MICHAEL E. ST. LOUIS, M.D.; SHAUN H.S. PECK, M.B., F.R.C.P.; DAVID BOWERING, M.D.; G. BARRY MORGAN, B.S.A.; JOHN BLATHERWICK, M.D., F.R.C.P.; SATYEN BANERJEE, Ph.D.; G.D.M. KETTYLS, M.D. F.R.C.P.; W.A. BLACK, M.D. F.R.C.P.; MAY E. MILLING, M.S.A.; ANDRE H.W. HAUSCHILD, Ph.D.; ROBERT V. TAUXE, M.D.; PAUL A. BLAKE, M.D., M.P.H.
Diagnosis of botulism in two teenaged sisters in Montreal led to the identification of 36 previously unrecognized cases of type B botulism in persons who had eaten at a restaurant in Vancouver, British Columbia, during the preceding 6 weeks. A case-control study implicated a new vehicle for botulism, commercial chopped garlic in soybean oil (P < 10-4). Relatively mild and slowly progressive illness, dispersion of patients over at least eight provinces and states in three countries, and a previously unsuspected vehicle had contributed to prolonged misdiagnoses, including myasthenia gravis (six patients), psychiatric disorders (four), stroke (three), and others. Ethnic background influenced severity of illness: 60% of Chinese patients but only 4% of others needed mechanical ventilation (P < 10-3). Trypsinization of serum was needed to show toxemia in one patient. Electromyography results with high-frequency repetitive stimulation corroborated the diagnosis of botulism up to 2 months after onset. Although botulism is a life-threatening disease, misdiagnosis may be common and large outbreaks can escape recognition completely.
ST. LOUIS ME, PECK SH, BOWERING D, MORGAN GB, BLATHERWICK J, BANERJEE S, et al. Botulism from Chopped Garlic: Delayed Recognition of a Major Outbreak. Ann Intern Med. ;108:363–368. doi: 10.7326/0003-4819-108-3-363
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Published: Ann Intern Med. 1988;108(3):363-368.
Emergency Medicine, Infectious Disease, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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