A survey on 80 cases of botulism and its clinical presentations as a public health concern

Background: Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulinum toxin is regarded as the most lethal ever-known substance. The diagnosis in sporadic cases and even in small outbreaks is the main physicians’ challenge. The aim of this study was to assess clinical presentations of 80 cases of botulism referred to Loghman Hakim hospital in Tehran. Materials and methods: A total of 80 botulism cases referred during a 10-year period (1996-2006) were included. The diagnosis of botulism was verified on epidemiological data and a clinical score of severity. Patients were assigned in 3 groups: mild, intermediate and severe. Results: The study population included 40 males and 40 females with a mean age of 30.7±15.2 years (a range, 1-66 years). The suspected causative foods were cheese in 25 (31%), and sea-food in 20 (25%). The mean incubation period was 1.1±1.8 days (a range, 4 hours-10 days). Nausea and vomiting was noted as the first symptom in 17 cases. Diagnosis was confirmed in 47 patients (58.8%). The most common toxin subgroups were A (in 22 cases) and E (in 15 cases). All the patients were treated with antitoxin and recovered without sequel, however, 6 patients were admitted to intensive care unit (ICU) and required ventilatory support. Only one patient (1.3%) died. Conclusion: The mainstays of therapy are meticulous intensive care (including mechanical ventilation, when necessary) and promptly treatment with antitoxin. Antitoxin should be given early in the course of illness, ideally < 24 hours after onset of symptoms.