Investigation of the Frequency of Foodborne Botulism in Patients Referred to Loghman Hospital in Tehran City, Iran, From 2008 to 2019
International Journal of Medical Toxicology and Forensic Medicine,
Vol. 10 No. 2 (2020),
21 June 2020
Background: Foodborne botulism is a fatal paralytic illness caused mainly by the neurotoxin produced by an anaerobic bacterium called Clostridium botulinum. In this study, the frequency of foodborne botulism in patients referred to a hospital in Iran has been reviewed for ten years.
Methods: In this routine database study, medical records of patients with foodborne botulism referred to Loghman Hospital in Tehran City, Iran, from March 20, 2008, to March 20, 2019, were reviewed. Information on variables of age, sex, place of residence, food consumed, clinical symptoms of patients (such as dysphagia, nausea, vomiting, ataxia, etc.), toxin type, and length of hospitalization were collected with a researcher-made questionnaire. Finally, the collected data were analyzed in SPSS-24 with descriptive and analytical statistical tests.
Results: In this study, 61 suspected botulism patients were clinically diagnosed in Loghman Hospital, of whom 55 patients were clinically suspected of foodborne botulism, 5 patients had iatrogenic botulism, and 1 patient had infant botulism. Of these 55 patients with the clinical diagnosis of foodborne botulism, 19 patients were confirmed by laboratory examinations, and 2 patients died. Sixteen patients confirmed by laboratory had neurotoxin botulinum type A. The mean age of the patients was 36.9 years with a standard deviation of 18.6 years. About 54.5% of the patients were male and 45.5% female. Weaknesses (58.2%), ptosis (droopy eyelid) (56.4%), and diplopia (double vision) (52.7%) were the common clinical symptoms of the patients under study. Canned foods and dairy products were the main foods consumed by the patients. The duration of admission time ranged between 1 and 41 days, with an average of 7.7 days. About 23.64% of patients were admitted to the intensive care unit.
Conclusion: The prevalence of foodborne botulism is rare compared with other food poisonings but is still a major public health problem due to the consumption of traditional food products and unboiled canned foods in Iran.
- Food poisoning
How to Cite
Lindstrom M, Kiviniemi K, Korkeala H. Hazard and control of group II (non-proteolytic) Clostridium botulinum in modern food processing. Int J Food Microbiol. 2006; 108(1):92-104. [DOI:10.1016/j.ijfoodmicro.2005.11.003] [PMID]
Espelund M, Klaveness D. Botulism outbreaks in natural environments - an update. Front Microbiol. 2014; 5:287. [DOI:10.3389/fmicb.2014.00287] [PMID] [PMCID]
Forss N, Ramstad R, Bäcklund T, Lindström M, Kolho E. Difficulties in diagnosing food-borne botulism. Case Rep Neurol. 2012; 4(2):113-5. [DOI:10.1159/000339736] [PMID] [PMCID]
Peck MW. Clostridium botulinum and the safety of minimally heated, chilled foods: An emerging issue? J appl Microbiol. 2006; 101(3):556-70. [DOI:10.1111/j.1365-2672.2006.02987.x] [PMID]
Poulain B, Popoff MR. Why are botulinum neurotoxin-producing bacteria so diverse and botulinum neurotoxins so toxic? Toxins (Basel). 2019; 11(1). pii: E34. [DOI:10.3390/toxins11010034] [PMID] [PMCID]
Horowitz BZ. Type E botulism. Clin Toxicol Phila. 2010; 48(9):880-95. [DOI:10.3109/15563650.2010.526943] [PMID]
