October 10, 2025 • 24 mins
Imagine a toxin so potent that a few nanograms can shut down a muscle—and yet, in the right hands, it eases migraines and calms spasms. We take you from the sausage-linked origins of botulism to the science of spores, food safety, infant risks, wound contamination, and the carefully controlled medical use of botulinum toxin. Along the way, we unpack how this anaerobic bacterium survives heat, why improperly canned foods can become dangerous, and what really happens at the neuromuscular junction when acetylcholine release is blocked.
We break down the top-down pattern of paralysis—double vision, drooping eyelids, trouble swallowing—and why sensation stays intact even as movement fades. You’ll hear practical prevention tips for home canning and fermentation, the reason honey is off-limits for infants, and what to do if you suspect exposure. We also explore diagnosis and treatment: toxin detection, antitoxin for adults, immune globulin for infants, and the crucial role of timely supportive care when breathing muscles weaken.
Then we shift to the paradox of Botox. Type A botulinum toxin is FDA-approved and widely used for migraines, dystonias, overactive bladder, and cosmetic goals, yet outcomes depend on expertise, dosing, and aftercare. We discuss diffusion risks, emerging research on toxin migration in animal models, and how to choose trained, licensed providers. Rounding out the story, we touch on botulism’s biosecurity history and why strong surveillance and sound public health systems matter just as much as good kitchen habits.
If this exploration helped you see botulism with fresh eyes, subscribe for more science you can use, share the episode with a friend who loves microbiology and medicine, and leave a quick review to help others find the show.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
This is the podcast about one health.
The idea that the health ofhumans, animals, plants, and the
environment that we all shareare intrinsically linked.
Coming to you from a team ofscientists, physicians, and
veterinarians, this isinfectious science.
Where enthusiasm for science iscontagious.
(00:20):
Alright.
Hello everyone.
Welcome back to this episode ofInfectious Science.
We're going to talk about one ofthe most poisonous substances on
Earth.
It's been linked to everythingfrom food poisoning to doomsday
cults and cosmetic treatments.
So pretty broad.
So we're going to dive into thescience behind a
neurotoxin-producing bacteriaknown as Clostridium botulinum.
(00:41):
This has caused unintentionalfood poisonings, has been used
by humans intentionally as abioweapon and also as a cosmetic
treatment.
And Clostridium botulinum causesthe rare poisoning known as
botulism.
So to start off, I just want tostart us off with some history.
So let's get into that.
The discovery of botulism isactually credited to a German
physician.
So that should make you veryhappy, Dr.
(01:03):
Benza.
So this German physician namedJustinius Kerner, which I'm
probably mispronouncing.
I don't know if there's a Germanway to pronounce that.
Is there?
Kerner?
SPEAKER_00 (01:14):
That's close enough.
SPEAKER_02 (01:15):
Close enough.
Okay.
It's possible.
This was back in 1793 and foundbotulism in spoiled sausages.
So botulus, which is the root ofthe word botulism, is Latin for
sausage.
So I think that's just a funanecdote.
SPEAKER_03 (01:30):
Wait, that's so funny.
I didn't know that.
SPEAKER_02 (01:33):
Yeah.
But um, it's it comes fromsausage.
So I don't know.
I think that it's a cool littleI love to, I've been looking
into the root roots of likewords recently.
So that's fine.
And then a uh uh so then afterit was discovered by a German
physician, so he found botulism.
But Emile Kahn Urban Gem is theone who identified the
(01:54):
Clostridium botulinum toxicbacteria as the source of a
Belgian botulism outbreak.
And so then botulism outbreaksin 1919 and 1973 in the US are
what led to basically federalregulation of food preservation
that demanded high temperaturesand then safe processing to
protect consumers from thedeadly toxins.
So most people think of botulismthese days as a foodborne
(02:18):
illness, basically.
So I just want to get into howexactly it causes illness.
And I know, Christina, youprobably have some to contribute
here, but I'm gonna give anoverview of the organism.
And then if you want to jump inon more like symptoms and how we
see this in people, so it'sspore-forming bacteria.
The spores are really commonlyfound in soil.
They are super resistant toheat.
(02:39):
They have a potential to survivea hundred degrees Celsius heat
for several hours, which is veryresistant.
Oh my gosh.
Most bacteria are long dead bythen, I would say.
It's also really resistant tolight, desiccation, and
radiation, which is interesting.
So they can really, these sporescan survive a great deal of
time, particularly in the rightconditions.
(03:00):
And they wait until those rightconditions that kind of, I don't
know, humanizes them.
They're not waiting, but whenthe conditions are right, they
will terminate.
And those conditions have to bewarm, mildly alkaline, and
anaerobic, which means it'slacking oxygen.
So you can probably think that agreat environment for them would
then be in something like a canof preserved food where the
(03:21):
oxygen has been removed, andalso it's probably sitting at
room temperature in your house.
So this is the ideal conditionsfor them.
So we'll talk about later, likehow we now know that canned
goods are safe or not frombotulism.
And what's also interesting isthat people that can their own
goods, a lot of that is based onmaking sure you are safe from
botulism.
(03:42):
Exposing the spores to moist 120degrees Celsius heat for 30
minutes is effective at killingthem.
But as it's cooking food at 80degrees Celsius for 30 minutes,
which will destroy the toxin,but it won't destroy the spores.
So ADC for 30 minutes, toxin isdestroyed, the spores are still
potentially there and couldstill potentially germinate.
