Characteristics of different forms of botulism
| Type of botulism | Incidence | Risk factors | Incubation period | Laboratory diagnosis | Pathophysiology |
|---|---|---|---|---|---|
| Infant (2)– (4) | Canada: 1/yr United States: 100/yr | Age < 12 mo; exposure to contaminated dust/soil and honey† | Unknown | Toxin or spores in feces (toxin in serum is rarely detected but would also confirm diagnosis) | Ingestion and subsequent growth of spores, with toxin production in gastrointestinal tract |
| Foodborne (2), (3) | Canada: 10/yr* United States: 20/yr* | Ingestion of contaminated food | 12–72 h | Toxin in serum, feces, gastric aspirate or implicated food; or culture of gastric aspirate or feces and clinical presentation consistent with botulism | Ingestion of preformed toxin |
| Wound (2), (3) | Canada: None reported United States: ~30/yr | Injection of illicit drugs; nasal or sinus lesions due to chronic cocaine sniffing; deep wounds | 7 d | Toxin in serum; or culture of tissue from the wound | Germination of spores in wound, with toxin production in vivo |
| Adult enteric (3), (5) | Canada: 5 reported | Crohn disease; long-term antimicrobial therapy | Unknown | Repeated positive culture of feces, toxin in feces, or both | Similar to infant botulism |
| Iatrogenic (6) | Rare | Overdose of injected botulinum toxin for medical or cosmetic purposes | Days | Toxin in serum | Intramuscular injection of toxin |
| Inhalational (3) | Very rare (none reported in Canada) | Laboratory worker or bioterrorism | 12–80 h | Toxin detection from nasal swab (toxin not usually detected in serum or feces) | Inhalation of aerosolized toxin |