Botulism and other clostridial disease in horse treatment and prevention

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Botulism and other clostridial disease in horse treatment and prevention Botulism is a rare and potentially fatal illness caused by a toxin produced by the bacterium Clostri Toxins of all types have the same pharmacologic action.

Botulism is a rapidly fatal motor paralysis caused by ingestion of the toxin produced by Clostridium botulinum types A-G. The spore-forming anaerobic organism proliferates in decomposing animal tissue and sometimes in plant material. Etiology:
Botulism is in most cases an intoxication, not an infection, and results from ingestion of toxin in food. There are seven types of C botulinum, differentiat

ed on the antigenic specificity of the toxins: A, B, C1, D, E, F, and G. Types A, B, and E are most important in people; C1 in most animal species, notably wild ducks, pheasants, chickens, mink, cattle, and horses; and D in cattle. In horses, the most common type in North America and Europe is type B (>85% of USA cases), and in the western USA type A has been reported in only two outbreaks, both in people, known to have been caused by type F. Type G, isolated from soil in Argentina, is not known to have been involved in any outbreak of botulism. The usual source of the toxin is decaying carcasses or vegetable materials such as decaying grass, hay, grain, or spoiled silage. Like tetanus toxin, botulinum toxin is a zinc-binding metalloprotease that cleaves specific proteins in synaptic vesicles. Motor neuron surface receptors vary for the different botulinum toxins, explaining some of the species differences in susceptibility to the different toxins. The exact incidence of botulism in animals is not known, but it is relatively low in cattle and horses, probably more frequent in chickens, and high in wild waterfowl. Probably 10,000–50,000 birds are lost in most years, with losses reaching 1 million or more during the great outbreaks in the western USA. Most affected birds are ducks, although loons, mergansers, geese, and gulls also are susceptible. (Also see Botulism.) Dogs, cats, and pigs are comparatively resistant to all types of botulinum toxin when challenged orally; however, there are recent individual case reports mentioning botulism in dogs. Most botulism in cattle occurs in South Africa and South America, where a combination of extensive agriculture, phosphorus deficiency in soil, and C botulinum type D in animals creates conditions ideal for the disease. The phosphorus-deficient cattle chew any bones with accompanying bits of flesh they find on the range; if these came from an animal carrying type D strains of C botulinum, intoxication is likely to result. Any animal eating such material also ingests spores, which germinate in the intestine and, after death of the host, invade the musculature, which in turn becomes toxic for other cattle. Type C strains also cause botulism in cattle in a similar fashion. This type of botulism in cattle is rare in the USA, although a few cases have been reported from Texas under the name of loin disease, and a few cases have occurred in Montana. Hay or silage contaminated with toxin-containing carcasses of birds or mammals and poultry litter fed to cattle have also been sources of type C or type D toxin for cattle (“forage botulism”). Big bale silage and haylage seem to be a particular risk and result in botulism problems if fermentation fails to produce a low and stable pH (

21/10/2022

How can botulism be prevented?
The best way to prevent botulism is through good husbandry practices. This includes properly storing and inspecting forage and avoiding feeding silage or fermented forages. Keep surrounding areas free of decaying vegetation and animal carcasses. Control rodents, birds, and other animals that might carry the toxin. Properly care for wounds to avoid infection.
A vaccine is available for type B botulism and is recommended annually in endemic areas. There are no vaccines that currently protect against multiple types of botulism

21/10/2022

What are the clinical signs of botulism?
Clinical signs of botulism in horses can include weakness, exercise intolerance, muscle tremors, drooling, and reduced tongue strength. Progressive paralysis can lead to labored breathing and difficulty swallowing. Death can occur from respiratory paralysis and heart failure.

C. botulinum bacteria are dispersed widely in soil and water throughout the world. Because of this, the risk of exposure...
13/09/2022