(04:02):
And once they germinate, that'swhen the neurotoxins that cause
flaccid paralysis are released.
SPEAKER_03 (04:09):
Yeah, and just like a little bit of information on
how that happens, the flaccidparalysis.
So the toxin itself basicallyprevents the release of the
signals in our body that allowus to move, right?
And so by preventing therelease, you can't move anymore.
And so that's how it causes thatflaccid paralysis in us.
But the actual spores themselvesdon't really do anything, it's
(04:30):
the toxin that they thenrelease.
SPEAKER_02 (04:32):
Yes, absolutely.
And it only takes a fewnanograms to cause severe
illness, which is really unique.
That is a very small amount.
Nanograms are minuscule amounts.
So one human cell weighs aboutone nanogram.
Or if you put that another way,if you like sliced a single
grain of rice into 25 millionparts, one of the 20 parts would
(04:54):
weigh one nanogram.
So it only takes a it's crazy.
A body to make you incrediblysick or even to kill you.
So that tells you how little ittakes.
I just thought when I was comingacross those comparisons, I was
like, wow, that is such aminuscule amount.
So it's like there can be trulyalmost none of this in anything
you eat, or you're riskingplastic paralysis.
(05:16):
And so these are incrediblysmall amounts, but they're very
deadly.
So just as you said, the deadlytoxins, they cause paralysis by
binding in near muscularjunctions and they prevent the
release of acetylcholine, whichis a neurotransmitter that is
incredibly crucial for musclemovement.
If you want to be moving, youneed acetylcholine.
And there's different types oftoxins too, but only A, B, and E
(05:36):
are known to affect humans.
So those are basically itusually is occurring because of
ingestion, either because youingested the bacterium itself,
the neurotoxins, or the spores.
So it might have already, sporesmight have already germinated uh
germinated, and there's toxin inwhatever you're eating or
ingesting.
The bacteria is in there, andthen you're gonna have the kind
of eventual release, or you haveingested the spores, and then
(05:57):
they can actually germinatewithin you and release the
toxin.
So all kinds of not fun waysthat it can affect us.
SPEAKER_03 (06:04):
Yes.
That does not sound good.
SPEAKER_02 (06:07):
No, not at all.
And I didn't realize that oncethey're ingested, the bacteria
can incubate in the stomach andthey can produce spores which
release toxins.
I can't think of anything elseoff the top of my head that can
just handle the acidity and thehow like severely our stomach is
just is meant to get rid ofthings and not let something
like this happen.
So it's pretty unique that thiscan survive that and then
(06:30):
germinate and release toxins.
I think that's pretty wild.
Yeah.
But, anyways, the most rapidprogression of disease is caused
by ingesting food that'scontaminated with the neurotoxin
itself.
So that would mean that aclercigen botuline was in it,
the or the spores were, theygerminated and the toxin was
already produced.
So if the toxin is in whatever'sbeing ingested, that's the kind
(06:50):
of the fastest way that we seeparalysis happening.
But there's other ways to getbotulism.
You can also get it from sporecontamination of open wounds,
which I didn't know until I wasresearching this episode.
But what I think is reallyinteresting is despite there
being outbreaks of botulism,there's no secondary
person-to-person transmission ofbotulism that has ever been
(07:12):
documented.
So someone around you could havebotulism, and you're not going
to get sick, but unless you wereeating the same food or
something.
But like you can't get it fromthem, essentially, is what that
means.
And the incubation period reallyranges for this once either the
bacteria, the spores, or thetoxin has been ingested.
It can range from hours up totwo weeks, depending on whether
it was the bacterium, the spore,or the toxin that was introduced
(07:34):
to the body.
But yeah, I don't know,Christina, do you want to get
into the symptoms of botulismbesides flacid paralysis?
I can also jump into them too.
SPEAKER_03 (07:42):
Yeah.
So at least what we're taught inmedical school is that botulism
presents as like a head-to-toe,so top-down paralysis.
So the first symptoms that we'retaught about is myopia, which is
double vision and also drooling,right?
And so you have this kind ofdouble vision, hard to keep your
eyes open, start to drool forthat you can't explain.
(08:04):
And it's because all those tinylittle muscles in your face to
keep your eyes open, to keepyour eyes centered and moving
together and coordinated, andthen the muscles in our throat
and our mouth, everything likethat, kind of provide that
stabilization, I suppose, arethe first to become affected,
right?
Because of the ones that we useso frequently as well.
And so because those kind of go,we start to notice the symptoms
(08:28):
that we normally take forgranted.
So the double vision, thedrooling, and then it works its
way down.
But the thing that's reallydangerous about botulism, as I'm
sure a lot of us can imagine andunderstand, and the way that
most people end up dying fromthis is once it gets to the
muscles of your diaphragm.
And so the diaphragm is amuscle, even though we don't
really think about it as one,because we don't actively think
(08:49):
about our lungs being opened andexpanded and closed.
But the diaphragm really does alot of that heavy work.
And if that muscle itself getsparalyzed, we can't breathe
anymore.
And so unfortunately, that istypically the most dangerous
presentation of botulism and theone that presents as the most
lethal symptom of infection.
SPEAKER_02 (09:09):
Yeah, no, absolutely.
Paralysis of respiratory musclesis absolutely what's gonna often
lead to death in botulism.
