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True Stories From The Disease Files

Foodborne Botulism in Oklahoma

Foodborne botulism is caused by ingestion of the preformed toxin produced by the bacteria Clostridium botulinum.  Botulism is a notifiable disease in Oklahoma.  When a suspected case is reported to the Communicable Disease Division (CDD), an epidemiologist will assist in requesting antitoxin, laboratory confirmation through CDC, and identify potential sources and other cases.

During July, 2005, the Oklahoma State Department of Health (OSDH), CDD was notified about a suspected case of botulism in a 14 year-old female. The child initially experienced symptoms of nausea, vomiting, trouble speaking, and was taken to a local hospital.  Additional symptoms included constipation, abnormal deep tendon reflexes, and descending bilateral paralysis.  The case had no fever, which is common for disease caused by C. botulinum intoxication.  She was transferred to a hospital in Oklahoma City where she was placed on a ventilator.  Foodborne botulism was suspected when it was learned that the case had recently consumed home-canned venison stew.  Based on the clinical presentation and consumption history of a home-canned product, CDD contacted the Centers for Disease Control and Prevention (CDC) to coordinate botulinum antitoxin delivery and laboratory testing to confirm botulism.

Antitoxin was air delivered from CDC in Atlanta and administered.  Further investigation into the source of intoxication identified improperly home-canned venison and potato stew as the most likely source.  Serum and stool specimens were obtained and sent to CDC’s National Botulism Surveillance and Reference Laboratory; C. botulinum toxin type A was detected in the serum.  The case required mechanical ventilation for over two months and suffered recurrent pneumonia.  She was discharged during September 2005; however, the prolonged paralysis associated with botulism required several months of rehabilitation.

C. botulinum is ubiquitous in the environment and rarely causes disease when ingested by healthy adults.  Ingestion of preformed toxin is the cause of foodborne botulism, a relatively rare condition.  Foods which are conducive to the reproduction of C. botulinum and synthesis of botulism toxin are those stored in anaerobic conditions, not exposed to prolonged heat, and having low acid content.  Examples of foods causing botulism intoxication in recent years include home-canned foods, foil-wrapped baked potatoes, and commercially prepared chili. 1

Prior to 2005, Oklahoma’s last case of foodborne botulism was in 1994.  The case reported in 1994 was also epidemiologically linked to consumption of stew.  In this instance, the stew was not canned, but left unrefrigerated for three days before being eaten without reheating.  The lid of the pot or the gravy of the stew was thought to have provided an anaerobic environment for toxin production.2   Botulinum toxin type A was detected in the patient’s stool and in the stew.

Most cases of foodborne botulism in the U.S. result from eating improperly home-canned foods.  C. botulinum may cause container lids to bulge and the contents to have “off-odors.”  Commercial cans and home-canned products that are bulging or rusted around the rim or seam should not be eaten.  Because honey can contain spores of Clostriduim botulinum and this has been a source of infection for infants, children less than 12 months of age should not be fed honey.  Honey is safe for individuals one year of age and older.  To reduce the risk for botulism when pickling, food items should be washed and cooked adequately, and utensils, containers, and other surfaces in contact with food, including cutting boards and hands, should be cleaned thoroughly with soap and warm water.  The time needed to destroy C. botulinum during canning varies by the acidity of the food, size of the jars, pressure, and altitude.  To learn more about safe home canning practices, see the National Center for Home Food Preservation’s website.

References
1 Sobel, J, Tucker N., Sulka A., McLaughlin J, Maslanka, S.  Foodborne Botulism in the United States, 1990-2000.  Emer Inf Dis. 2004;10:1606-1611.
2 Foodborne Botulism—Oklahoma, 1994.  MMWR.  1995;44:200-202


Suspected cases should be reported immediately to ADS at (405) 271-4060.  Clinicians should consider botulism in patients who present with symmetric cranial nerve palsies (ptosis, dyplopia, dysarthria, and dysphagia) and bilateral flaccid paralysis.

Please visit the following links for more information regarding botulism:

Botulism Fact Sheets and Information:

Botulism Fact Sheet (41k.pdf)
 Botulsim Hoja Informativa (44k.pdf)

External Botulism Resources:

Botulism (CDC)

National Center for Home Food Preservation

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