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Botulism Mode of Action

Botulism is a serious paralytic illness with the muscle weakness of botulism usually starts in the muscles supplied by the cranial nerves. This group of nerves controls eye movements, facial muscles and the muscles that control chewing and swallowing. Difficulty with talking, double vision, drooping of eyelids, loss of facial expression and swallowing problems may also occur. The weakness then spreads to the arms and legs. 1 Severe botulism leads to reduced movement of the muscles of respiration, and results in problems with gas exchange. This may be experienced as difficulty breathing, when severe it can lead to respiratory failure (the buildup of unexhaled carbon dioxide and its resultant depressant effect on the brain). Respiratory failure can lead to coma and death if untreated. 1

In addition to affecting the voluntary muscles, botulism can also cause disruptions in the autonomic nervous system (ANS). It decreases the production of saliva (causing dry mouth and throat), decreases blood pressure when standing (called postural hypotension) with resulting lightheadedness and possible blackouts, and eventually decreased peristalsis causes constipation, some of the toxins also cause nausea and vomiting. 1


The United States reports an average of 110 cases of botulism annually. Approximately, 72% are infant botulism, and 3% are wound botulism. Foodborne botulism outbreaks that involve two or more persons occur most years, with home-canned foods being the cause. The number of cases of foodborne and infant botulism has stayed static in recent years, but wound botulism has increased. This is due to increased use of black tar heroin, especially in California.2

1.Sobel J (October 2005). “Botulism”. Clin. Infect. Dis. 41 (8): 1167–73. doi:10.1086/444507. PMID 16163636.
2.Passaro DJ, Werner SB, McGee J, Mac Kenzie WR, Vugia DJ (March 1998). “Wound botulism associated with black tar heroin among injecting drug users”. JAMA 279 (11): 859–63. doi:10.1001/jama.279.11.859. PMID 9516001.

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