And besides the paralysis andwhat you talk about with like
double vision, difficulty seeingand swallowing or speaking,
there can also be like nausea,vomiting, diarrhea.
In infants, it's usuallylethargy and weakness, is how
it's presenting.
But I found somethinginteresting that I actually was
(09:30):
curious if you could clear upfor me.
I found evidence that suggeststhat the sensory nerves are not
affected by botulism.
So I would interpret that as youcan feel things while paralyzed,
but you can't move.
Is that do you think a correctinterpretation of that?
SPEAKER_03 (09:43):
Yeah, I definitely do.
And it's because botulism itselfisn't going to affect like the
what's it called?
The the sensations, because itinhibits acetylcholine, which
for the most part plays the mostactive role in actual muscle
movement and kinetic energy andstuff like that, but not so much
in perpetuating or projectingsensory input and output through
(10:04):
the body.
SPEAKER_02 (10:04):
Yeah, yeah.
And that also just that soundsjust like a my worst nightmare.
I don't know.
SPEAKER_03 (10:09):
Sounds like a horror movie.
SPEAKER_02 (10:11):
I don't know if anyone listening has ever
experienced sleep paralysis, butI used to experience sleep
paralysis.
And you're awake to some degree,you're awake, but you can't move
because you are still paralyzedin your body's still interpreted
as I'm paralyzed because I'msleeping.
And so it feels awful.
Like it is the worst thing.
And I feel like it seems to melike what botulism would feel
(10:31):
like is that like you can feelthings, like you can feel that
there's the covers on you, oryou can feel your pillow or
whatever, but you can't eventwitch your fingers.
And so to me, that is theultimate horror.
I hate it.
SPEAKER_03 (10:41):
Yes.
Oh my gosh.
Yes.
SPEAKER_02 (10:44):
I think it's pretty common.
Like it's just a little bit of amismatch that your body is kind
of awake, but not really awake.
But yeah, I was like, oh, I'mawful.
SPEAKER_00 (10:52):
So yeah, I feel like a lot of those signs and
symptoms sound so terrible.
Tristina was saying like ahorror movie, right?
Like it's just crazy stuff.
And one thing that that when Ilearned about botulism, I you
hear these terrible stories ofthe terrible way we can die
based on this, right?
But I always wonder what's howoften does this really occur.
(11:13):
And I know it's fairly rare inthe US, but it's consistent.
I think that consistently likearound 200 cases in the US,
sometimes less, sometimes 150,sometimes 250, or something like
that.
Mostly around 200 cases peryear.
So it's a consistent case.
And 70% of those cases areactually infant cases.
20% or 25%, maybe like woundcontamination, like you said,
(11:37):
Camille is for us.
The rest, I think, is foodpoisoning.
But can we talk a little bitmore about the infants side of
the clinical presentation?
SPEAKER_02 (11:46):
Yeah, I have a little bit on this, and I know
Christina and more about it, butI know that one unintentional
botulism exposure is infantbotulism, which really it occurs
on average in two infants per100,000 live births in the
United States.
And it occurs when botulismscores are digested.
So usually that's from honey,corn syrup, food, or dust, from
what I was reading.
And this is why honey jars arelabeled with do not feed to
(12:09):
children less than one year old.
But yeah, Christine, I don'tknow if you want to get more
into that.
SPEAKER_03 (12:13):
Yeah, so when we're infants and when we're children,
our immune systems are stilldeveloping.
So they're not fully developedwhatsoever.
What we learned basically inschool is that as infants are
developing, they don't have asmature of a digestive tract or a
digestive system as adults have.
And as a result, the infantdigestive system itself is a
less acidic environment.
And so infants themselves aremore prone to having more
(12:37):
serious GI infections.
And if botulism, somethingthat's so aggressive, is
introduced to the digestivetract, it can result in much
more devastating effects than itwould be if it were introduced
into the digestive tract of anadult.
So that's just why we recommendnot giving infants honey or
anything like that.
You know, honey is sticky, it'san anaerobic environment, it's
(12:59):
like that niche environment forthe spore to drive in.
We really recommend not givinghoney to children because
historically it's been somethingthat has shown to perpetuate
this infection within infantsand children.
And so we have seen just a fewcases of botulism infections and
(13:20):
toxin exposure in infants whohave been given honey.
SPEAKER_02 (13:24):
Yeah.
And I also want to talk a bitabout what do we do when we
suspect botulism.
Usually a mouse neutralizationtest is used to detect.
So if it's suspected, basicallywhat's done is that serum or
stool from a suspected case isinjected into a mouse, and then
that mouse is observed for signsof botulism.
And once you confirm that it'sbotulism, there's an toxin
(13:44):
that's available.
But for infants, there's animmunoglobin.
And that's a protein that'sfound in blood that contains
antibodies, for those who don'tknow.
And that's been approved fortoxins A and G.
So we can treat those, but as Imentioned earlier, there are
other subtoxins like so A, B,and E all affect humans.
Oh, and F also affects humans.
But we only have something fortoxins A and G, as far as I
(14:05):
know, for that.
But as you were mentioning, Dr.
Mente, that there's a lot ofother ways that people get
botulism now.
So usually the biggest riskfactor for unintentional
exposure is people canning theirown goods like vegetables or
fermented fish.
You can easily be exposed tobotulism there.
50% of US foodborne botch breaksare caused by type A toxins,
which are usually found incanned goods.
(14:27):
And then whereas like fermentedfish products are usually
associated with like type Etoxins.
