Clinical and electrophysiological features of foodborne botulism: a retrospective case series

BACKGROUND: Foodborne botulism is a rare but potentially serious and lethal disease that is considered a threat to public health systems across the globe. Botulism is a paralytic disorder caused by the neurotoxin, produced by Clostridium botulinum, which acts upon peripheral cholinergic nerve terminals by inhibiting acetylcholine release, subsequently causing denervation to muscle fibers. CASE SERIES: In April 2024, an outbreak of foodborne botulism was reported in Riyadh, Saudi Arabia, following consumption of contaminated fast food. Four patients were affected: two females and two males, aged 14 to 21 years. All patients developed neurological symptoms, including cranial nerve involvement, dysphagia, and generalized weakness. Three patients progressed to severe hypercapnic respiratory failure requiring prolonged mechanical ventilation. Electrophysiological studies demonstrated characteristic findings of presynaptic neuromuscular junction dysfunction. CONCLUSIONS: This case series adds to existing knowledge by providing detailed descriptions of the clinical course, neurological examination findings, and electrodiagnostic features of foodborne botulism cases in Saudi Arabia. Our findings highlight that, despite early antitoxin administration, patients can develop prolonged neuromuscular weakness requiring extended mechanical ventilation. This underscores the importance of considering botulism in the differential diagnosis of acute flaccid paralysis and the need for timely electrophysiological evaluation to guide management and prognosis.

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