CLINICAL DESCRIPTION

A group of neurologic syndromes manifested by weakness and flaccid paralysis caused by neurotoxins produced by Clostridium botulinum bacteria. The foodborne botulism caused by neurotoxins present in contaminated food, is characterized by acute bilateral cranial nerve impairment and descending weakness or paralysis. Visual difficulty (blurred or double vision), dysphagia and dry mouth are often first complaints. Infant botulism (intestinal botulism), caused by production of toxin by organisms within the gastrointestinal tract, is characterized by gradual onset of constipation, hypotonia and poor feeding ("floppy baby" syndrome). Wound botulism and other forms of botulism can vary in clinical presentation. The incubation period of foodborne botulism is usually 12 - 36 hours, ranging to several days, after eating contaminated food. The incubation period of infant botulism is unknown.

CASE CLASSIFICATION

1. CONFIRMED
   Foodborne botulism:
   A clinically compatible case AND
   • Detection of botulinum toxin in serum, stool, or patient's food, OR
   • Isolation of Clostridium botulinum from stool

   
   Infant botulism:
   A clinically compatible case AND

   • Detection of botulinum toxin in stool or serum, OR
   • Isolation of Clostridium botulinum from stool

   
   Wound botulism
   A clinically compatible case, with no exposure to contaminated food, history of a fresh, contaminated wound during the 2 weeks before onset of symptoms, AND

   • Detection of botulinum toxin in serum, OR
   • Isolation of Clostridium botulinum from wound

   
   Other botulism
   A clinically compatible case, older than 1 year, who has NO history of ingestion of suspected food and has no wounds AND

   • Detection of botulinum toxin in clinical specimen, OR
   • Isolation of Clostridium botulinum in clinical specimen.
   
   
2. PROBABLE

   Term only used in a case of Foodborne botulism: a clinically compatible case with an epidemiologic link (e.g., ingestion of a home-canned food within the previous 48 hrs).

   
   

3. POSSIBLE
   
   Not used