Health officials probe more botulism cases

Aug 2, 2007 (CIDRAP News) – Since the US Food and Drug Administration (FDA) warned of a link between four botulism cases and contaminated chili sauce 2 weeks ago, state health departments have confirmed one additional botulism case and reported at least three more suspected cases.

The initial recall, issued Jul 19, involved canned hot-dog chili sauce made at a Castleberry Foods production facility in Augusta, Ga. A few days later the recall was expanded to more than 80 of the company's products, which included chili, hash, barbecue meat products, and a few pet food products.

The four previous patients included two Texas children and an Indiana couple. In a Jul 30 early-release article in Morbidity and Mortality Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) said the children, who are siblings, were hospitalized on Jun 29 and received botulinum antitoxin on Jul 7. Initial stool cultures did not reveal the pathogen, and stool and serum cultures taken 9 days after symptom onset were negative for botulinum toxin. Both are still hospitalized, andone is still on mechanical ventilation.

The Indiana couple became ill Jul 7 and were hospitalized 2 days later, the MMWR report said. In view of their shared symptoms, they received botulinum antitoxin on Jul 11.The man's serum sample tested positive for botulinum toxin type A. The woman's serum sample was also positive, but the scant volume didn't allow the laboratory to determine the toxin type. Samples from leftover chili sauce also tested positive for botulinum toxin type A. The patients remained hospitalized and on mechanical ventilation.

Botulinum toxin is a nerve poison produced by Clostridium botulinum, a bacterium commonly found in soil. Botulism symptoms include double or blurred vision, droopy eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness, according to the CDC. If untreated, the illness can progress to paralysis of the limbs, trunk, and breathing muscles.

Mark Horton, director of the California Department of Public Health (CDPH), said tests confirmed that a 51-year-old San Diego woman has botulism poisoning, according to a Jul 27 CDPH press release. State health authorities were investigating whether her illness was linked to the contaminated products. The woman reported buying and eating one of the recalled products, Kroger Chili with Beans, in early July, the CDPH said. However, she threw the product away before it could be tested.

She had been hospitalized but was recovering at home, the CDPH reported.

On Jul 27 the Hawaii Department of Health (HDH) said it was investigating a possible case of botulism poisoning on Maui, according a press release. The department said the patient met some of the clinical criteria for botulism and was being treated pending laboratory confirmation.

"The DOH has consulted with the Centers for Disease Control and Prevention (CDC), and although the case has not been confirmed as botulism poisoning, we are taking every precaution," said HDH Director Chiyome Fukino, MD.

In addition, Indiana television station WISH reported Jul 31 that a Logansport resident was hospitalized with suspected botulism poisoning. Doctors at Logansport Memorial Hospital had noticed the patient had some botulism symptoms, though it was not clear if the patient had consumed any of the recalled products.

The TV station reported that the CDC provided botulism antitoxin for the patient and that Indiana state police delivered it to the hospital.

Elsewhere, state officials in New Mexico said yesterday that a 52-year-old man from Sandoval County was paralyzed with botulism poisoning, the Associated Press (AP) reported today. Officials were trying to determine if he ate food included in the national recall, the report said.

Deboarah Busemeyer, a spokeswoman for the New Mexico Department of Health, told the AP that the man was hospitalized on Jul 26, was in serious condition, and could only wiggle his toes. She said preliminary tests, reported by the CDC, pointed to botulism, the AP reported.

In other developments, a Wisconsin company yesterday recalled cans of its French-style green beans after routine monitoring revealed a possible production problem. Lakeside Foods, based in Manitowoc, said in a press release that no illnesses had been reported and that no botulism toxin had been found in any of the product tests, which were ongoing.

The recall involves 14.5-ounce cans of the green beans, which are sold under about 17 different store brands in 20 states and Canada.

See also:

Jul 30 MMWR article on botulism cases

Jul 27 Hawaii Department of Health press release

Jul 31 New Mexico Department of Health press release
http://www.health.state.nm.us/pdf/botulism.pdf

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