And then wound botulism, Itouched on earlier, but just to
expand on it, it's when you havedirt or gravel that gets into a
wound that is anaerobic, whichmeans it's lacking oxygen.
And it's often associated withuse of what's known as like
black tar heroin.
And it's probably due to likecontamination during like the
drug prep process.
(14:48):
But yeah, and so this is whyalso if you think about
botulism, this is why if you'veever heard that you should
discard food that's in dentedcans, it's because of the risk
of unintentional botulismpoisoning.
Basically, canning, if the stuffyou're buying in the store, is
safe because it removes the airfrom food and that it's heated
and all that stuff.
But if it's dented, that air hasbeen removed.
So it's an anaerobicenvironment.
(15:10):
It's probably potentially morealkaline conditions and it's
warm conditions.
And so that creates a goodenvironment for botulism to grow
if it's dented or pierced andsheep botulinum is around.
So that's a concern, is thatcans themselves, there's high
safety standards, but whenthey're dented or they're
pierced, there's the potentialfor introducing it.
Also, I did not know this untilI started reading a bunch of
(15:31):
botulism, that botulism has beenused as a bioweapon, which I was
not aware of at all.
A large concern with it on thebioweapon front is that not only
can food be contaminated, whichcan cause an outbreak, which we
have seen food outbreaks, notintentional ones, but the
neurotoxin can also be inhaled,and that makes it really
dangerous.
So in 1990, 1993, 1994, and1995, a Japanese doomsday cult
(15:55):
called Riki, it's now known asELF, actually released botulism
toxin aerosols in Tokyo.
But very fortunately foreveryone, these attempts failed.
They did later attempt, I thinkit was sarin, and a lot of
people got hurt or died.
But if you want to learn aboutan instance of botulism being
used as a voucher weapon withreally deadly consequences, you
should check out season one withthe episode Poison and Poetry,
(16:18):
where botulism was found to bethe cause of death for a poet.
And Dr.
Mental Kurt, if I'm wrong, but Ibelieve the government was
trying to silence him, right?
SPEAKER_00 (16:27):
Yeah, that's correct.
Yeah, we had Alfredo Torres ontalking a little bit about the
history of how the poet waskilled for standing up to the
government.
So really interesting story.
Go back to that episode forsure.
SPEAKER_02 (16:39):
Yeah, yeah.
It's really wild.
I do want to talk about one waythat adults intentionally get
exposed to botulinum toxin.
Yes.
Botox prevents muscles frommoving for a limited time.
So that can help prevent thingslike migraines.
It treats overactive bladder, italso treats the neck spasms.
It's also been used cosmeticallyto smooth facial wrinkles and
(16:59):
really relax muscles that cancause frown lines.
So Botox injections are made ofFDA-approved purified botulinum
toxin.
While considered safe when useis directed by a licensed
healthcare provider, it is worthmentioning that the toxin can
spread to other parts of thebody other than the injection
site.
That can lead to visionproblems, trouble swallowing,
difficulty breathing.
(17:19):
If a patient lies down withintwo to four hours after getting
the procedure, or if you rub thetreated area after getting a
Botox injection.
And something that I found,which was really wild, is that a
recent 2024 article from Sciencehighlights that despite 25 years
of use with few complications,Botox has recently been found to
migrate from the skin to thecentral nerve system after
(17:42):
injection in mice.
So this is in mice.
Doesn't necessarily mean thatthe exact same effect is
happening in humans, but it'sworth considering that you don't
want bodulum toxin in yourcentral nervous system.
And you really don't want itanywhere in the body.
But if you're getting Botoxinjections, you definitely don't
want it outside of the areawhere it's being injected for
whatever purpose, whether that'sto prevent certain muscles from
(18:05):
moving and prevent like spasmsor for something cosmetic.
So also just for reference, thetoxin most commonly used in
cosmetic Botox injections istype A toxin.
SPEAKER_03 (18:14):
Yeah.
Yep.
And I think that just points outwhy it's so important that if
you are getting Botox injectionsto go to someone who is really
well trained in this, uhlicensed, has had years of
practice giving this treatmentbecause nothing comes without a
risk, right?
And the risk of some treatmentsis a lot higher than others.
So when it comes to getting yourBotox, just make sure you're
(18:36):
doing your research and going tosomeone who has a lot of
experience in what they'redoing.
SPEAKER_02 (18:40):
Yeah, absolutely.
And I think that's always athing, right?
When it comes to your health,that's not the place to ever cut
corners.
SPEAKER_03 (18:46):
Yes, exactly.
unknown (18:48):
Yeah.
SPEAKER_02 (18:48):
Cool.
We went over a lot in thisepisode.
So we hope that you enjoyed it.
That's all I have on botulism.
I don't know if either of youhave some closing thoughts to
add.
SPEAKER_03 (18:57):
I do remember one of the first episodes that I
listened to of the podcast whendeciding to join the podcast in
the first place was thatprevious episode on botulism.
So I really recommend whoever'slistening to this episode to go
back and listen to that one aswell because it's a really fun
episode.
SPEAKER_02 (19:13):
Yes.
And that's season one, Poisonand Poetry.
All right, everyone.
SPEAKER_01 (19:17):
As always, thanks for listening.
Thank you.
Thanks for listening to theInfectious Science Podcast.
Be sure to hit subscribe andvisit infectious science.org to
join the conversation, accessthe show notes, and to sign up
for our newsletter and receiveour free material.
