0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Botulism from Chopped Garlic: Delayed Recognition of a Major Outbreak

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.; and PAUL A. BLAKE, M.D., M.P.H.
[+] Article and Author Information

▸Requests for reprints should be addressed to Michael St. Louis, M.D.; CID:DBD:EDB 1-5428, Centers for Disease Control, Atlanta, GA 30333.


Atlanta, Georgia; Vancouver and Victoria, British Columbia; and Ottawa, Ontario


Ann Intern Med. 1988;108(3):363-368. doi:10.7326/0003-4819-108-3-363
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)