Botulism is a rare and potentially fatal disease resulting from intoxication by botulinum neurotoxin, a potent biological substance generated by the bacterium Clostridium botulinum [1][2][3]. The toxin acts as a zinc metalloprotease that blocks neurotransmitter release at neuromuscular junctions, producing flaccid paralysis [3]. Human disease arises from foodborne ingestion of preformed toxin, intestinal colonization by spores in infants, or wound infection [2][3].
Disease overview
Bacterial Evidence-backed information EN 5/7 applicable sections · ZH 5/7 applicable sections Updated Oct 23, 2026
Botulism is a rare but potentially fatal illness caused by botulinum neurotoxin produced by Clostridium botulinum, occurring in foodborne, wound, and infant forms [1][2][3]. In the United States in 2021, 273 confirmed and probable cases were reported, with infant botulism predominating at 66% of cases [1]. The disease is not transmitted person to person and is preventable through proper food handling and processing [1][2].
Read the full clinical and epidemiological profile 6
The illness typically begins with weakness, blurred vision, fatigue, and difficulty speaking, progressing to descending flaccid paralysis of the arms, chest, and legs and potentially respiratory failure [1][2][3]. Early features may include dry mouth, vertigo, vomiting, abdominal swelling, diarrhea, or constipation, but fever and loss of consciousness are usually absent [1][2]. Infant botulism presents with constipation, poor feeding, weakness, altered cry, and marked loss of head control [2]. Symptoms generally appear within 12 to 36 hours of exposure, with a range of 4 hours to 8 days [2].
In 2021, US health departments reported 273 confirmed and probable botulism cases: 66% infant, 24% wound, 8% foodborne, and 2% other or unknown [1]. Infant botulism remained largely sporadic with pronounced geographic variation, as California accounted for 25% and Pennsylvania for 12% of the 2021 infant cases [1]. Between 1990 and 2000, US surveillance recorded 263 foodborne cases from 160 events with a 4% case-fatality rate [1]. The largest UK foodborne outbreak occurred in June 1989 with 27 affected patients and one death linked to hazelnut yogurt [1].
Botulism is not passed directly between people [1][2]. Foodborne transmission occurs through eating foods containing preformed toxin produced when spores germinate under low-oxygen conditions [1][2]. Infant botulism follows ingestion of spores that colonize the gut and release toxin, mainly in children under one year [1][2]. Wound botulism arises when spores enter a wound, typically among people who inject street drugs, and produce toxin in anaerobic tissue [1].
Prevention relies chiefly on proper food preparation, because heating above 85°C for over five minutes destroys the toxin, though spores require autoclaving or commercial canning temperatures for inactivation [1]. Avoidance of spore-contaminated honey in infants is relevant to reducing intestinal colonization risk [2]. No FDA-approved vaccine exists; an investigational penta-serotype toxoid vaccine for high-risk groups was discontinued, with candidate vaccines under study [4].
- 1 Wikipedia contributors. Botulism - Wikipedia [Internet]. Wikipedia. cited 12 Aug 2026. Available from: https://en.wikipedia.org/wiki/Botulism
- 2 World Health Organization. Botulism [Internet]. cited 23 Oct 2026. Available from: https://www.who.int/news-room/fact-sheets/detail/botulism
- 3 Rawson AM et al. Pathogenicity and virulence of Clostridium botulinum. Virulence. 2023 Dec. PMID: 37157163. doi: 10.1080/21505594.2023.2205251. PubMed: https://pubmed.ncbi.nlm.nih.gov/37157163/
- 4 Sundeen G et al. Vaccines against Botulism. Toxins (Basel). 2017 Sep 2. PMID: 28869493. doi: 10.3390/toxins9090268. PubMed: https://pubmed.ncbi.nlm.nih.gov/28869493/
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