Table. Description of botulism cases hospitalised at Bordeaux University Hospital, Bordeaux, France, September 2023 (n = 8).
| Case | Symptoms | Clinical outcomes | Laboratory testing | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Serum samplea | Rectal or stool sampleb | |||||||||||
| Neuro-ophthalmic | Digestive | ENT | Other | Time to onset | ICU admission | Orotracheal intubation | Antitoxin administration | Date | Result | Date (sample) | Result | |
| 1 | Oculomotor palsy, mydriasis, ptosis | Nausea, vomiting | Impaired swallowing | None | 15 h | 6 Sep, 13:00 | 6 Sep, 15:00 | 12 Sep, 08:00 | 7 Sep, 09:30 | Positive (type B BoNT) | 11 Sep, 06:00 (rectal swab) |
Negative |
| 2 | Oculomotor palsy, mydriasis, ptosis | Nausea, vomiting | Impaired swallowing | None | 11 h | 9 Sep, 21:00 | 9 Sep, 22:00 | 11 Sep, 12:00 | 11 Sep, 06:40 | Strong suspicion of BoNT | 9 Sep, 22:30 (stool sample) | Positive (type B Cb) |
| 3 | Oculomotor palsy, mydriasis, ptosis | None | Impaired swallowing, dysphonia, dysarthria | Headache | 13 h | 10 Sep, 21:00 | 11 Sep, 10:00 | 11 Sep, 21:00 | 11 Sep, 05:00 | Strong suspicion of BoNT | 11 Sep, 23:00 (rectal swab) |
Negative |
| 4 | Ptosis | Nausea, diarrhoea | Dysphagia | Descending paralysis, chest pain | 13 h | 11 Sep, 11:00 | None | 12 Sep, 01:00 | 11 Sep, 11:40 | Negative | 11 Sep, 16:00 (rectal swab) |
Negative |
| 5 | Oculomotor palsy, mydriasis, blurry vision, ptosis | Nausea, vomiting | Impaired swallowing | Descending paralysis, respiratory distress | 59 h | 11 Sep, 12:00 | 11 Sep, 19:00 | 12 Sep, 08:00 | 12 Sep, 12:00 | Positive (type B BoNT) | 12 Sep, 12:00 (rectal swab) |
Positive (type B Cb) |
| 6 | Oculomotor palsy, mydriasis | Diarrhoea | Dysphagia, dysphonia, dysarthria | None | 39 h | 11 Sep, 13:00 | None | 12 Sep, 8:00 | 11 Sep, 16:20 | Negative | 13 Sep, 13:00 (rectal swab) |
Negative |
| 7 | Oculomotor palsy | Diarrhoea | Impaired swallowing, dysphonia, dysarthria | None | 11 h | 11 Sep, 15:00 | 13 Sep, 13:00 | 12 Sep, 11:00 | 11 Sep, 16:15 | Negative | 13 Sep, 11:00 (rectal swab) |
Positive (type B Cb) |
| 8 | Oculomotor palsy, mydriasis, blurry vision, ptosis | Nausea, vomiting | Impaired swallowing, dysphonia, dysarthria | None | 18 h | 12 Sep, 02:30 | 12 Sep, 16:00 | 12 Sep, 12:00 | 12 Sep, 02:30 | Strong suspicion of BoNT | 12 Sep, 02:30 (stool sample) | Positive (type B Cb) |
BoNT: botulinum neurotoxin; Cb: Clostridium botulinum; ENT: ear, nose, throat; ICU: intensive care unit.
a Detection of botulinum neurotoxin (BoNT) was confirmed using a mouse bioassay (intraperitoneal administration of patient serum to mice) [2]. BoNT serotype was determined by neutralisation of toxicity in mice by serotype-specific antibodies. Strong suspicion of BoNT indicates that patient sera caused toxic activity in the mouse bioassay, but positivity could not be confirmed by seroneutralisation.
b Detection and characterisation of Clostridium botulinum was performed by real-time PCR targeting BoNT-producing clostridia [3], with enrichment culture on stool samples or rectal swabs.