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.
Subject(s)
Botulism/mortality , Botulism/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Botulism/complications , Botulism/transmission , Child , Child, Preschool , Dyspnea/etiology , Dyspnea/mortality , Female , Food Microbiology , Georgia (Republic)/epidemiology , Humans , Infant , Male , Middle Aged , Odds Ratio , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Foodborne botulism is a potentially fatal, paralytic illness that can cause large outbreaks. A possible increase in botulism incidence during 2001 in the Republic of Georgia prompted this study. We reviewed surveillance data and abstracted records of patients with botulism who were hospitalized from 1980 to 2002. During this period, 879 botulism cases were detected. The median annual incidence increased from 0.3 per 100,000 during 1980 to 1990 to 0.9 per 100,000 during 1991 to 2002. For 706 botulism patients hospitalized from 1980 to 2002, 80% of their cases were attributed to home-preserved vegetables. Surveillance evaluation verified that botulism incidence varied greatly by region. Georgia has the highest nationally reported rate of foodborne botulism in the world. A strategy addressing individual behaviors in the home is needed to improve food safety; developing this strategy requires a deeper understanding of why botulism has increased and varies by region.