C. botulinum bacteria are dispersed widely in soil and water throughout the world. Because of this, the risk of exposure and potential toxicity looms large. Horses with botulism acquire the disease in one of three ways: (1) ingestion of toxin with forage or feed by mature horses; (2) ingestion of C. botulinum spores that later proliferate in the gastrointestinal tract of foals; and (3) contamination of wounds with C. botulinum with consequent bacterial growth and toxin release.
Scientists recognize different C. botulinum neurotoxins, each denoted by a letter (A, B, C-1, C-2, D, E, F, G). Horses are known to be affected by only three of the eight types: A, B, and C.
Type B is the most common cause of botulism in horses and typically occurs as a result of consuming moldy hay or improperly fermented haylage, though grain has been implicated in some cases. Decomposing animal carcasses have also been a source of C. botulinum intoxication, usually type C. Regardless of type, when ingested, the toxin is absorbed from the intestine and spread throughout the body by the circulatory system. Toxins interrupt nerve transmission, which leads to physical manifestation of disease.
Clinical signs of botulism, which usually occur within 24 hours of exposure, include generalized muscle weakness with recumbency, difficulty swallowing, pupil dilation, respiratory changes, and decreased tone of eyelids, tongue, and tail. Because difficulty swallowing is a consistent clinical sign among affected horses, astute horsemen will sometimes report a change in eating behavior in the early stages of the disease—the horse may take longer to consume a meal, leave meals unfinished, or be reluctant to swallow. A presumptive diagnosis of botulism can be made on clinical signs.
Early presumptive diagnosis and swift, aggressive treatment is warranted in suspected cases of botulism. Antitoxin is available in some countries. The goal of intravenous antitoxin therapy is the neutralization of circulating toxin. Antitoxin therapy does not reverse existing clinical signs and does not necessarily derail disease progression. Supportive care at a veterinary clinic often entails frequent turning of recumbent patients to avoid pressure sores, feeding through nasogastric tube, eye lubricants to offset the effects of decreased eyelid tone, and sedation to reduce muscle activity.
In a retrospective study at New Bolton Center, University of Pennsylvania School of Veterinary Medicine, researchers reviewed the medical records of 92 horses with botulism in an attempt to identify variables associated with survival based on information gathered at admission and clinical findings during hospitalization.** Higher re**al temperature at the time of admission and treatment with antitoxin increased the chance of survival. On the contrary, an inability to stand or abnormal respiratory effort signaled decreased likelihood for survival. Of the 92 horses, 44 survived. The researchers acknowledged that the most important predictor of survival was maintaining the ability to stand.
Botulism in foals, often called shaker foal syndrome, is a sporadic condition affecting foals of all ages, from only a few days old to several months of age. Foals are thought to consume soil contaminated with the toxin, usually type B, which initiates toxicity.
Botulism is often preventable by vaccination. The usual schedule involves three doses at one-month intervals followed by annual boosters.

17/07/2022

There are 7 types of Clostridium botulinum toxins; the C1 toxin is seen in most animal species, although type B is most common in North America and Europe. The usual source of the toxin is decaying carcasses or vegetable materials such as decaying grass, hay, grain, or spoiled silage. Toxins of all types have the same action.
The signs of botulism are caused by muscle paralysis. They include paralysis that becomes progressively more severe, disturbed vision, difficulty in chewing and swallowing, and overall weakness. Death is usually due to paralysis of the lungs or heart. Diagnosis of this condition is difficult, and it is often made by excluding any other possible causes of paralysis and by association with a likely source of the toxin.
Botulism may also originate in 2 other ways. Clostridium botulinum has occasionally been found to grow in the gastrointestinal tract and produce toxins there. When the toxins are released, they cause typical botulism. This occurs in foals usually less than 4 weeks old and results in the shaker foal syndrome. Foals may be found dead without previous signs, but most often, foals show signs of paralysis that slowly progresses. Stilted gait, muscle tremors, and the inability to stand for more than 4 to 5 minutes are key signs. Other signs include difficulty swallowing, constipation, dilated pupils, and frequent urination. As the disease progresses, labored breathing with extension of the head and neck, rapid heart rate, and respiratory arrest occur. Death occurs most often 1 to 3 days after signs are first noted. Botulinum antitoxin has been used for treatment, with varying success. Early administration to foals, before they can no longer stand, is reported to be successful. Full supportive care is also important. In endemic areas, such as Kentucky, vaccination with type B toxoid appears to be effective.

Botulism is a rapidly fatal disease with motor paralysis. It is commonly caused by eating food contaminated with the tox...
26/04/2022

Botulism is a rapidly fatal disease with motor paralysis. It is commonly caused by eating food contaminated with the toxin (a type of poison) produced by Clostridium botulinum bacteria. This organism grows rapidly in decomposing animal tissue and sometimes in plant material. It results in rapid death due to the paralysis of vital organs. Botulism is not usually an infection but a poisoning. The frequency of botulism in animals is not known with accuracy, but it is low in horses.

There are 7 types of Clostridium botulinum toxins; the C1 toxin is seen in most animal species, although type B is most common in North America and Europe. The usual source of the toxin is decaying carcasses or vegetable materials such as decaying grass, hay, grain, or spoiled silage. Toxins of all types have the same action.

