Signs and Symptoms Predictive of Death in Patients with Foodborne Botulism--Republic of Georgia, 1980-2002

Abstract

Foodborne botulism is a severe, potentially fatal disease characterized by cranial nerve palsies and descending paralysis. Little is known about signs and symptoms predictive of death from botulism. We studied patients with botulism in the Republic of Georgia, which has the highest reported rate of foodborne botulism in the world. After abstracting medical records of patients with botulism who were hospitalized during 1980-2002, we performed classification-and-regression-tree analysis to identify clinical syndromes predictive of survival and death. We identified records for 706 patients hospitalized for foodborne botulism from 1980-2002. Trivalent antitoxin was administered to 623 patients (88%). Fifty-four (8%) died. Patients with shortness of breath and impaired gag reflex and without diarrhea were 23 times more likely to die than were patients without this syndrome. Validating this clinical prediction rule may help reduce mortality from botulism in Georgia. Validation in other settings could help public health preparations for large outbreaks of naturally occurring or bioterrorism-related botulism.

Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia

“…Second, no standard case definition for botulism has been used in Georgia, and misclassification was possible. However, a previous study found that clinical diagnoses of botulism in Georgia were generally valid [8], most patients in our study reported having had characteristic symptoms during acute illness, and almost all patients reported having consumed high-risk foods before illness onset. Thus, we believe misclassification was unlikely.…”

“…A patient was defined as a Georgia resident who had received a clinical diagnosis of botulism that was reported to the national surveillance system during 1998-2003 and who had lived for at least 6 months after the onset of illness. Although there is no formal case definition used by all clinicians in Georgia, a previous surveillance system evaluation, with in-depth chart review of 1700 Georgian botulism cases, found that reported cases had characteristic presentations [8]. Diagnostic testing for botulinum toxin, using standard mouse bioassay, became available in Georgia only in late 2001 [9].…”

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“…The most common positive findings on examination are ophthalmoplegia (79%), ptosis (76%), and slurred speech (58%). 7 Other manifestations such as bulbar involvement, nasality of voice, hoarseness, dysarthria, and dysphagia follow in quick succession. These, in turn, are followed by the progressive weakness of the muscles of the face, neck, trunk, and limbs as well as by respiratory insufficiency.…”

Botulism Outbreak in a Family after Ingestion of Locally Produced Cheese

“…As a rule, blurred vision and diplopia are the initial neural symptoms. The most common positive findings on examination are ophthalmoplegia (79%), ptosis (76%), and slurred speech (58%) [7]. Other manifestations such as bulbar involvement, nasality of voice, hoarseness, dysarthria, and dysphagia follow in quick succession.…”