Abstract
Botulism is a potentially life-threatening disease caused by toxins produced by Clostridium botulinum. Here we reported a case series of six patients who presented with botulism following ingestion of commercially made pâté. The key features of presentation were acute onset of bilateral cranial nerve palsies and symmetrical descending weakness in the absence of fever resulting in the need for mechanical ventilation in all six patients. The clinical diagnosis of botulism was confirmed through the identification of C. botulinum from the suspected food source. Given that botulinum antitoxin was not available in Vietnam at the time, and their severe status, all patients received a trial of plasma exchange therapy, but no clear benefit was seen. Due to its rarity, diagnosing botulism is a challenge, demanding high clinical suspicion. Successful outcomes depend upon early recognition and rapid initiation of specific treatment with botulinum antitoxin. There is a need to improve global access to antitoxin. These cases, the first in Viet Nam, serve as a reminder of the need to maintain the highest possible food hygiene and preservation practices.
Highlights
Botulism is a potentially life-threatening disease caused by toxins produced by Clostridium botulinum
These patients had similar clinical manifestations to the six reported here, and had eaten the same brand of vegetarian pâté as our patients. In two of these seven cases, Clostridium botulinum was detected in both clinical samples and pâté. None of these additional cases received botulinum antitoxin until the beginning of September when this was kindly provided by the World Health Organization
The antitoxin was administered after at least 4 weeks of Botulism is caused by C. botulinum through the action of botulinum neurotoxins (BoNTs)
Summary
We report six patients who presented to our hospital with symptoms suggestive of botulism following consumption of a commercially produced vegetarian pâté. The cases had no social link to cases 1 and 2 and lived approximately 400 kilometers from them They gave a history of gastrointestinal symptoms (nausea, vomiting and abdominal pain) followed by the development over the 2 days of neurological deficits including dysarthria, bilateral ptosis, difficulty in breathing and limb weakness (strength 2-3/5 Medical Research Council grade). The last case was a 54-year-old Vietnamese salesman who presented to our department in August approximately 3 weeks after the first 5 cases He gave a history of dizziness, nausea, vomiting and abdominal pain which occurred 24 hours after eating the same brand of vegetarian pâté.
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