Epidemiologic Notes and Reports Botulism from Fresh
Foods -- California
In August 1984, three cases of botulism were reported in
California from two episodes in which the ill persons had eaten
improperly handled food made from fresh ingredients.
Episode 1: Botulism was reported in a 61-year-old Santa Cruz
County woman and her 13-year-old granddaughter. The older woman
had
classic symptoms of bilateral ptosis, diplopia, and facial
weakness;
the granddaughter was less ill. Food histories revealed no recent
exposures to home-canned food, but improper food handling was
identified as the likely cause of illness. Three days before
onset,
the grandmother prepared two turkey loaves that included cereal,
onion, and green pepper. One loaf was consumed without incident
immediately after cooking. The other was inadvertently stored in
the
gas oven with the pilot light on (later measured at 32.2 C (90 F)),
until the grandmother discovered it the next afternoon. She tasted
a
small portion before reheating it at approximately 150 C (300 F)
for
approximately 20 minutes and served the turkey loaf to the three
other
members of her household. Thirty-six hours later, she awoke with
ptosis, diplopia, and facial weakness. Of the others who ate the
rewarmed loaf, only the granddaughter developed symptoms. When
questioned, she could not recall tasting the turkey loaf with her
grandmother before reheating, but did recall eating a portion from
the
center of the loaf. Type A botulinal toxin was detected in the
sera
of both patients. Trivalent botulinum antitoxin was administered,
and
both recovered completely. Since the turkey loaves were completely
consumed, confirmatory tests on the suspected vehicle were not
possible.
Episode 2: A 22-year-old Orange County man awoke at 2 a.m.
with
vomiting, blurred vision, and a "thick tongue." Symptoms
progressed
to total quadriplegia, then respiratory failure requiring
mechanical
ventilation. Forty hours before onset, he had consumed stew
prepared
by his roommate from fresh ingredients (including meat and unpeeled
potatoes and carrots), then left overnight at room temperature.
The
stew was cooked in a 7-inch deep pot filled to the top and simmered
for 45 minutes; the gas was then turned off and the pot left on the
range. The roommate ate it hot after the initial cooking, without
incident. The patient tasted it without reheating 16 hours later
and
complained of a bad taste. The roommate confirmed a sour taste,
immediately spit it out, rinsed his mouth, and remained well. The
stew was then discarded and could not be tested. Type A botulinal
toxin was detected in the patient's serum; he was treated with
botulinal antitoxin and recovered after extended hospitalization.
Adapted from California Morbidity (February 1, 1985 (4)), as
reported
by D Corzine, MD, Capitola, M Stroe, MD, Santa Cruz County Health
Dept, CS Kim, MD, J Lysiak, MD, L Spurgeon, MD, J Wallace, MD, M
Gallagher, Anaheim, T Prendergast, MD, Orange County Health Dept,
SB
Werner, MD, California Dept of Health Svcs; Enteric Diseases Br,
Div
of Bacterial Diseases, Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: Because spores of Clostridium botulinum are
ubiquitous in soil, they can contaminate fresh foods, particularly
those harvested from the ground. The spores are quite heat
resistant
and can survive boiling for several hours. For spores to germinate
and produce toxin, several conditions must be met, including
appropriate temperature and pH and oxygen contents. Foodborne
botulism generally results from home-canned vegetables that are
contaminated with spores and are improperly prepared, thereby
allowing
the production of botulinal toxin. Toxin can also be elaborated in
foods that are initially cooked, then held at ambient temperatures
for
at least 16 hours. The cases presented here are not unique, since
the
same mechanism of toxin production appears to have accounted for
previous episodes of botulism from commercial pot pies, sauteed
onions, and, in one instance, a baked potato (1-4). These foods
were
cooked, allowed to stand at ambient temperatures, and consumed
later
without reheating. Foods heated for serving should either be eaten
hot or refrigerated and later reheated thoroughly (since the toxin
is
heat labile) before re-serving.
References
California Department of Health Services. Botulism and
commercial
pot pie. California Morbidity, November 12, 1982 (44).
California Department of Health Services. Type A botulism
associated with commercial pot pie. California Morbidity,
December 30, 1976 (51).
MacDonald KL, Spengler RF, Hatheway CL, Hargrett NT, Cohen ML.
Type A botulism from sauteed onions. Clinical and
epidemiologic
observations. JAMA 1985;253:1275-8.
Louisiana Department of Health and Human Resources.
Unpublished
data.
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