 |
Foodborne Botulism -- Oklahoma, 1994
On July 2, 1994, the Arkansas Department of Health and the
Oklahoma State Department of Health were notified about a possible
case of foodborne botulism. This report summarizes the
investigation, which implicated consumption of improperly stored
beef stew.
On June 30, 1994, a 47-year-old resident of Oklahoma was
admitted to an Arkansas hospital with subacute onset of progressive
dizziness, blurred vision, slurred speech, difficulty swallowing,
and nausea. Findings on examination included ptosis, extraocular
palsies, facial paralysis, palatal weakness, and impaired gag
reflex. The patient also had partially healed superficial knee
wounds incurred while laying cement. He developed respiratory
compromise and required mechanical ventilation.
Differential diagnoses included wound and foodborne botulism,
and botulism antitoxin was administered intravenously.
Electromyography demonstrated an incremental response to rapid
repetitive stimulation consistent with botulism. Anaerobic culture
of the wounds were negative for Clostridium. However, analysis of
a stool sample obtained on July 5 detected type A toxin, and
culture of stool yielded C. botulinum. The patient was hospitalized
for 49 days, including 42 days on mechanical ventilation, before
being discharged.
The patient had reported that, during the 24 hours before
onset of symptoms, he had eaten home-canned green beans and a stew
containing roast beef and potatoes. Although analysis of the
leftover green beans was negative for botulism toxin, type A toxin
was detected in the stew. The stew had been cooked, covered with a
heavy lid, and left on the stove for 3 days before being eaten
without reheating. No other persons had eaten the stew.
Reported by: W Knubley, MD, Cooper Clinic, Fort Smith; TC
McChesney, DVM, State Epidemiologist, Arkansas Dept of Health. J
Mallonee, MPH, Acting State Epidemiologist, Oklahoma State Dept of
Health. Foodborne and Diarrheal Diseases Br, Div of Bacterial and
Mycotic Diseases, National Center for Infectious Diseases; Div of
Field Epidemiology, Epidemiology Program Office, CDC. Editorial Note
Editorial Note: Botulism is a paralytic illness resulting from a
potent toxin produced under anaerobic conditions by C. botulinum.
Although foodborne botulism is rare in the United States (34 cases
reported in 1994 {CDC, unpublished data, 1995}), manifestations can
be severe and can progress rapidly. Because of the potential
severity of disease and the possibility for exposure of many
persons to contaminated products, foodborne botulism is a public
health emergency requiring rapid investigation.
When botulism is suggested by clinical manifestations, (e.g.,
descending neuroparalysis, ptosis, and extraocular palsies),
physicians should obtain a thorough food history to assist in the
diagnosis and in identifying and obtaining potentially contaminated
leftover food. In the case described in this report, heat-resistant
C. botulinum spores either survived the initial cooking or were
introduced afterwards; the spores subsequently germinated and
produced toxin. The lid of the pot or the gravy of the stew most
likely provided the anaerobic environment necessary for toxin
production. Previous cases with similar features have resulted from
consumption of commercial pot pies (1) and onions sauteed in
margarine (2), both of which were left at room temperature for
greater than 4 hours after cooking.
Most outbreaks of foodborne botulism in the United States
result from eating improperly preserved home-canned foods (3);
vegetables (especially asparagus, green beans, and peppers) account
for most outbreaks caused by home-canning (CDC, unpublished data,
1995). A pressure cooker must be used to home-can vegetables safely
because it can reach temperatures necessary to kill botulism spores
(substantially greater than 212 F { greater than 100 C} for 10
minutes); however, specific times and pressures needed vary for
different foods (4). Jams and jellies can be safely home-canned
without a pressure cooker because their high sugar content will not
support the growth of C. botulinum. Instructions for home-canning
are available from county extension offices. Cooked foods should
not be held at temperatures 40 F-140 F (4 C-60 C) for greater than
4 hours (5). Boiling food for 10 minutes before eating destroys any
toxin present.
CDC provides epidemiologic consultation and laboratory
diagnostic services for suspected botulism cases and authorizes
release of botulism antitoxin to state health departments and
physicians in the United States. These services are available 24
hours a day from CDC through state health departments.
References
CDC. Botulism and commercial pot pie -- California. MMWR
1983;32:39-40,45.
MacDonald KL, Spengler RF, Hatheway CL, Hargrett NT, Cohen ML.
Type A botulism from sauteed onions: clinical and epidemiologic
observations. JAMA 1985;253:1275-8.
St. Louis ME. Botulism. In: Evans AS, Brachman P, eds. Bacterial
infections of humans: epidemiology and control. 2nd ed. New York:
Plenum Publishing, 1991:115-31.
Extension Service, US Department of Agriculture. Complete guide
to home canning. Washington, DC: US Department of Agriculture,
Extension Service, September 1994. (Agriculture information
bulletin no. 539).
Food and Drug Administration. Food code, 1993. Washington, DC:
US Department of Health and Human Services, Public Health Service,
Food and Drug Administration, 1993.
Disclaimer
All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov. Page converted: 09/19/98
|
|
