Clostridium botulinum and Botulism: Epidemiology, Diagnosis, Treatment, Control and Prevention

Abstract

Clostridium botulinum is a Gram-positive, obligate anaerobic, spore-forming bacterium that produces botulinum toxin. It is one of the most potent neurotoxins known and this toxin causes botulism, a rare but life-threatening neuroparalytic disease characterized by descending flaccid paralysis and possible respiratory failure. Epidemiologically, botulism is characterized as a rare but high-severity neuroparalytic disease. Globally, the annual incidence remains low, typically under 1 case per 100,000 population, yet it carries a significant public health burden due to a case fatality rate (CFR) of 5–10% in developed health systems, rising to over 15% in resource-limited regions where antitoxins are scarce (Investigating the dual nature, 2026). Surveillance data from 2018 to 2025 indicates that global outbreaks are predominantly foodborne, often linked to home-canned products as seen in the 2024 BoNT/A outbreak in California and traditional fermented foods (MMWR, 2025). In Africa and West Africa, the morbidity is compounded by long-term sequelae; survivors report chronic fatigue (66.2%), general weakness (57.1%), and respiratory impairment (42.9%) persisting up to six years post-intoxication (Botulism Sequelae, 2025). Within Nigeria, C. botulinum is not a routinely notifiable disease under the NCDC surveillance framework, resulting in an absence of official prevalence figures across the 36 states, including Rivers State. However, clinical literature identifies high-risk practices in local food processing, suggesting significant under-reporting of cases. Although botulism occurs infrequently, its severity and association with food safety, infant health, wound infections, and therapeutic toxin use make it a significant public health concern. This review presents an overview of Clostridium botulinum, including its microbiological characteristics, toxin production, pathogenesis, clinical manifestations, diagnosis and control of botulism. Emphasis is placed on recent updates in diagnostic techniques, epidemiology, treatment, and public health control measures. Advances such as molecular diagnostic methods have improved early detection, while improved antitoxin availability and supportive care have reduced mortality rates. Additionally, the expanding medical and cosmetic use of botulinum toxin highlights the need for strict regulation and professional administration. Continuous public health surveillance, food safety practices, and health education remain vital in reducing disease burden.