The signs of botulism are caused by muscle paralysis. They include paralysis that becomes progressively more severe, disturbed vision, difficulty in chewing and swallowing, and overall weakness. Death is usually due to paralysis of the lungs or heart. Diagnosis of this condition is difficult, and it is often made by excluding any other possible causes of paralysis and by association with a likely source of the toxin.

Botulism may also originate in 2 other ways. Clostridium botulinum has occasionally been found to grow in the gastrointestinal tract and produce toxins there. When the toxins are released, they cause typical botulism. This occurs in foals usually less than 4 weeks old and results in the shaker foal syndrome. Foals may be found dead without previous signs, but most often, foals show signs of paralysis that slowly progresses. Stilted gait, muscle tremors, and the inability to stand for more than 4 to 5 minutes are key signs. Other signs include difficulty swallowing, constipation, dilated pupils, and frequent urination. As the disease progresses, labored breathing with extension of the head and neck, rapid heart rate, and respiratory arrest occur. Death occurs most often 1 to 3 days after signs are first noted. Botulinum antitoxin has been used for treatment, with varying success. Early administration to foals, before they can no longer stand, is reported to be successful. Full supportive care is also important. In endemic areas, such as Kentucky, vaccination with type B toxoid appears to be effective.

A third form of botulism occurs in humans—and sometimes in adult horses—when the bacterium grows and produces toxin in a wound. This is referred to as wound botulism.

Botulism in Horses & Other Mammals
botulism post
Information below provided by Dr. Robert MacKay, Dr. Sarah Reuss and Dr. Chris Sanchez of the UF Large Animal Medicine Service.

What is botulism?
Botulism is a disease caused by ingestion of botulinum toxin, one of the most potent toxins known. It can affect all mammals, however horses are one of the most susceptible species. Botulism can affect both adult horses and foals (called “shaker foal syndrome”).

What are the clinical signs of botulism?
Signs vary in severity depending on the amount of toxin ingested.

The main sign is flaccid paralysis (weakness with decreased muscle tone). This may start off looking like a stiff, stilted gait but progresses to muscle tremors, weakness, and then recumbency (inability to rise).
Some affected horses may just spend more time lying down.
Other signs of paralysis involve the eyelids and tongue. When looking closely at the eyes, the pupils will be dilated and the blink will be weak. The horse often has trouble chewing and swallowing. Tail tone will also be decreased.
Once the horse is recumbent, issues with bladder paralysis and colic can result.
Ultimately, horses may die due to paralysis of the respiratory muscles.
One important thing to note that helps differentiate this disease from other neurologic diseases is that the horse’s mentation will be normal. They will be aware of their surroundings and often want to eat.
What causes botulism?
Botulism is a disease caused by toxins produced by the bacteria Clostridium botulinum. There are 8 different types of botulism that produce toxins of varying potency. Types A, B, and C are the types that usually affect horses. Horses can acquire disease three different ways. The most common route is by eating feed that is contaminated with toxin already in it that has been released by bacteria. This can be from spoiled feed or feed contaminated with an animal carcass. They can also acquire disease by ingesting the bacteria which then sporulate within the GI tract and release toxin inside the animal. This is more common in foals and is due to type B toxin. Rarely, horses can acquire botulism if a wound becomes contaminated with bacteria that then release toxin. The toxin itself acts at the junction between nerves and muscles so that the muscles don’t get the signal to contract when they should, hence the “flaccid paralysis.”

Can an infected horse spread botulism?
No. Botulism is only acquired from ingestion or infection of a wound. It is not spread directly from horse to horse, or from horses to people.

How can I prevent my horse from getting botulism?
Do not feed any obviously spoiled grain, or feed in which any animal carcasses are found (rats, birds, squirrels, etc). Also avoid feeding silage or haylage to horses as, if improperly fermented, it can harbor Clostridial organisms. Do not feed hay from plastic-wrapped bales if the plastic is torn. There is a vaccine against one type of botulism (Type B). This vaccine is given in certain geographic areas (central Kentucky, the mid-Atlantic) to reduce the risk of “Shaker Foal Syndrome.” Mares should be vaccinated with a 3 dose series in the last 3 months of pregnancy. Unfortunately, this vaccine is not effective against other types of botulism.

