Botulism: Countering Common Clinical Misperceptions

Agam Rao, MD


April 01, 2013

Editorial Collaboration

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In This Article

Common Clinical Inquiries

I would like to finish with some facts about botulism risk factors that we commonly share during our clinical consultations:

Improperly home-canned foods are the most common vehicle of foodborne botulism in the United States.[7] Commercially canned foods purchased in retail establishments are a much less likely source of botulism because modern commercial canning uses processes that kill C botulinum spores.

Honey is associated with botulism only in infants and is an unlikely vehicle in non-infant botulism.[8]

"Skin-popping" (or subcutaneous injection) of black tar heroin is the most common cause of wound botulism in the United States.[9] Another cause is contamination of open wounds with soil or debris from motor vehicle accidents.

High doses of injected botulinum toxin can cause botulism.[10] Botulinum toxin injections are used in many on-and off-label treatments, including facial wrinkles, spasmodic dysphonia, movement and eye disorders, and refractory pain.[11]

I hope this commentary has given you a better understanding of botulism as it pertains to your clinical work. Please remember that public health authorities are eager to discuss any suspected case of botulism with you. State health departments and CDC are only a phone call away. Please don't hesitate to contact us. Thank you.

Web Resources

CDC National Center for Emerging and Zoonotic Infectious Diseases: Botulism

CDC Features: Home Canning and Botulism

Food Home Canning: Keep Your Family Safe

US Department of Agriculture: Complete Guide to Home Canning.

California Department of Public Health, Division of Communicable Disease Control: Infant Botulism Treatment and Prevention Program

Agam Rao, MD, is a medical epidemiologist and infectious disease physician in the Enteric Diseases Epidemiology Branch at the US Centers for Disease Control and Prevention (CDC). Dr. Rao trained as a "disease detective" in CDC's Epidemic Intelligence Service (EIS) and is an officer in the US Public Health Service. She currently serves as CDC's botulism subject matter expert, where she supervises the national botulism clinical consultation service; provides consultation and epidemiologic support to public health authorities for botulism outbreaks; and contributes to bioterrorism preparedness plans related to intentional distribution of botulinum toxin, a Category A biological agent.