Underdiagnosis of botulism as a cause of tragedy: A case report

Abstract

Botulism has unique clinical picture; however, some of its manifestations, when analyzed separately, are similar to the manifestations of other, both infectious and noncommunicable diseases. This contributes to the occurrence of diagnostic errors because botulism is not one of the most common infectious diseases; as a result, most practitioners are familiar with the clinical picture of botulism purely theoretically and clearly insufficiently. The article analyzes the course of botulism in a group of family diseases when, at the first visit to specialists, botulism was diagnosed in any of the patients not receiving medical care. In addition, the causes and effects of prolonged toxemia (20 days) in one of the patients are discussed.

Keywords

botulism / underdiagnosis / myasthenia gravis / encephalitis / prolonged toxemia / antibotulinum serum / case report

References

[1] Nikiforov VV. Botulism. Saint Petersburg: Eco-Vector; 2024. 528 p. (In Russ.) EDN: NDPUMZ

[2] Никифоров В.В. Ботулизм. Санкт-Петербург: Эко-Вектор, 2024. 528 с. EDN: NDPUMZ

[3] Chatham-Stephens K, Fleck-Derderian S, Johnson SD, et al. Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932–2015. Clin Infect Dis. 2017;66 Suppl. 1: S11–S16. doi: 10.1093/cid/cix811

[4] Chatham-Stephens K., Fleck-Derderian S., Johnson S.D., et al. Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932–2015 // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S11–S16. doi: 10.1093/cid/cix811

[5] Harvey RR, Cooper R, Bennett S, et al. Outbreak of Foodborne Botulism in an Immigrant Community: Overcoming Delayed Disease Recognition, Ambiguous Epidemiologic Links, and Cultural Barriers to Identify the Cause. Clin Infect Dis. 2017;66 Suppl. 1:S82–S84. doi: 10.1093/cid/cix817

[6] Harvey R.R., Cooper R., Bennett S., et al. Outbreak of Foodborne Botulism in an Immigrant Community: Overcoming Delayed Disease Recognition, Ambiguous Epidemiologic Links, and Cultural Barriers to Identify the Cause // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S82–S84. doi: 10.1093/cid/cix817

[7] Rao AK, Walters M, Hall J, et al. Outbreak of Botulism Due to Illicit Prison-Brewed Alcohol: Public Health Response to a Serious and Recurrent Problem. Clin Infect Dis. 2017;66 Suppl. 1:S85–S91. doi: 10.1093/cid/cix936

[8] Rao A.K., Walters M., Hall J., et al. Outbreak of Botulism Due to Illicit Prison-Brewed Alcohol: Public Health Response to a Serious and Recurrent Problem // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S85–S91. doi: 10.1093/cid/cix936

[9] St Louis ME, Peck SH, Bowering D, et al. Botulism from chopped garlic: delayed recognition of a major outbreak. Ann Intern Med. 1988;108(3):363–368. doi: 10.7326/0003-4819-108-3-363

[10] St Louis M.E., Peck S.H., Bowering D., et al. Botulism from chopped garlic: delayed recognition of a major outbreak // Ann Intern Med. 1988. Vol. 108, N 3. P. 363–368. doi: 10.7326/0003-4819-108-3-363

[11] Rao AK, Lin NH, Griese SE, et al. Clinical Criteria to Trigger Suspicion for Botulism: An Evidence-Based Tool to Facilitate Timely Recognition of Suspected Cases During Sporadic Events and Outbreaks. Clin Infect Dis. 2017;66 Suppl. 1:S38–S42. doi: 10.1093/cid/cix814

[12] Rao A.K., Lin N.H., Griese S.E., et al. Clinical Criteria to Trigger Suspicion for Botulism: An Evidence-Based Tool to Facilitate Timely Recognition of Suspected Cases During Sporadic Events and Outbreaks // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S38–S42. doi: 10.1093/cid/cix814

[13] Hughes JM, Blumenthal JR, Merson MH, et al. Clinical features of types A and B food-borne botulism. Ann Intern Med. 1981;95(4): 442–445. doi: 10.7326/0003-4819-95-4-442

[14] Hughes J.M., Blumenthal J.R., Merson M.H., et al. Clinical features of types A and B food-borne botulism // Ann Intern Med. 1981. Vol. 95, N 4. P. 442–445. doi: 10.7326/0003-4819-95-4-442

[15] Badell ML, Rimawi BH, Rao AK, et al. Botulism During Pregnancy and the Postpartum Period: A Systematic Review. Clin Infect Dis. 2017;66 Suppl. 1:S30–S37. doi: 10.1093/cid/cix813

[16] Badell M.L., Rimawi B.H., Rao A.K., et al. Botulism During Pregnancy and the Postpartum Period: A Systematic Review // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S30–S37. doi: 10.1093/cid/cix813

[17] Griese SE, Kisselburgh HM, Bartenfeld MT, et al. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review. Clin Infect Dis. 2017;66 Suppl. 1:S17–S29. doi: 10.1093/cid/cix812

[18] Griese S.E., Kisselburgh H.M., Bartenfeld M.T., et al. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review // Clin Infect Dis. 2017. Vol. 66, Suppl. 1. P. S17–S29. doi: 10.1093/cid/cix812

[19] Sheth AN, Wiersma P, Atrubin D, et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis. 2008;47(10):1245–1251. doi: 10.1086/592574

[20] Sheth A.N., Wiersma P., Atrubin D., et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice // Clin Infect Dis. 2008. Vol. 47, N 10. P. 1245–1251. doi: 10.1086/592574

[21] Centers for Disease Control and Prevention (CDC). Botulism Annual Summary, 2018. Atlanta: U.S. Department of Health and Human Services, CDC; 2021.

[22] Centers for Disease Control and Prevention (CDC). Botulism Annual Summary, 2018. Atlanta: U.S. Department of Health and Human Services, CDC, 2021.

[23] Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021;70(2):1–30. doi: 10.15585/mmwr.rr7002a1

[24] Rao A.K., Sobel J., Chatham-Stephens K., Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 // MMWR Recomm Rep. 2021. Vol. 70, N 2. P. 1–30. doi: 10.15585/mmwr.rr7002a1

RIGHTS & PERMISSIONS

Eco-vector