BOTULISM
(Clostridium botulinum)

Clinical Criteria
Any person with at least one of the following clinical forms:

Food-borne and wound botulism
At least one of the following two:
– Bilateral cranial nerve impairment (e.g. diplopia, blurred vision, dysphagia, bulbar
weakness)
– Peripheral symmetric paralysis

Infant botulism
Any infant with at least one of the following six:
– Constipation
– Lethargy
– Poor feeding
– Ptosis
– Dysphagia
– General muscle weakness
The type of botulism usually encountered in infants (<12 months of age) can affect children
also over 12 months of age and occasionally adults, with altered gastrointestinal anatomy and
microflora.

Laboratory Criteria
At least one of the following two:
– Isolation of C. botulinum for infant botulism (stool) or wound botulism (wound) (isolation
of C. botulinum in stool of adults not relevant for the diagnosis of food-borne botulism)
– Detection of botulinum toxin in a clinical specimen

Epidemiological Criteria
At least one of the following two epidemiological links:
– Exposure to a common source (e.g. food, sharing of needles or other devices)
– Exposure to contaminated food / drinking water

Case Classification
A. Possible case    NA
B. Probable case
Any person meeting the clinical criteria and with an epidemiological link
C. Confirmed case
Any person meeting the clinical and the laboratory criteria