical or cosmetic treatments.

 

Globally, most cases arise from foodborne botulism, often linked to improperly preserved or canned foods. "Consumption of processed meat, fish, fermented foods, cheese, canned foods, and honey that has been preserved are the most common causes," said Dr Manish Itolikar, consultant-internal medicine, Fortis Hospital, Mumbai.

 

Cosmetic use and risk

 

Botox injection is produced from the neurotoxin of this clostridium botulinum. "It is used for reducing wrinkles, treating muscle spasms. It works by temporarily blocking nerve signals that cause muscle contraction," shared Dr Mukherjee.

 

"Botulism can occasionally result from receiving Botox injections because the bacteria releases toxin that enters the bloodstream.   These things frequently occur when an injection is given by an untrained clinician," added Dr Itolikar.

 

Symptoms of botulism

 

The symptoms typically appear 12 to 36 hours after consuming contaminated food. It begins with drooping eyelids, followed by blurred or double vision.

 

As the condition progresses, there may be difficulty in speaking or swallowing, with slurred speech and muscle weakness.

 

This can advance to paralysis, affecting the face, arms, and legs. It can further progress to severe breathing difficulties, respiratory failure

 

"We can confirm botulism by testing for the presence of the botulinum toxin in a patient’s body through neurotoxin assays, which detect the toxin in samples of stool (faeces) or blood (serum). Finding the toxin in these samples provides clear evidence of the illness," explained Dr Itolikar.

 

Treatment and recovery

 

"Treatment of botulism requires immediate medical intervention, starting with the administration of botulinum antitoxin to neutralize the toxin already in the body. Supportive care is critical, especially if the patient is experiencing breathing difficulties, where mechanical ventilation may be needed to assist respiration," said Dr Mukherjee.

 

In cases of wound botulism, proper surgical cleaning (debridement) is essential to remove infected tissue, combined with antibiotics such as penicillin or metronidazole. For infants, botulinum immunoglobulin plays a crucial role in neutralizing the toxin, he shared.

 

"The key goal of treatment is to prevent further progression of paralysis, not to reverse the existing nerve damage, which can take months to recover. During recovery, continuous physiotherapy and supportive care are necessary to help regain muscle function," he added.

 

Food safety first

 

Strict hygiene and correct preservation techniques are critical, explained Dr Itolikar.

 

• Promptly place the jars of pickled or canned food in the refrigerator after opening them
• Home-canned food should be boiled before eating
• Meat and fish items should be properly refrigerated

 

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This report is for informational purposes only and is not a substitute for professional medical advice.