Outbreak of Botulism Due to Illicit Prison-Brewed Alcohol: Public Health Response to a Serious and Recurrent Problem

Rao, Agam K.; Walters, Maroya; Hall, Julia; Guymon, Colleen; Garden, Richard; Sturdy, Pauline; Thurston, Diana; Smith, Lori; Dimond, Melissa; Vitek, Dagmar; Bogdanow, Linda; Hill, Mary; Lin, Neng-Yu; Lúquez, Carolina; Griffin, Patricia M.

doi:10.1093/cid/cix936

Cited by 13 publications

(8 citation statements)

References 16 publications

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“…The pediatric and pregnancy systematic reviews included non-English-language articles that were professionally translated; the other systematic reviews included only English-language articles. The six systematic reviews were published, along with nine other manuscripts on various botulism topics, including clinical characteristics and ancillary test results among patients with botulism and clinical criteria to trigger suspicion for botulism, that also informed these guidelines (13,26,(32)(33)(34)(35)(36)(37)(38). In addition, an analysis of detailed abstractions of medical records from 99 hospitalized patients with laboratory-confirmed botulism provided data on presence and progression of signs and symptoms (CDC, unpublished data, 2016).…”

Section: Methodsmentioning

confidence: 99%

“…The reasons for initial failure to diagnose botulism in subsequently confirmed cases has been investigated most productively in outbreaks, in which cases initially misdiagnosed were eventually identified by outbreak investigators. Outbreak investigations in which some botulism cases were only identified after the patients had been discharged with alternative diagnoses highlight the potential for delayed or missed diagnoses (35,38) (CDC, unpublished data, 2016). The critical initial treatment and management decisions for patients with suspected botulism must be made based on clinical findings.…”

Section: Challenges In the Diagnosis Of Botulismmentioning

confidence: 99%

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Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021

et al. 2021

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Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.

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Section: Methodsmentioning

confidence: 99%

Section: Challenges In the Diagnosis Of Botulismmentioning

confidence: 99%

Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021

et al. 2021

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“…Most alcohol-associated deaths result from the behavioral or long-term consequence of excessive alcohol ingestion (e.g., accidents, suicides, and medical complications). In addition, drugs are possibly easier to smuggle into jails than alcohol although "prison wine," also called "pruno," is sometimes illicitly produced in jails and prisons (Rao et al, 2017). Second, opioids accounted for a minority of drug-associated deaths.…”

Section: Discussionmentioning

confidence: 99%

Drug- and Alcohol-Associated Deaths in U.S. Jails

Fiscella

Noonan

Leonard

et al. 2020

Journal of Correctional Health Care

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Drugs and alcohol are the third leading cause of death in U.S. jails. We analyzed 2000 to 2013 national jail mortality data by coding text data. We identified 1,442 deaths associated with drugs and alcohol. Drug-associated deaths were more than double alcohol-associated deaths during 2009 to 2013 when drug type was available for drug-associated mortality. Only 18% of deaths within 7 days of arrest for alcohol intoxication were officially coded as involving drugs/alcohol intoxication. Among the 103 deaths associated with substance withdrawal, 66 involved alcohol, 21 involved drugs (primarily opioids), and 16 could not be determined. Drugs and alcohol likely contribute to more deaths in jails than has been recognized due to how deaths are coded. Alcohol and opioid withdrawal represent a small but underappreciated contributor to jail deaths.

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“…In this supplement, several articles examine clinical presentation [17][18][19][20], and we offer a diagnostic aid for clinicians based on presenting symptoms and patient age [21]. Two reports highlight diagnostic challenges in an outbreak setting [3,22].…”

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confidence: 99%

“…In a mass event, many worried asymptomatic persons and those with symptoms that might be due to botulism may seek care. Triaging patients to quickly identify those in danger of respiratory failure and to reassure others will present challenges; this was apparent even in an outbreak with 8 cases [22]. An antitoxin shortage, even if temporary, will compel clinicians to prioritize some patients for treatment.…”

mentioning

confidence: 99%