SPEAKER_04 (19:31):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts at
Spotify.
And go ahead and share thisepisode with some of your
friends.
SPEAKER_01 (19:40):
Also, don't hesitate to ask questions entitled to
what topics you'd like us tocover for future episodes.
To get in touch, drop a line inthe comments section or send us
a message on social media.
SPEAKER_04 (19:49):
So we'll see you next time for a new episode.
And in the meantime, stay happy,stay healthy, stay interested.
SPEAKER_02 (19:56):
This podcast is sponsored in part by the
Institute for Collaboration andHealth, an action-oriented
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health, working with communitiesto develop nimble approaches to
the world's most challenginghealth problems.
This is the podcast about one health.
The idea that the health ofhumans, animals, plants, and the
environment that we all shareare intrinsically linked.
Coming to you from a team ofscientists, physicians, and
veterinarians, this isinfectious science.
Where enthusiasm for science iscontagious.
(00:20):
Alright.
Hello everyone.
Welcome back to this episode ofInfectious Science.
We're going to talk about one ofthe most poisonous substances on
Earth.
It's been linked to everythingfrom food poisoning to doomsday
cults and cosmetic treatments.
So pretty broad.
So we're going to dive into thescience behind a
neurotoxin-producing bacteriaknown as Clostridium botulinum.
(00:41):
This has caused unintentionalfood poisonings, has been used
by humans intentionally as abioweapon and also as a cosmetic
treatment.
And Clostridium botulinum causesthe rare poisoning known as
botulism.
So to start off, I just want tostart us off with some history.
So let's get into that.
The discovery of botulism isactually credited to a German
physician.
So that should make you veryhappy, Dr.
(01:03):
Benza.
So this German physician namedJustinius Kerner, which I'm
probably mispronouncing.
I don't know if there's a Germanway to pronounce that.
Is there?
Kerner?
SPEAKER_00 (01:14):
That's close enough.
SPEAKER_02 (01:15):
Close enough.
Okay.
It's possible.
This was back in 1793 and foundbotulism in spoiled sausages.
So botulus, which is the root ofthe word botulism, is Latin for
sausage.
So I think that's just a funanecdote.
SPEAKER_03 (01:30):
Wait, that's so funny.
I didn't know that.
SPEAKER_02 (01:33):
Yeah.
But um, it's it comes fromsausage.
So I don't know.
I think that it's a cool littleI love to, I've been looking
into the root roots of likewords recently.
So that's fine.
And then a uh uh so then afterit was discovered by a German
physician, so he found botulism.
But Emile Kahn Urban Gem is theone who identified the
(01:54):
Clostridium botulinum toxicbacteria as the source of a
Belgian botulism outbreak.
And so then botulism outbreaksin 1919 and 1973 in the US are
what led to basically federalregulation of food preservation
that demanded high temperaturesand then safe processing to
protect consumers from thedeadly toxins.
So most people think of botulismthese days as a foodborne
(02:18):
illness, basically.
So I just want to get into howexactly it causes illness.
And I know, Christina, youprobably have some to contribute
here, but I'm gonna give anoverview of the organism.
And then if you want to jump inon more like symptoms and how we
see this in people, so it'sspore-forming bacteria.
The spores are really commonlyfound in soil.
They are super resistant toheat.
(02:39):
They have a potential to survivea hundred degrees Celsius heat
for several hours, which is veryresistant.
Oh my gosh.
Most bacteria are long dead bythen, I would say.
It's also really resistant tolight, desiccation, and
radiation, which is interesting.
So they can really, these sporescan survive a great deal of
time, particularly in the rightconditions.
(03:00):
And they wait until those rightconditions that kind of, I don't
know, humanizes them.
They're not waiting, but whenthe conditions are right, they
will terminate.
And those conditions have to bewarm, mildly alkaline, and
anaerobic, which means it'slacking oxygen.
So you can probably think that agreat environment for them would
then be in something like a canof preserved food where the
(03:21):
oxygen has been removed, andalso it's probably sitting at
room temperature in your house.
So this is the ideal conditionsfor them.
So we'll talk about later, likehow we now know that canned
goods are safe or not frombotulism.
And what's also interesting isthat people that can their own
goods, a lot of that is based onmaking sure you are safe from
botulism.
(03:42):
Exposing the spores to moist 120degrees Celsius heat for 30
minutes is effective at killingthem.
But as it's cooking food at 80degrees Celsius for 30 minutes,
which will destroy the toxin,but it won't destroy the spores.
So ADC for 30 minutes, toxin isdestroyed, the spores are still
potentially there and couldstill potentially germinate.
(04:02):
And once they germinate, that'swhen the neurotoxins that cause
flaccid paralysis are released.
SPEAKER_03 (04:09):
Yeah, and just like a little bit of information on
how that happens, the flaccidparalysis.
So the toxin itself basicallyprevents the release of the
signals in our body that allowus to move, right?
And so by preventing therelease, you can't move anymore.
And so that's how it causes thatflaccid paralysis in us.
But the actual spores themselvesdon't really do anything, it's
(04:30):
the toxin that they thenrelease.
SPEAKER_02 (04:32):
Yes, absolutely.
And it only takes a fewnanograms to cause severe
illness, which is really unique.
That is a very small amount.
Nanograms are minuscule amounts.
So one human cell weighs aboutone nanogram.