How is botulism diagnosed?
Botulism is diagnosed based on known risk factors and clinical signs. There is no blood test for botulism. As many horses with botulism have difficulty eating, a grain test can easily be performed to help make a diagnosis. Give 8 oz of grain in a pan, and a normal horse should be able to eat it in less than 2 minutes. If they take longer, that may be a sign of botulism, especially if they have other signs of weakness or recumbency. The bacteria may be able to be cultured from the f***s, more frequently in foals than adult horses. If the horse does not survive, a post-mortem exam will usually not find anything obviously abnormal. Contents of the gastrointestinal tract can be tested for toxin to confirm the diagnosis.

What if my horse gets botulism?
If you think your horse may have botulism, call your veterinarian immediately. While you wait, try to keep the horse as quiet as possible. You do NOT want to make affected horses walk any further than absolutely necessary, as they will quickly use up their energy reserves. There is an antitoxin available that has improved survival over the years. The antitoxin helps by binding to any toxin that is still in the bloodstream. Once the toxin has bound to the nerve cells, it will not be removed by antitoxin. Therefore, antitoxin will not reverse clinical signs, and the earlier it can be given, the better. Because the antitoxin is expensive and botulism is a relatively rare disease in Florida, most veterinarians do not keep this in stock. The University of Florida maintains a limited supply of the antitoxin in our pharmacy that we are happy to get to your veterinarian if needed. Nursing care is also very important to prevent eye ulcers, sores on the body, and pneumonia if the horse is recumbent. Foals may be put on mechanical ventilation if necessary, and this procedure is also available at the University of Florida Large Animal Hospital.

Contact the UF Large Animal Hospital at (352) 392-2229 or your primary care veterinarian for additional questions.

16/12/2021

Symptoms of foodborne botulism typically begin between 12 and 36 hours after ingesting the toxin, according to the Mayo Clinic, but can range from a few hours to a few days. The bacteria have an incubation period of 12 to 72 hours in children and adults. The appearance of symptoms depends on how much of the bacteria was ingested.

Common symptoms are:

nausea
vomiting
abdominal cramps
dry mouth
difficulty swallowing or speaking
facial weakness on both sides of the face
drooping eyelids
blurred or double vision
trouble breathing
paralysis
Another type of botulism is wound botulism. This is caused by the bacteria entering a cut, which can cause an infection that produces the toxin. People who inject drugs are more likely to get this form of botulism.

Symptoms of wound botulism are:

trouble breathing
difficulty swallowing or speaking
blurred or double vision
facial weakness
drooping eyelids
paralysis
Infants may be exposed to botulism, too. Infant botulism is when Clostridium botulinum spores grow in a baby's intestinal tract. This is the most common form of botulism and it usually occurs to children between the ages of 6 weeks and 6 months, according to the U.S. National Library of Medicine. Babies as young as 6 days and old as 1 year can be affected, though.

Symptoms of infant botulism usually occurs around 18 to 36 hours after the baby ingests the bacteria, which have an incubation period of 3 to 30 days in infants.

Symptoms include:

constipation (this is often the first sign)
difficulty sucking or feeding
drooling
floppy movements due to muscle weakness
drooping eyelids
trouble controlling the head
weak cry
irritability
tiredness
paralysis
Adult intestinal toxemia botulism is when the spores of the bacteria get into an adult's intestines. Once there, they grow and produce the toxin, according to the CDC.

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An additional way a person can also get botulism is from Botox cosmetic injections. This is called latrogenic botulism. Botox is actually made from a toxin produced by Clostridium botulinum.

"Getting botulism from a Botox injection is extremely rare," said Dr. Alexes Hazen, an associate professor at the Hansjörg Wyss department of plastic surgery at NYU Langone. "The form of Botox used for cosmetic purposes is a highly regulated and attenuated form of Botox. If a person is using unregulated Botox that is not FDA approved — this could be possible."

Iatrogenic botulism can also occur when too much Botox is injected at one time, according to the CDC.

Diagnosis & treatment
To diagnose botulism, the medical professional will often do a medical exam that looks for muscle weakness or paralysis. A blood, stool or vomit analysis may also be ordered.

Treatment of foodborne or infant botulism typically includes ridding the body of the toxin by inducing vomiting or bowel movements. Wound botulism may be treated by removing the infected tissue. Antitoxins and antibiotics may also be prescribed for various forms of botulism.

After the person starts to recover, rehabilitation treatment may be needed to help retrain the body after the nerve damage from the toxins.

Prevention
There are many ways to prevent botulism. First, food should be prepared properly and stored safely. For example, when canning foods, they should be pressure cooked at 250 degrees Fahrenheit (121 degrees Celsius) for 20 to 100 minutes, depending on the food, according to the Mayo Clinic. Also, if a food container is bulging or if the food smells spoiled, it is best to throw it away.

