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: Seyedmahdi Pahlavani, M.D. [2]


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.[1][2]


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:[3][1][2]


The prognosis depends on the type of toxin. 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.[4]

There are, in fact, 7 different forms of the toxin. 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 older than 60 years carry a higher risk of mortality than the general population..[5] The mortality rate of infant botulism is much lower; usually less than 1%.

Wound botulism is, on average, more fatal than foodborne botulism. Wound botulism carries a mortality rate of approximately 15%.[2]

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.


  1. 1.0 1.1 Sobel J, Malavet M, John S (2007). "Outbreak of clinically mild botulism type E illness from home-salted fish in patients presenting with predominantly gastrointestinal symptoms". Clin. Infect. Dis. 45 (2): e14–6. doi:10.1086/518993. PMID 17578769.
  2. 2.0 2.1 2.2 Varma JK, Katsitadze G, Moiscrafishvili M, Zardiashvili T, Chokheli M, Tarkhashvili N, Jhorjholiani E, Chubinidze M, Kukhalashvili T, Khmaladze I, Chakvetadze N, Imnadze P, Hoekstra M, Sobel J (2004). "Signs and symptoms predictive of death in patients with foodborne botulism--Republic of Georgia, 1980-2002". Clin. Infect. Dis. 39 (3): 357–62. doi:10.1086/422318. PMID 15307002.
  3. Sobel J (2005). "Botulism". Clin. Infect. Dis. 41 (8): 1167–73. doi:10.1086/444507. PMID 16163636.
  4. David WS, Temin ES, Kraeft JJ, Hooper DC (2015). "Case records of the Massachusetts General Hospital. Case 3-2015. A 60-year-old woman with abdominal pain, dyspnea, and diplopia". N. Engl. J. Med. 372 (4): 364–72. doi:10.1056/NEJMcpc1410936. PMID 25607430.
  5. Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ (1981). "Clinical features of types A and B food-borne botulism". Ann. Intern. Med. 95 (4): 442–5. PMID 7283294.

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