Or if you put that another way,if you like sliced a single
grain of rice into 25 millionparts, one of the 20 parts would
(04:54):
weigh one nanogram.
So it only takes a it's crazy.
A body to make you incrediblysick or even to kill you.
So that tells you how little ittakes.
I just thought when I was comingacross those comparisons, I was
like, wow, that is such aminuscule amount.
So it's like there can be trulyalmost none of this in anything
you eat, or you're riskingplastic paralysis.
(05:16):
And so these are incrediblysmall amounts, but they're very
deadly.
So just as you said, the deadlytoxins, they cause paralysis by
binding in near muscularjunctions and they prevent the
release of acetylcholine, whichis a neurotransmitter that is
incredibly crucial for musclemovement.
If you want to be moving, youneed acetylcholine.
And there's different types oftoxins too, but only A, B, and E
(05:36):
are known to affect humans.
So those are basically itusually is occurring because of
ingestion, either because youingested the bacterium itself,
the neurotoxins, or the spores.
So it might have already, sporesmight have already germinated uh
germinated, and there's toxin inwhatever you're eating or
ingesting.
The bacteria is in there, andthen you're gonna have the kind
of eventual release, or you haveingested the spores, and then
(05:57):
they can actually germinatewithin you and release the
toxin.
So all kinds of not fun waysthat it can affect us.
SPEAKER_03 (06:04):
Yes.
That does not sound good.
SPEAKER_02 (06:07):
No, not at all.
And I didn't realize that oncethey're ingested, the bacteria
can incubate in the stomach andthey can produce spores which
release toxins.
I can't think of anything elseoff the top of my head that can
just handle the acidity and thehow like severely our stomach is
just is meant to get rid ofthings and not let something
like this happen.
So it's pretty unique that thiscan survive that and then
(06:30):
germinate and release toxins.
I think that's pretty wild.
Yeah.
But, anyways, the most rapidprogression of disease is caused
by ingesting food that'scontaminated with the neurotoxin
itself.
So that would mean that aclercigen botuline was in it,
the or the spores were, theygerminated and the toxin was
already produced.
So if the toxin is in whatever'sbeing ingested, that's the kind
(06:50):
of the fastest way that we seeparalysis happening.
But there's other ways to getbotulism.
You can also get it from sporecontamination of open wounds,
which I didn't know until I wasresearching this episode.
But what I think is reallyinteresting is despite there
being outbreaks of botulism,there's no secondary
person-to-person transmission ofbotulism that has ever been
(07:12):
documented.
So someone around you could havebotulism, and you're not going
to get sick, but unless you wereeating the same food or
something.
But like you can't get it fromthem, essentially, is what that
means.
And the incubation period reallyranges for this once either the
bacteria, the spores, or thetoxin has been ingested.
It can range from hours up totwo weeks, depending on whether
it was the bacterium, the spore,or the toxin that was introduced
(07:34):
to the body.
But yeah, I don't know,Christina, do you want to get
into the symptoms of botulismbesides flacid paralysis?
I can also jump into them too.
SPEAKER_03 (07:42):
Yeah.
So at least what we're taught inmedical school is that botulism
presents as like a head-to-toe,so top-down paralysis.
So the first symptoms that we'retaught about is myopia, which is
double vision and also drooling,right?
And so you have this kind ofdouble vision, hard to keep your
eyes open, start to drool forthat you can't explain.
(08:04):
And it's because all those tinylittle muscles in your face to
keep your eyes open, to keepyour eyes centered and moving
together and coordinated, andthen the muscles in our throat
and our mouth, everything likethat, kind of provide that
stabilization, I suppose, arethe first to become affected,
right?
Because of the ones that we useso frequently as well.
And so because those kind of go,we start to notice the symptoms
(08:28):
that we normally take forgranted.
So the double vision, thedrooling, and then it works its
way down.
But the thing that's reallydangerous about botulism, as I'm
sure a lot of us can imagine andunderstand, and the way that
most people end up dying fromthis is once it gets to the
muscles of your diaphragm.
And so the diaphragm is amuscle, even though we don't
really think about it as one,because we don't actively think
(08:49):
about our lungs being opened andexpanded and closed.
But the diaphragm really does alot of that heavy work.
And if that muscle itself getsparalyzed, we can't breathe
anymore.
And so unfortunately, that istypically the most dangerous
presentation of botulism and theone that presents as the most
lethal symptom of infection.
SPEAKER_02 (09:09):
Yeah, no, absolutely.
Paralysis of respiratory musclesis absolutely what's gonna often
lead to death in botulism.
And besides the paralysis andwhat you talk about with like
double vision, difficulty seeingand swallowing or speaking,
there can also be like nausea,vomiting, diarrhea.
In infants, it's usuallylethargy and weakness, is how
it's presenting.
But I found somethinginteresting that I actually was
(09:30):
curious if you could clear upfor me.
I found evidence that suggeststhat the sensory nerves are not
affected by botulism.
So I would interpret that as youcan feel things while paralyzed,
but you can't move.
Is that do you think a correctinterpretation of that?
SPEAKER_03 (09:43):
Yeah, I definitely do.
And it's because botulism itselfisn't going to affect like the
what's it called?
The the sensations, because itinhibits acetylcholine, which
for the most part plays the mostactive role in actual muscle
movement and kinetic energy andstuff like that, but not so much
in perpetuating or projectingsensory input and output through
(10:04):
the body.
