The muscle weakness which is caused by botulism starts in the muscles that are controlled by the cranial nerves. These nerves control eye movement muscles, facial muscles, chewing, swallowing, drooping of eyelid muscle and the double vision muscles.
In the initial stages, swallowing problems, loss of facial expression may occur along with talking difficulty. This is followed by weakness in the arms and legs. Severe botulism may cause reduced respiration which is experienced as dyspnea and can lead to failure of respiratory system which in turn leads to residual Carbon Dioxide leading to coma and eventually death if untreated.
Additionally, it can also cause disorder in autonomic nervous system, lowers blood pressure while on standing resulting in lightheadedness and blackouts.
There are four major modes of entry for the toxin known as of now. The most common form in Western countries is the infant botulism. This is found in small children who have the bacterium in their bodies during the early years of their lives. Intake of honey in the first year of birth is a risk factor for getting infant botulism. It is also a factor in a fifth of all cases recorded. The adult form of botulism is known as adult intestinal toxemia, and is exceptionally unusual to occur.
Food borne botulism occurs from contaminated foodstuffs in which C. botulinum spores develops in an anaerobic atmospheric conditions. This characteristically occurs in home-canned foods and fermented raw dishes. Because more than one people generally consume food from the same source, more than one person can be affected at the same time.
Wound botulism occurs due to the infection of a wound caused by the bacteria, it secretes the toxin into the main bloodstream. These instances are found largely amongst people who uses black tar heroin and inject it into the skin instead of in the veins.
Remote cases of botulism have also been reported after inhalation by laboratory workers and after cosmetic use of unacceptable quantity of a chemical such as Botox.
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