During medical school we are introduced to many diseases, some sparking particular interest because of a personal connection (for example, a past beloved relative afflicted by leukemia) or a discovered thrill over how a certain disease presents. For me, botulism is a disease ripe with dramatic intrigue.


Dad then explained how a bacterium grew within the can and produced a deadly poison. For me, the vichyssoise story was quite memorable, and I’ve been hooked on the subject of botulism and the science behind that disease ever since.
A year or two later, I watched a movie on late-night television entitled, “The Satan Bug,” a political action thriller in which a millionaire activist steals from a top-secret bioweapons laboratory one vial of a deadly virus and several vials of “botulinus” toxin. The protagonist releases the “botulinus” toxin into the air, which aerosolizes and instantly paralyzes nearby members of the investigative crime team. They die within seconds. My fascination with botulism was firmly cemented.Fast forward to medical school, where I learned that not only did Clostridium botulinum produce a toxin in an anaerobic environment, a toxin that when ingested could rapidly affect nerve synaptic junctions, the organism could also grow in an infant’s gut and slowly produce a toxin that, in turn, could slowly cause infant paralysis. Now I had a disease story with a riveting plot twist, a twist confirmed during residency when I saw several infants with botulism, all with considerable constipation, flaccid paralysis, and the “rag doll” cry.

That day came when I was asked to consult on a new admission of an infant with suspected inflicted head trauma who was becoming weaker by the hour. After entering the NICU where the infant and her mother waited for a scheduled head MRI,

This month, Dr. Maria Carrillo-Marquez writes in Pediatrics in Review about the various spellbinding presentations of botulism. As you read about botulism, consider the importance of the gut microbiome, spore contamination of the environment, toxin-tainted food supplies, and biological warfare, all involving a bacterium that can theatrically and lethally paralyze.