SPEAKER_02 (10:04):
Yeah, yeah.
And that also just that soundsjust like a my worst nightmare.
I don't know.
SPEAKER_03 (10:09):
Sounds like a horror movie.
SPEAKER_02 (10:11):
I don't know if anyone listening has ever
experienced sleep paralysis, butI used to experience sleep
paralysis.
And you're awake to some degree,you're awake, but you can't move
because you are still paralyzedin your body's still interpreted
as I'm paralyzed because I'msleeping.
And so it feels awful.
Like it is the worst thing.
And I feel like it seems to melike what botulism would feel
(10:31):
like is that like you can feelthings, like you can feel that
there's the covers on you, oryou can feel your pillow or
whatever, but you can't eventwitch your fingers.
And so to me, that is theultimate horror.
I hate it.
SPEAKER_03 (10:41):
Yes.
Oh my gosh.
Yes.
SPEAKER_02 (10:44):
I think it's pretty common.
Like it's just a little bit of amismatch that your body is kind
of awake, but not really awake.
But yeah, I was like, oh, I'mawful.
SPEAKER_00 (10:52):
So yeah, I feel like a lot of those signs and
symptoms sound so terrible.
Tristina was saying like ahorror movie, right?
Like it's just crazy stuff.
And one thing that that when Ilearned about botulism, I you
hear these terrible stories ofthe terrible way we can die
based on this, right?
But I always wonder what's howoften does this really occur.
(11:13):
And I know it's fairly rare inthe US, but it's consistent.
I think that consistently likearound 200 cases in the US,
sometimes less, sometimes 150,sometimes 250, or something like
that.
Mostly around 200 cases peryear.
So it's a consistent case.
And 70% of those cases areactually infant cases.
20% or 25%, maybe like woundcontamination, like you said,
(11:37):
Camille is for us.
The rest, I think, is foodpoisoning.
But can we talk a little bitmore about the infants side of
the clinical presentation?
SPEAKER_02 (11:46):
Yeah, I have a little bit on this, and I know
Christina and more about it, butI know that one unintentional
botulism exposure is infantbotulism, which really it occurs
on average in two infants per100,000 live births in the
United States.
And it occurs when botulismscores are digested.
So usually that's from honey,corn syrup, food, or dust, from
what I was reading.
And this is why honey jars arelabeled with do not feed to
(12:09):
children less than one year old.
But yeah, Christine, I don'tknow if you want to get more
into that.
SPEAKER_03 (12:13):
Yeah, so when we're infants and when we're children,
our immune systems are stilldeveloping.
So they're not fully developedwhatsoever.
What we learned basically inschool is that as infants are
developing, they don't have asmature of a digestive tract or a
digestive system as adults have.
And as a result, the infantdigestive system itself is a
less acidic environment.
And so infants themselves aremore prone to having more
(12:37):
serious GI infections.
And if botulism, somethingthat's so aggressive, is
introduced to the digestivetract, it can result in much
more devastating effects than itwould be if it were introduced
into the digestive tract of anadult.
So that's just why we recommendnot giving infants honey or
anything like that.
You know, honey is sticky, it'san anaerobic environment, it's
(12:59):
like that niche environment forthe spore to drive in.
We really recommend not givinghoney to children because
historically it's been somethingthat has shown to perpetuate
this infection within infantsand children.
And so we have seen just a fewcases of botulism infections and
(13:20):
toxin exposure in infants whohave been given honey.
SPEAKER_02 (13:24):
Yeah.
And I also want to talk a bitabout what do we do when we
suspect botulism.
Usually a mouse neutralizationtest is used to detect.
So if it's suspected, basicallywhat's done is that serum or
stool from a suspected case isinjected into a mouse, and then
that mouse is observed for signsof botulism.
And once you confirm that it'sbotulism, there's an toxin
(13:44):
that's available.
But for infants, there's animmunoglobin.
And that's a protein that'sfound in blood that contains
antibodies, for those who don'tknow.
And that's been approved fortoxins A and G.
So we can treat those, but as Imentioned earlier, there are
other subtoxins like so A, B,and E all affect humans.
Oh, and F also affects humans.
But we only have something fortoxins A and G, as far as I
(14:05):
know, for that.
But as you were mentioning, Dr.
Mente, that there's a lot ofother ways that people get
botulism now.
So usually the biggest riskfactor for unintentional
exposure is people canning theirown goods like vegetables or
fermented fish.
You can easily be exposed tobotulism there.
50% of US foodborne botch breaksare caused by type A toxins,
which are usually found incanned goods.
(14:27):
And then whereas like fermentedfish products are usually
associated with like type Etoxins.
And then wound botulism, Itouched on earlier, but just to
expand on it, it's when you havedirt or gravel that gets into a
wound that is anaerobic, whichmeans it's lacking oxygen.
And it's often associated withuse of what's known as like
black tar heroin.
And it's probably due to likecontamination during like the
drug prep process.
(14:48):
But yeah, and so this is whyalso if you think about
botulism, this is why if you'veever heard that you should
discard food that's in dentedcans, it's because of the risk
of unintentional botulismpoisoning.
Basically, canning, if the stuffyou're buying in the store, is
safe because it removes the airfrom food and that it's heated
and all that stuff.
But if it's dented, that air hasbeen removed.
So it's an anaerobicenvironment.
(15:10):
It's probably potentially morealkaline conditions and it's
warm conditions.
