Due to the advent of modern mechanical ventilation in the 1940s, mortality rates have decreased from 60% to 70% in the early 20th century, to the current rate of 3% to 5%.[67]Gangarosa EJ, Donadio JA, Armstrong RW, et al. Botulism in the United States, 1899-1969. Am J Epidemiol. 1971;93:93-101.
http://www.ncbi.nlm.nih.gov/pubmed/4925448?tool=bestpractice.com
[68]Varma JK, Katsitadze G, Moiscrafishvili M, et al. Signs and symptoms predictive of death in patients with foodborne botulism - Republic of Georgia, 1980-2002. Clin Infect Dis. 2004;39:357-362.
http://cid.oxfordjournals.org/content/39/3/357.full
http://www.ncbi.nlm.nih.gov/pubmed/15307002?tool=bestpractice.com
The mortality rate for infant botulism is <1%.[25]Arnon S. Infant botulism. In: Feigen RD, Cherry JD, eds. Textbook of pediatric infectious diseases. 4th ed. Philadelphia, PA: WB Saunders; 1998:570-577. Although muscle strength improves greatly in the first 3 months of recovery from botulism, patients continue to show an increase in strength and endurance for up to 1 year after disease onset.[64]Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006 Feb 2;354(5):462-71.
http://www.nejm.org/doi/full/10.1056/NEJMoa051926#t=article
http://www.ncbi.nlm.nih.gov/pubmed/16452558?tool=bestpractice.com
Relapse of infant botulism is rare but has been reported in infants despite complete resolution of symptoms.[69]Glauser TA, Maguire HC, Sladky JT. Relapse of infant botulism. Ann Neurol. 1990;28:187-189.
http://www.ncbi.nlm.nih.gov/pubmed/2221848?tool=bestpractice.com
Therefore, close follow-up is important during the first month after discharge. Long-term consequences of botulism include fatigue, weakness, dyspnea on exertion, and impaired psychosocial well-being.[5]Gottlieb SL, Kretsinger K, Tarkhashvili N, et al. Long-term outcomes of 217 botulism cases in the Republic of Georgia. Clin Infect Dis. 2007 Jul 15;45(2):174-80.
http://cid.oxfordjournals.org/content/45/2/174.full
http://www.ncbi.nlm.nih.gov/pubmed/17578775?tool=bestpractice.com