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

Abstract

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 30.715.2 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 1.11.8 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