And so that creates a goodenvironment for botulism to grow
if it's dented or pierced andsheep botulinum is around.
So that's a concern, is thatcans themselves, there's high
safety standards, but whenthey're dented or they're
pierced, there's the potentialfor introducing it.
Also, I did not know this untilI started reading a bunch of
(15:31):
botulism, that botulism has beenused as a bioweapon, which I was
not aware of at all.
A large concern with it on thebioweapon front is that not only
can food be contaminated, whichcan cause an outbreak, which we
have seen food outbreaks, notintentional ones, but the
neurotoxin can also be inhaled,and that makes it really
dangerous.
So in 1990, 1993, 1994, and1995, a Japanese doomsday cult
(15:55):
called Riki, it's now known asELF, actually released botulism
toxin aerosols in Tokyo.
But very fortunately foreveryone, these attempts failed.
They did later attempt, I thinkit was sarin, and a lot of
people got hurt or died.
But if you want to learn aboutan instance of botulism being
used as a voucher weapon withreally deadly consequences, you
should check out season one withthe episode Poison and Poetry,
(16:18):
where botulism was found to bethe cause of death for a poet.
And Dr.
Mental Kurt, if I'm wrong, but Ibelieve the government was
trying to silence him, right?
SPEAKER_00 (16:27):
Yeah, that's correct.
Yeah, we had Alfredo Torres ontalking a little bit about the
history of how the poet waskilled for standing up to the
government.
So really interesting story.
Go back to that episode forsure.
SPEAKER_02 (16:39):
Yeah, yeah.
It's really wild.
I do want to talk about one waythat adults intentionally get
exposed to botulinum toxin.
Yes.
Botox prevents muscles frommoving for a limited time.
So that can help prevent thingslike migraines.
It treats overactive bladder, italso treats the neck spasms.
It's also been used cosmeticallyto smooth facial wrinkles and
(16:59):
really relax muscles that cancause frown lines.
So Botox injections are made ofFDA-approved purified botulinum
toxin.
While considered safe when useis directed by a licensed
healthcare provider, it is worthmentioning that the toxin can
spread to other parts of thebody other than the injection
site.
That can lead to visionproblems, trouble swallowing,
difficulty breathing.
(17:19):
If a patient lies down withintwo to four hours after getting
the procedure, or if you rub thetreated area after getting a
Botox injection.
And something that I found,which was really wild, is that a
recent 2024 article from Sciencehighlights that despite 25 years
of use with few complications,Botox has recently been found to
migrate from the skin to thecentral nerve system after
(17:42):
injection in mice.
So this is in mice.
Doesn't necessarily mean thatthe exact same effect is
happening in humans, but it'sworth considering that you don't
want bodulum toxin in yourcentral nervous system.
And you really don't want itanywhere in the body.
But if you're getting Botoxinjections, you definitely don't
want it outside of the areawhere it's being injected for
whatever purpose, whether that'sto prevent certain muscles from
(18:05):
moving and prevent like spasmsor for something cosmetic.
So also just for reference, thetoxin most commonly used in
cosmetic Botox injections istype A toxin.
SPEAKER_03 (18:14):
Yeah.
Yep.
And I think that just points outwhy it's so important that if
you are getting Botox injectionsto go to someone who is really
well trained in this, uhlicensed, has had years of
practice giving this treatmentbecause nothing comes without a
risk, right?
And the risk of some treatmentsis a lot higher than others.
So when it comes to getting yourBotox, just make sure you're
(18:36):
doing your research and going tosomeone who has a lot of
experience in what they'redoing.
SPEAKER_02 (18:40):
Yeah, absolutely.
And I think that's always athing, right?
When it comes to your health,that's not the place to ever cut
corners.
SPEAKER_03 (18:46):
Yes, exactly.
unknown (18:48):
Yeah.
SPEAKER_02 (18:48):
Cool.
We went over a lot in thisepisode.
So we hope that you enjoyed it.
That's all I have on botulism.
I don't know if either of youhave some closing thoughts to
add.
SPEAKER_03 (18:57):
I do remember one of the first episodes that I
listened to of the podcast whendeciding to join the podcast in
the first place was thatprevious episode on botulism.
So I really recommend whoever'slistening to this episode to go
back and listen to that one aswell because it's a really fun
episode.
SPEAKER_02 (19:13):
Yes.
And that's season one, Poisonand Poetry.
All right, everyone.
SPEAKER_01 (19:17):
As always, thanks for listening.
Thank you.
Thanks for listening to theInfectious Science Podcast.
Be sure to hit subscribe andvisit infectious science.org to
join the conversation, accessthe show notes, and to sign up
for our newsletter and receiveour free material.
SPEAKER_04 (19:31):
If you enjoyed this new episode of Infectious
Science, please leave us areview on Apple Podcasts at
Spotify.
And go ahead and share thisepisode with some of your
friends.
SPEAKER_01 (19:40):
Also, don't hesitate to ask questions entitled to
what topics you'd like us tocover for future episodes.
To get in touch, drop a line inthe comments section or send us
a message on social media.
SPEAKER_04 (19:49):
So we'll see you next time for a new episode.
And in the meantime, stay happy,stay healthy, stay interested.
SPEAKER_02 (19:56):
This podcast is sponsored in part by the
Institute for Collaboration andHealth, an action-oriented
nonprofit that partners withinnovators in science and
health, working with communitiesto develop nimble approaches to
the world's most challenginghealth problems.
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