TOXICOLOGY & ADDICTION MEDICINE
Botulism: Early Recognition and Time-Sensitive Management in the Emergency Department SAEM PULSE | MARCH-APRIL 2026
By Kyle Schuchter, PharmD, and Julianne Yeary, PharmD on behalf of the SAEM Toxicology and Addiction Medicine Interest Group and the SAEM Academy of Emergency of Medicine Pharmacists
114
Background
As recently as November 2025, a botulism outbreak linked to infant formula affected 51 patients across 19 states. The U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention identified Clostridium botulinum toxin type A in whole milk powder used in ByHeart Whole Nutrition infant formula and recalled the product.
Botulism is a rare, life-threatening disease caused by botulinum neurotoxin produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, less commonly, Clostridium baratii and Clostridium butyricum. These bacteria can survive extreme conditions and are not virulent until spores germinate and produce toxin under anaerobic conditions, low acidity, low salt or sugar content, and temperatures between 37 and 99 F.
Seven distinct botulinum toxin types (A through G) bind at the neuromuscular junction, inhibiting acetylcholine release from the presynaptic motor neuron and ultimately blocking neuromuscular transmission. Botulism syndromes include foodborne (ingestion of toxin, such as through improperly canned or preserved foods), wound (toxin production in colonized wounds),