To prevent infant botulism, do not give honey or corn syrup to babies under the age of 1 year, according to the U.S. National Library of Medicine. Wound botulism can be avoided by not injecting or inhaling street drugs.

05/11/2021

Horses are the most sensitive of the domesticated animals to botulism. Botulism is a disease that occurs when toxins produced by the bacterium, Clostridium botulinum, enter the horse's body causing weakness which may progress to paralysis. The botulism bacterium is a spore-forming, anaerobic bacteria (grows in the absence of oxygen) which is found world wide. It is commonly present in soil and in decaying animal carcasses. It occurs less often in decaying plant material. Hay, and especially haylage, can be contaminated with the botulism bacterium during the raking and baling process. The higher moisture levels (in comparison to dry hay), the anaerobic conditions and a pH above 4.5 in some haylage are ideal conditions for the growth of this bacterium.

05/11/2021

National Botulism Surveillance
The CDC Botulism Consultation Service, the Alaska Division of Public Healthexternal icon, and the California Department of Public Healthexternal icon provide clinical consultations on suspected cases of all types of botulism except infant botulism. These agencies are the only sources of antitoxin for non-infant botulism in the United States. The California Infant Botulism Treatment and Prevention Programexternal icon provides clinical consultations on suspected infant botulism cases; it is the only source of antitoxin for infant botulism in the United States. Together, these clinical consultations provide expert guidance to clinicians and support the collection of epidemiologic and medical information for all suspected botulism cases reported in the United States.

Transmission Categories
For surveillance purposes, CDC categorizes human botulism cases into four transmission categories:

Foodborne botulism
Wound botulism
Infant botulism
“Other” botulism: includes adult intestinal colonization, iatrogenic botulism, and unknown routes of transmission

05/11/2021

Information for Health Professionals
Clinical Features
Botulism Case Consultation
If you suspect your patient may have botulism, call your state public health departmentexternal icon immediately. If there is no answer, contact CDC 24/7 at 770-488-7100.

For non-infant cases: State public health officials can reach the CDC clinical emergency botulism service for consultation and antitoxin 24/7 at 770-488-7100.
For infant botulism: The Infant Botulism Treatment and Prevention Programexternal icon(IBTPP) at the California Department of Public Health provides consultation 24/7 and can be reached at 510-231-7600.
If clinical consultation supports botulism, request antitoxin immediately and begin treatment as soon as it is available. Do not wait for laboratory confirmation. If administered early in the course of illness, antitoxin can prevent progression of illness and shorten its duration.

Is your patient an infant?
See step-by-step guidance for clinicians of patients who may have infant botulism.

Take a look >

A baby with botulism.
Botulism is a neuroparalytic illness characterized by symmetric, descending flaccid paralysis of motor and autonomic nerves, always beginning with the cranial nerves.

Signs and symptoms may include:

Dysphagia
Muscle weakness
Diplopia
Ptosis
Blurry vision
Slurred speech
Respiratory distress or failure
Ocular palsy
Possible signs and symptoms in foodborne botulism may also include:

Vomiting
Nausea
Abdominal pain
Diarrhea
Signs and symptoms in an infant may include:

Constipation
Poor feeding
Ptosis
Sluggish pupils
Flattened facial expression
Diminished suck and gag reflexes
Weak and altered cry
Respiratory distress or failure
If untreated, illness from any type of botulism can progress to descending paralysis of respiratory muscles, arms, and legs.

Diagnosis
Initial diagnosis is based on clinical symptoms. Do not wait for laboratory confirmation to begin treatment.

Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. It also differs in its invariable descending progression, in its symmetry, and in its absence of sensory nerve dysfunction.

Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barré or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system.

Differential Diagnoses
Bacterial or chemical food poisoning
Cerebrovascular accident (CVA)
Chemical intoxication
(e.g., carbon monoxide, opioid intoxication)
Congenital myopathy
Electrolyte-mineral imbalance
Guillain-Barré syndrome
Lambert-Eaton myasthenic syndrome
Leigh syndrome
Meningitis
Miller-Fisher syndrome
Mushroom poisoning
Myasthenia gravis
Poliomyelitis
Reye’s syndrome
Sepsis
Tick paralysis
Werdnig-Hoffman disease
West Nile Virus
Routine laboratory test results are usually unremarkable for people with botulism. A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. A normal CT or MRI helps to rule out cerebrovascular accident.