Rafie S, Salmanzadeh S, Mehramiri A, Nejati A. Botulism outbreak in a family after ingestion of locally produced cheese. Iran J Med Sci. 2017; 42(2):201-4. https://www.ncbi.nlm.nih.gov/pubmed/28360447
Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: A clinical and epidemiologic review. Ann Intern Med. 1998; 129(3):221-8. [DOI:10.7326/0003-4819-129-3-199808010-00011] [PMID]
Proverbio MR, Lamba M, Rossi A, Siani P. Early diagnosis and treatment in a child with foodborne botulism. Anaerobe. 2016; 39:189-92. [DOI:10.1016/j.anaerobe.2015.12.002] [PMID]
Shrivastava SR, Shrivastava PS, Ramasamy J. Preventing the outbreaks of foodborne botulism and minimizing the risk of fatality. Ann Trop Med PH. 2017; 10(5):1360-1. [DOI:10.4103/1755-6783.196826]
Montazer Khorasan MR, Rahbar M, Zahedi Bialvaei A, Gouya MM, Shahcheraghi F, Eshrati B. National surveillance of foodborne botulism in Iran during 2011-2015. Rev Med Microbiol. 2020; 31(1):42-6. https://journals.lww.com/revmedmicrobiol/Citation/2020/01000/National_surveillance_of_food_borne_botulism_in.5.aspx
Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR Jr, Gangarosa EJ. Clinical features of types A and B foodborne botulism. Ann Intern Med. 1981; 95(4):442-5. [DOI:10.7326/0003-4819-95-4-442] [PMID]
Botulism in the United States, 1899-1996: Handbook for epidemiologists, clinicians, and laboratory workers. Centers for Disease Control and Prevention. Atlanta, Ga: 1998. https://stacks.cdc.gov/view/cdc/6673/
Hauschild A, Gauvreau L. Food-borne botulism in Canada, 1971-84. Can Med Assoc J. 1985; 133(11):1141-6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1346371/
Shahcheraghi F, Nobari S, Vahdani P, Majdian J, Aslani MM. [Type A botulism in members of a family following the consumption of locally made cheese (Persian)]. J Mazand Univ Med Sci. 2013; 22(96):124-9. https://www.magiran.com/paper/1233080/?lang=en
Nejadrahim R, Delirrad M. Foodborne Botulism: A study of 57 cases in Northwest Iran. Iran J Toxicol. 2016; 10(6):45-50. [DOI:10.29252/arakmu.10.6.45]
Pourshafie MR, Saifie M, Shafiee A, Vahdani P, Aslani M, Salemian J. An outbreak of foodborne botulism associated with contaminated locally made cheese in Iran. Scand J Infect Dis. 1998; 30(1):92-4. [DOI:10.1080/003655498750002385] [PMID]
Nobari S, Aslani M, Masoumi-Asl H, Vahdani P, Shouraj F, Shahcheraghi F. [Botulism in Iran, 2004-2010 (Persian)]. Paper presented at: 20th Iranian Congress of Infec-tious Diseases and Tropical Medicine. 2011; Tehran, Iran.
Habibiyan Nejad Z, Afshari R. Foodborne Botulism in Mashhad from 2003 to 2010. J Clinic Toxicol. 2011; 1(3):1-4. https://www.longdom.org/abstract/foodborne-botulism-in-mashhad-from-2003-to-2010-47971.html
Sandrock CE, Murin S. Clinical predictors of respiratory failure and long-term outcome in black tar heroin-associated wound botulism. Chest. 2001; 120(2):562-6. [DOI:10.1378/chest.120.2.562] [PMID]
Sharma SK, Whiting RC. Methods for detection of Clostridium botulinum toxin in foods. J Food Prot. 2005; 68(6):1256-63. [DOI:10.4315/0362-028X-68.6.1256] [PMID]
Sobel J. Botulism. Clin Infect Dis 2005; 41(8):1167-73. [DOI:10.1086/444507] [PMID]
Anniballi F, Lonati D, Fiore A, Auricchio B, De Medici D, Locatelli CA. New targets in the search for preventive and therapeutic agents for botulism. Expert Rev Anti In-fect Ther. 2014; 12(9):1075-86. [DOI:10.1586/14787210.2014.945917] [PMID]
- Abstract Viewed: 11 times
- PDF Downloaded: 4 times