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, et al. Botulism from Chopped Garlic: Delayed Recognition of a Major Outbreak. Ann Intern Med. 1988;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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