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Botulism from chopped garlic: delayed recognition of a major outbreak
M E St Louis1, S H Peck, D Bowering
1Enteric Diseases Branch, Centers for Disease Control, Atlanta, Georgia.
Annals of Internal Medicine
|March 1, 1988
Summary
A restaurant outbreak revealed 36 cases of type B botulism linked to commercial chopped garlic in soybean oil. This foodborne illness caused misdiagnoses, with ethnic background affecting illness severity.
Area of Science:
- Foodborne illness
- Neurotoxicology
- Epidemiology
Background:
- Botulism is a rare but severe neuroparalytic illness caused by botulinum toxin.
- Outbreaks can be challenging to detect due to varied symptoms and incubation periods.
Purpose of the Study:
- To identify the source and characteristics of an unrecognized outbreak of type B botulism.
- To investigate the role of a specific food vehicle in the outbreak.
Main Methods:
- Case-control study to identify risk factors.
- Clinical case review and diagnostic testing (serum trypsinization, electromyography).
Main Results:
- Identified 36 cases of type B botulism linked to commercial chopped garlic in soybean oil.
- Misdiagnoses were common, including myasthenia gravis and stroke.
- Chinese patients experienced more severe illness, requiring mechanical ventilation more frequently.
Conclusions:
- Commercial chopped garlic in soybean oil can be a vehicle for botulism outbreaks.
- Botulism outbreaks may go unrecognized due to mild symptoms, varied presentation, and unusual vehicles.
- Prompt diagnosis and identification of the food source are crucial for outbreak control.
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