Botulism

Reportable by Laboratories and Providers

About this Reportable Disease

This is an immediately reportable condition. Please contact the Tennessee Department of Health at 615-741-7247 and ask to speak to the epidemiologist on call. 

Infectious agent:  Clostridium botulinum, botulinum toxin

Description of illness: Botulism is a muscle-paralyzing disease caused by botulinum toxin, from Clostridium botulinum bacteria. Botulism is characterized by an acute, afebrile, symmetric descending flaccid paralysis, caused by blockade of neurotransmitters at the neuromuscular junction. Onset of symptoms can occur abruptly within hours or evolve gradually over several days. There are 3 distinct forms of botulism: foodborne botulism, infant botulism, and wound botulism.

Interactive Disease Data


Laboratory Reporting for this Disease

Clostridium botulinum

TEST NAME Clostridium botulinum
DISEASE/DISORDER Botulism
ALTERNATE NAME(S) None
METHODOLOGY LRN-B Botulinum toxin testing:  PCR/ 7500DX and Mouse Bioassay
SPECIAL INSTRUCTIONS
  • Isolate Submission REQUIRED.
  • Contact Bioterrorism laboratory before submission. 
ORDERING INFORMATION

Lab Web Portal

TDH DLS Requisition:  PH-4263 Clinical Select Agent Rule-Out Submission Requisition

Specimen Requirements

Patient Preparation
  • None
Specimen Collection
  • Acceptable Specimen Sources/Type(s) for Submission

-  Serum

-  Stool

-  Vomitus

-  Wound culture (swab)

-  Culture isolate
Specimen Labeling
  • Specimen should be labeled with at least two unique patient identifiers along with specimen source and match accompanying test order.
Specimen Processing
  • None
Specimen Storage and Preservation
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
Specimen Transportation
  • Contact Bioterrorism laboratory prior to shipment to determine appropriate specimen handling based on LRN protocols.
  • All infectious substance shipments must conform to U.S. Department of Transportation (DOT) Hazardous Materials Regulations (HMR 49 C.F.R. Parts 171-180).
Specimen Acceptability and Rejection
  • Contact Bioterrorism laboratory before submission. 
Testing Location
  • Nashville

Laboratory Reporting

Reporting requirements apply to all laboratories located within Tennessee, as well as laboratories outside of Tennessee that test residents of Tennessee, including laboratories located within healthcare facilities. Healthcare providers and laboratories in the same healthcare facility both have a duty to report. The type of organisms and analytes laboratories must report to TDH for 2026 are indicated, and there are several ways laboratories can report results to TDH.

Information about this Reportable Disease for Healthcare Providers

Clinical Details

  • Botulism is a neuroparalytic illness characterized by symmetric, descending flaccid paralysis of motor and autonomic nerves, always beginning with the cranial nerves.
  • 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
Symmetry
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.
  • Signs and symptoms may include:

Dysphagia
Muscle weakness
Diplopia
Ptosis
Blurry vision
Slurred speech
Respiratory distress or failure
Ocular palsy

Information about this Reportable Disease for the Public

What It Is

Botulism is a rare but serious illness caused by a toxin that attacks the body's nerves. Botulism causes difficulty breathing, muscle paralysis, and even death.The toxin is made by Clostridium botulinum and sometimes Clostridium butyricum and Clostridium baratii bacteria (germs). These bacteria can produce the toxin in food, wounds, and the intestines of infants.The bacteria that make botulinum toxin are found naturally in many places, but it's rare for them to make people sick. These bacteria make spores, which act like protective coatings. Spores help the bacteria survive in the environment, even in extreme conditions.The spores usually do not cause people to become sick, even when they're eaten. But under certain conditions, these spores can grow and make one of the most lethal toxins known.

Signs and Symptoms

Difficulty swallowing
Muscle weakness
Double vision
Drooping eyelids
Blurry vision
Slurred speech
Difficulty breathing
Difficulty moving the eyes

Signs and symptoms in foodborne botulism also might include:

Vomiting
Nausea
Stomach pain
Diarrhea

Signs and symptoms in an infant might include:

Constipation
Poor feeding
Drooping eyelids
Pupils that are slow to react to light
Face showing less expression than usual
Weak cry that sounds different than usual

Mishandled Botulinum Toxin Injections 

Data show that injections of counterfeit or mishandled botulinum toxin (commonly called "Botox") made people sick.

  • Some people received injections with counterfeit products or products with unverified sources.
  • Some people received injections from individuals who did not follow jurisdictional (state or local) requirements.

What You Should Do

If you are considering an injection of botulinum toxin for a medical condition or cosmetic reason (such as for wrinkles):

  • Ask your provider if they are licensed and trained to give the injection.
  • Ask if the botulinum toxin product is approved by FDA and obtained from a reliable source.
  • If in doubt, don't get the injection.

See your healthcare provider or go to the emergency room immediately if you have any symptoms of botulism, includingBlurry or double vision

Drooping eyelids
Difficulty swallowing
Difficulty breathing
Muscle weakness

This Page Last Updated: March 25, 2026 at 8:45 PM