Treatment
Botulism Antitoxin

media iconLow Resolution Video
Video with audio descriptions
Low resolution video with audio descriptions
If consultation supports botulism, request treatment and administer it as soon as possible. Botulism Antitoxin Heptavalentexternal icon and BabyBIGexternal icon do not reverse paralysis but arrest its progression. Recovery follows the regeneration of new neuromuscular connections.

Exercise meticulous intensive care, including monitoring of respiratory function and, when required, mechanical ventilation. In more severe cases, ventilator support may be required for weeks to months.

Treatment for wound botulism may also include wound debridement to remove the source of toxin‑producing bacteria and antibiotic therapy.

Diagnostic Testing
Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food, or by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound.

Diagnostic testing is done through the state public health department’s laboratory. CDC provides testing services for some state public health departments.

This specialized testing often takes days to complete. Follow up with your state health department if you do not receive results within 5 days.

See information on submitting a specimen to CDC >

Sequelae
Death can result from respiratory failure or the consequences of extended paralysis. About 5% of patients die. Recovery takes weeks to months. Those who survive may have fatigue and shortness of breath for years.

Notification and Reporting
Botulism is a notifiable disease in the United States. Physicians must promptly notify the state health department of suspected cases, and laboratories must notify the state health department of all confirmed cases.

State health departments report confirmed cases to CDC through the National Notifiable Diseases Surveillance System.

Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021

These are the first comprehensive clinical care guidelines for botulism. They include

Best practices for diagnosing, monitoring, and treating botulism, including during outbreaks
Special considerations for infants, children, and people who are pregnant or breastfeeding
Recommendations for supportive care, including psychosocial support for patients and family members
Illustration of a female with botulism
“Botulism,” a CDC-sponsored supplement to Clinical Infectious Diseasesexternal icon

The supplement includes six systematic reviews and other articles that provided the evidence base for the clinical guidelines. Contents include reviews and articles on

Clinical presentation
Effectiveness of antitoxin
Antitoxin adverse reactions
Outbreaks
And more

05/11/2021

Pruno: A Recipe for Botulism
You may have heard about a cheap, quick way to make a kind of homemade alcohol that goes by many different names, including pruno, h***h, brew, prison wine, and buck. No matter what it’s called, it can give you more than a cheap buzz. It can give you botulism, a life-threatening illness.

What is botulism?
Botulism is a rare but serious illness caused by a toxin (poison) that attacks the body’s nerves and can lead to paralysis and death. Because the disease can paralyze the muscles used in breathing, people can die soon after symptoms first appear. Even those who get medical treatment right away may be paralyzed and hooked up to a ventilator (breathing machine) for many weeks.

One way people get botulism is by eating or drinking something that has the toxin in it. Some prison inmates in California, Arizona, Utah, and Mississippi have gotten botulism after making and drinking pruno. Almost all of those inmates had to be hospitalized for treatment, and many were put on a ventilator (breathing machine) for days or even weeks. All of the botulism outbreaks linked to pruno have occurred among inmates. However, anyone who drinks this kind of alcohol is at risk.

How can pruno give me botulism?
When people make pruno, they usually ferment fruit, sugar, water, and other common ingredients for several days in a sealed plastic bag. Making alcohol this way can cause botulism germs to make toxin (poison). The toxin is what makes you sick.

It’s hard to know if pruno has botulism toxin in it, because you can’t see, smell, or taste the toxin.

How can I stay safe?
If you make pruno, you put yourself and anyone who drinks it in danger of getting botulism. The alcohol in your drink won’t destroy the toxin (make it harmless). The only way to be sure you don’t get botulism from pruno is to not drink it.

We don’t know how to make this kind of alcohol safely. But we do know that batches of pruno that gave people botulism used at least one of these ingredients:

Potatoes
Honey
Food from bulging cans
How would I know if I have botulism?
If you drink pruno and have symptoms of botulism, get medical help immediately. Be sure to tell your doctor that you drank pruno. The sooner you get medical help, the better your chances of surviving the illness.

Remember, if you want to keep from getting botulism, your best bet is to not drink pruno. But if you do and you have symptoms of botulism, get medical help immediately and tell your doctor that you drank pruno.

Some of the symptoms of botulism are:

Double vision
Blurred vision
Drooping eyelids
Slurred speech
Difficulty swallowing
A thick-feeling tongue
Dry mouth
Muscle weakness
As the disease gets worse, you may develop more symptoms, such as:

Difficulty breathing
Paralysis (can’t move your body)

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