Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia

Abstract

The acute paralytic syndrome of botulism has been well-described; however, little is known about its long-term consequences. We conducted a case-control study in the Republic of Georgia to evaluate the health of patients > or =6 months after they had experienced an episode of botulism. Case patients were selected on the basis of who had had a clinical diagnosis of foodborne botulism reported to the national surveillance system from 1998 through 2003. Three control subjects were randomly selected from each patient's community. We located 217 patients who had had botulism from surveillance records, with a median time since onset of illness of 4.3 years. The median age was 37 years, and 49% of the patients were female, similar to the control subjects. Most of the patients (68%) had acquired botulism from home-conserved vegetables (probably containing toxin type B), 15% had been hospitalized for >1 month, and 25% had required mechanical ventilation. Six patients died. Of the remaining 211 patients, 68% reported having worse health at the time of the interview than 6 years before the interview, compared with 17% of 656 control subjects (matched odds ratio, 17.6; 95% confidence interval, 10.9-28.4). Overall, 49% of the patients reported their current health as "fair" or "poor," versus 25% of the control subjects (odds ratio, 5.0; 95% confidence interval, 3.2-7.6). Patients were more likely than control subjects to report fatigue, weakness, dizziness, dry mouth, and difficulty lifting objects (P<.05, for each). Patients were more likely than control subjects to report difficulty breathing caused by moderate exertion (P<.001) but not by minimal exertion or at rest. Patients were also more likely to report being limited in vigorous activities, walking 3 blocks, and climbing 3 flights of stairs (P<.05, for each). Finally, patients reported feeling significantly worse than control subjects for 6 of 11 questions regarding psychosocial well-being (P<.05, for each). In a multivariable model involving patients who had had botulism, mechanical ventilation during acute illness, older age, and region of residence independently predicted worse health. Several years after acute botulism, patients reported significant health, functional, and psychosocial limitations that are likely to be consequences of the illness.