RESUMEN
INTRODUCTION: Botulism is a rare presynaptic neuromuscular junction disorder caused by potent toxins produced by the anaerobic, spore-forming, Gram-positive bacterium Clostridium botulinum. Food-borne botulism is caused by the ingestion of foods contaminated with botulinum toxin. In March 2006, there was a large outbreak of food-borne botulism associated with the ingestion of home-canned bamboo shoots in Thailand. The survival analyses for respiratory failure in these patients were studied and are reported here. METHODS: A prospective observational cohort study was conducted on this outbreak. The primary outcome of interest was the time to respiratory failure. The secondary outcome was the time to weaning off ventilator. The prognostic factors associated with respiratory failure and weaning off ventilator are presented. RESULTS: A total of 91 in-patients with baseline clinical characteristics were included. Most cases first presented with gastrointestinal symptoms followed by neurological symptoms, the most striking of which being difficulty in swallowing. Common clinical features included ptosis, ophthalmoplegia, proximal muscle weakness, pupillary abnormality, and respiratory failure. Forty-two patients developed respiratory failure requiring mechanical ventilation and the median duration on ventilator was 14 days. The median length of hospital stay for all patients was 13.5 days. Difficulty in breathing, moderate to severe ptosis, and dilated and fixed pupils were associated with respiratory failure. Among patients who were on ventilators, a short incubation period and pupillary abnormality were associated with a longer period of mechanical ventilation. All patients had antitoxin injection and there was no mortality in this outbreak. CONCLUSION: The history of difficult breathing and the findings of moderate to severe ptosis and pupillary abnormality were associated with severe illness and respiratory failure. A long incubation time was associated with a better prognosis. Although botulism is a potentially fatal disease, there was no mortality in this outbreak. All patients had antitoxin injection and good intensive care that resulted in good clinical outcomes.
Asunto(s)
Bambusa/microbiología , Botulismo/mortalidad , Clostridium botulinum/aislamiento & purificación , Microbiología de Alimentos , Insuficiencia Respiratoria/mortalidad , Adolescente , Adulto , Anciano , Botulismo/fisiopatología , Estudios de Cohortes , Brotes de Enfermedades , Femenino , Embalaje de Alimentos , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Prospectivos , Insuficiencia Respiratoria/etiología , Análisis de Supervivencia , Tailandia/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: An electrophysiological study can help to confirm the diagnosis of botulism. This study was aimed at validating a simple and reliable electrodiagnostic test and at correlating the findings with clinical severity. METHODS: Pre- and post-exercise single supramaximal stimulations (SSSs) were performed in 63 patients with botulism. The sensitivity and specificity of amplitude of compound muscle action potential (CMAP) and percentage increment (PI) of SSS were determined. These two parameters were then correlated with respiratory failure. The relationship between the amplitude of CMAP and PI was also studied. RESULTS: SSS with a PI of 25% showed a sensitivity of 95.2% and a specificity of 100% in association with botulism. The area under the receiver operating characteristic (ROC) curve of CMAP and PI was associated with the respiratory failure by 0.7 and 0.6, respectively. An inverse relationship between the amplitude of CMAP and PI was also demonstrated. CONCLUSIONS: SSS is sensitive and specific in the diagnosis of botulism. There was some correlation of the findings with clinical severity. The inverse relationship between the amplitude of CMAP and PI reflects the pathophysiology of this disorder. SIGNIFICANCE: This study has validated SSS as being a simple and reliable electrodiagnostic test for botulism.
Asunto(s)
Potenciales de Acción/fisiología , Botulismo/diagnóstico , Botulismo/fisiopatología , Electrodiagnóstico/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Electromiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Curva ROC , Reproducibilidad de los Resultados , Insuficiencia Respiratoria/fisiopatología , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
We conducted a clinical study of 137 patients with home-canned bamboo shoot botulism at Nan Hospital, northern Thailand. The median age of the patients was 44 years (range = 14-74 years) and 36.2% were male. The median incubation period was 2 days (range = 1-8 days). Forty-three patients (31.4%) developed respiratory failure, but there were no deaths. Patients who did not have either nausea or vomiting and did not have urinary retention that required Foley catheterization was less likely to develop respiratory failure. This clinical predictor rule had a sensitivity of 75.5% and a specificity of 90.7%. The clinical syndrome most predictive of respiratory failure was nausea or vomiting and any cranial neuropathy with urinary retention or difficulty swallowing. This clinical syndrome had a sensitivity of 69.8% and a specificity of 93.6%. These clinical characteristics could help triage large numbers of patient in the event of a future outbreak.