Timeliness and Diagnostic Yield of Suspected Botulism Notifications in a Tertiary Medical Center in Taiwan, 2014-2024

Botulism is a rare but high-consequence foodborne intoxication in which early recognition and prompt reporting are essential for a timely public health response. We conducted a retrospective review of suspected botulism notifications reported through the hospital notifiable-disease system at National Taiwan University Hospital from 2014 to 2024. Demographics, presenting features, time from hospital presentation to notification, specimen types, and reference laboratory results were summarized, and the institutional response workflow was described as the operational context. Between 2014 and 2024, six suspected Clostridium botulinum cases were reported to the Taiwan Centers for Disease Control (Taiwan CDC). The mean age was 49.8 ± 30.9 years, and most patients were female (5/6). Presentations were heterogeneous, with three cases featuring primarily ocular symptoms and three featuring limb weakness. The median interval from hospital presentation to notification was 6.0 days (IQR, 2.25-10.5 days). Notifications originated from general wards (5/6) and the intensive care unit (1/6). Specimens submitted for testing included stool, vomitus, and/or serum; all samples tested negative for botulinum toxin. Final diagnoses included ophthalmoplegia, Guillain-Barré syndrome, Miller Fisher syndrome, diabetic polyneuropathy, encephalitis, and systemic toxic/metabolic disorder. Although confirmed botulism was not identified, suspected notifications activated the institutional response pathway and highlighted the importance of clinician recognition and timely reporting. Routine assessment of TOCC (travel, occupation, contact, and cluster) history together with dietary exposure and compatible neurologic features may improve early suspicion and enhance the public health value of hospital-based surveillance for botulism.