Botulism: symptoms, causes, treatment and recovery

The NHS says symptoms of botulism can include blurred or double vision, drooping eyelids, difficulty swallowing and speaking, weak muscles (particularly in your face), constipation and a dry mouth. If not treated quickly, botulism can lead to paralysis that spreads down from your head to the rest of your body and can affect the muscles that control breathing.

UKHSA's clinical guidance describes a characteristic acute, afebrile (without fever), descending, symmetrical paralysis. In foodborne botulism, nausea, vomiting and diarrhoea may come before the neurological symptoms but are not always present. It lists disturbances of vision including dilated pupils, difficulty swallowing and talking, slurred speech, dry mouth, descending muscle weakness, respiratory difficulty and constipation.

• Blurred or double vision, drooping eyelids.

• Difficulty swallowing and speaking, slurred speech.

• Weak muscles, particularly in the face, spreading downwards.

• Constipation and a dry mouth.

• Breathing difficulty in severe cases.

UKHSA describes botulism as a rare but potentially life-threatening clinical syndrome caused by a potent neurotoxin produced by a spore-forming bacterium, Clostridium botulinum, which is naturally present in soil, water and marine sediments. Once in the body, the toxin is carried to the neuromuscular junction where it blocks the release of acetylcholine, causing paralysis of the muscles.

The NHS says botulism is rare in the UK, in all of its forms.

The NHS says botulism is caused when a certain type of bacteria, or the toxin the bacteria make, gets into your body. All types are rare in the UK.

UKHSA adds that for infant botulism the source of spores is not identified in most cases and they are assumed to be swallowed from the environment, and that honey and peanut butter are foods that have been linked with infant botulism in the UK. In foodborne botulism the incubation period can vary from a few hours up to 8 days, but is usually within 12 to 36 hours.

The NHS says botulism needs immediate treatment in hospital and can be life-threatening if not treated quickly. The main treatment is medicine to stop the symptoms getting worse, given into a vein through a drip, and helping your body do things until you recover, such as using a ventilator to help you breathe. If the botulism was caused by bacteria getting into a wound, you may also need medicine to treat the infection and surgery to remove infected tissue.

UKHSA explains that the treatment is botulinum antitoxin, which neutralises toxin circulating in the blood but cannot reverse symptoms already caused, and that botulism is a clinical diagnosis, so treatment should not be delayed for laboratory results.

The NHS says most people recover fully if treated quickly. The medicine stops symptoms from getting worse but does not treat muscle weakness or paralysis that has already happened. These symptoms will improve over a few weeks or months, but it can take up to a year for breathing problems and muscle strength to get better.

The NHS adds that some people continue to have longer-term problems such as feeling very tired, getting out of breath easily, finding it hard to lift things and struggling with their mental wellbeing.

The NHS says symptoms in babies and young children may include a weak cry or crying that sounds different, difficulty feeding, being quieter or less active than usual or constantly sleepy, and having a limp or floppy head, neck, arms or legs. Call 999 if your child is limp or floppy.

UKHSA describes infant botulism as a rare disease affecting infants under one year old, with non-specific features such as constipation, a feeble cry, poor sucking reflex, feeding difficulties, listlessness, droopy eyelids, loss of head control and muscle weakness. It says infant botulism is extremely rare in the UK. Do not give honey to babies younger than 12 months.

The NHS suggests preparing, cooking and storing food safely, properly cleaning and covering cuts and grazes, and choosing someone who is trained and qualified to do a cosmetic procedure. It says not to give honey to babies younger than 12 months, not to eat food from tins, jars or bottles that are bulging or damaged, not to eat food that smells bad or is past its use-by date, and not to inject illegal drugs.

UKHSA advises people to take precautions when seeking aesthetic procedures, including checking that the product being used is licensed, and not to buy products from websites for self-administration.

The NHS says to call 999 if you think you or your child may have symptoms of botulism, your child is limp or floppy, you have had a botulinum toxin injection in the past 4 weeks and have symptoms of botulism, you have problems with your face muscles such as drooping eyelids or difficulty swallowing or speaking, you cannot move part of your body, or you have severe difficulty breathing.

Do not drive yourself to A&E. The person you speak to at 999 will give you advice about what to do.

Botulism is treated as an emergency in hospital. UKHSA's botulism service supports clinicians with advice and supply of antitoxin, so clinicians in emergency departments can arrange treatment quickly. Aftercare, including rehabilitation for muscle weakness and breathing, is organised by the hospital team and your GP.

If you have concerns after a cosmetic injection, do not wait for a private clinic appointment: use NHS emergency routes if you have the symptoms listed above.