Mild Botulism: The Most Common Type

Mild botulism symptoms have been reported after as little as 5 units of Botox

In order to fully understand botulism in all its presentations, it is imperative that medical professionals become educated on the nuances of "mild" botulism.

Having suffered from mild botulism myself, I can assure you that nothing about it is mild. The term "mild botulism" is used to define botulism cases that are not life-threatening, ie: those that require a feeding tube or mechanical ventilation.

Bai et al reported that 75% of patients in their clinical review of 86 cosmetic iatrogenic botulism cases presented with mild botulism.

The most common symptoms of mild botulism include (in order of occurrence):

-fatigue

-blurry vision

-dizziness

-ptosis (eyelid drooping)

-dysphagia (difficulty swallowing)

-dysarthria (difficulty speaking)

-anxiety

-insomnia

-headache

-constipation

It is important to note that this is not a comprehensive list of mild botulism symptoms. Dry eyes, dry mouth, ear congestion and disorders, hair loss, dysphonia (hoarse voice), muscle weakness, and weight loss are just a small sample of other non-life threatening symptoms that are listed in Botox's package insert as occurring in patients post-injections.

Mild botulism does not show up on any blood tests or any other objective tests performed at ERs. It is essentially a cluster of subjective symptoms that patients may experience in the hours, days, and weeks following injections.

Many people with mild botulism show up to the ER with subjective complaints of dizziness, blurry vision, difficulty swallowing, dry mouth, anxiety, etc., and because they are not experiencing flaccid paralysis or decreased O2 sats, they are simply sent home on anxiety meds and told that their symptoms are "in their head" and certainly not a result of their Botox treatment. (This is what happened to me, as well as every other IB sufferer I have spoken with.)

Interestingly, mild botulism also occurred in foodborne cases throughout history. There are many reports of people experiencing mild botulism symptoms during foodborne botulism outbreaks and not receiving antitoxin, because doctors didn't believe the patients' subjective reports of their symptoms.

Mild botulism is an insidious disease. It can be absolutely torturous to live through it for many months (if not years), and many of its victims rush from doctor to doctor seeking treatment, only to be told that there is nothing wrong with them.

Mild botulism is a reminder to medical professionals that we must not only believe patients when they report new and worsening symptoms (even if they are subjective experiences only), but that we must also practice critical thinking and discernment when attempting to get to the root cause of a patients' medical issues. Nobody at the ER seems to be asking the critical question "Have you received Botox injections in the past 6-12 months?" to patients who are presenting with mild botulism symptoms.

I have no doubt that there are hundreds of thousands of people walking around with mild botulism resulting from Botox injections; if you extrapolate the percentages from Botox's own clinical trial data to the millions of injections that are performed each year, it adds up to tens of thousands of injured patients each year.

Iatrogenic botulism rates will continue to rise as the ubiquitousness of Botox rises. It is imperative that medical professionals (especially injectors and ER docs/nurses) are being thoroughly educated and trained in recognizing and responding to mild botulism.

References:

Bai L, Peng X, Liu Y, Sun Y, Wang X, Wang X, Lin G, Zhang P, Wan K, Qiu Z. Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT). Medicine (Baltimore). 2018 Aug;97(34):e10659. doi: 10.1097/MD.0000000000010659. PMID: 30142749; PMCID: PMC6112997.

Talkington, J.A. Recognizing Botulism. 2025. Independently published.