Table 1.

Listing of adult intestinal toxemia botulism cases reported in the literature.

Year Published	Year of Case	Age/Sex	Symptoms	Possible Redisposing Factors	Length of Colonization 1	Length of Hospitalization	Toxin Type	Samples Testing Positive	Reference
1980	1980	47/M	Abdominal bloating, nausea, vomiting, diarrhea, diplopia, dry mouth, dysphagia, unreactive pupils, hypotension, ptosis, bilateral peripheral facial weakness, respiratory paralysis, colonic dilatation, partial ileus	None	N.D. 2	21 days	B	Clostridium botulinum type B in stool	[68]
1981 and 1988	1978	33/F	Dizziness, “thick tongue”, weakness, respiratory arrest	Jejunoileal bypass	N.D.	Died of respirator complications 17 days after admission	A	C. botulinum type A in stool; type A toxin in serum	[34,40]
1986	N.S.	45/F	Generalized weakness, fatigue, loose stools, gastric distension, constipation, dysphagia, diplopia, ptosis, facial weakness, bilateral tinnitus, slurred speech	Jejunoileal bypass	N.D.	22 days	B	C. botulinum type B in stool	[41]
1988	1973	Elderly/M	N.S. 3	N.S.	32 days	N.S.	B	Type B toxin in stool and serum; C. botulinum type B in stool	[34]
1988	1981	27/M	“classic signs of botulism”	Classical foodborne botulism outbreak with secondary cases	47 days	N.S.	B	Type B in serum; C. botulinum type B isolated from stool	[34]
1986 and 1988	1985	37/F	Weakness, dysarthria, diplopia, malaise, abdominal pain, constipation, dysarthria, dysphagia, otherwise alert and oriented, followed by dyspnea, ophthalmoplegia, bulbar paralysis, descending paralysis	Billroth I surgical procedure to remove pyloric valve, 5 weeks prior to admission for botulism	119 days	Died of polymicrobial sepsis after 240 days	A	Type A toxin in serum; type A toxin in stool; C. botulinum type A in stool	[33,34]
1991	1987	54/M	Dysarthria, diplopia, dysphagia, weakness, respiratory arrest, remained alert	Truncal vagotomy, pyloroplasty, and cholecystectomy 4 years prior	14 days	31 days; limited physical endurance 3 years later	F	Clostridium baratii type F in stool; C. botulinum type B in colonic washing	[43]
1994	1992	3/F	Slurred speech, progressive weakness, respiratory failure, constipation	Immunosuppression and antimicrobials pre- and post-autologous bone marrow transplant	N.D.	Died after 150 days	A and B	Types A and B toxins in stool	[45]
1997	1988	67/M	Abdominal pain, diplopia, decreased bowel sounds, abdominal distension, dysarthria, dyspnea, bilateral facial weakness, respiratory arrest	Crohn’s disease; terminal ileum and right colon had each been resected; treated with prednisone	19 weeks	79 weeks	A	C. botulinum type A in stool and gastric aspirate; type A toxin in serum, stool, and gastric aspirate	[44]
1999 and 2007	1994	9/M	Diplopia, bilateral mydriasis, dysphonia, dry mouth, dry eyes, constipation, tympanic abdomen, urinary retention, tachycardia, tachypnea, dyspnea, facial nerve palsies, upper limb weakness, respiratory failure, electromyography (EMG) compatible with botulism	Meckel’s diverticulum	16 days	37 days	E	Clostridium butyricum type E in stool	[48] [46]
1999 and 2007	1995	19/F	Abdominal pain, nausea, vomiting, diplopia, dysphagia, dry mouth, dysphonia, facial nerve dysfuntion, constipation, ptosis, mydriasis, respiratory failure, asthenia, coma, complete paralysis, EMG compatible with botulism	Meckel’s diverticulum	11 days	23 days	E	C. butyricum type E from rectal swab	[48] [46]
2007	1997	56/M	Diplopia, dysphagia, nausea, vomiting, afebrile, respiratory failure	Ceftriazone therapy	45 days	90 days	A	C. botulinum type A in stool; type A toxin in serum	[46]
2002	2001	41/F	Shortness of breath, weakness, vomited several times, dizziness, bradycardia, respiratory arrest, unreactive pupils	Amoxicillin for 2 days before symptom onset	N.D.	>12 weeks	F	Type F toxin in serum; C. baratii type F from spaghetti sauce and can of tuna 4	[35]
2003	1999	12/F	Constipation	Foodborne botulism, antibiotics	>122 days	425 days	Ab	C. botulinum Ab in stool; type Ab toxin in serum	[36]
2012	2006	63/F	Abdominal pain, blurred vision, diarrhea, dysarthria, dysphagia, diplopia, imbalance, weakness in arms and hands, opthalmoplegia, ptosis, respiratory arrest	Crohn’s disease, previous bowel surgery, short bowel syndrome	61 days	7 months	A	C. botulinum type A in enema fluid, stool, and gastric aspirate	[37]
2012	2007	50/F	Opthalmoparesis, dysphagia, quadriparesis	Crohn’s disease, four previous bowel resections, ileocolonic anastomosis, enterocutaneous fistulas	56 days	128 days in hospital; 4 months in rehabilitation hospital	B	Botulinum toxin in serum and stool; C. botulinum in stool	[37]
2008 and 2012	2008	45/M	Small bowel obstruction, distended abdomen, minimal bowel sounds, blurry vision, pupils unreactive to light	None identified	41 days	51 days	B	C. botulinum type B in stool	[37,38]
2014	2007	79/M	Diplopia, weakness, diarrhea, nausea, vomiting	Endoscopy 3 days prior to symptom onset	N.D.	Died on day 15 of acute respiratory failure resulting from paralysis and an underlying medical condition	F	Botulinum toxin in serum; type F toxin and C. baratii type F in gastric liquid.	[69]
2014	N.S.	68/F	Diplopia, nausea, weakness	Single dose of antibiotic	N.D.	20 days	F	Type F toxin in serum; C. baratii type F in gastric liquid and stool	[69]
2017	N.S.	43/F	Nausea, lethargy, unsteadiness, dysphagia, dysarthria, respiratory failure, sluggish pupils, quadriparesis, distended abdomen, minimal bowel sounds	None identified	33 days	Died from caudiopulmonary arrest 8 months after onset	A	Type A toxin in serum; C. botulinum type A in stool	[66]
2017	N.S.	5/M	Bilateral ptosis, dysarthria, mydriasis, walking difficulty, followed by constipation, muscle hypotonia, facial weakness, dilated and underactive pupils, otherwise alert	Intravenous antibiotics	Between 23 to 40 days	Discharged after 90 days	A	C. botulinum isolated from stool	[67]
2017	N.S.	33/F	Lower extremity weakness, shortness of breath, blurred vision, slurred speech, symmetric flaccid paralysis that rapidly progressed to respiratory failure requiring intubation	Previous gastric bypass surgery	N.D.	Discharged after 53 days	F	“test results positive for botulinum toxin type F”	[42]
2018	2017	Elderly/M	Dysarthria, dysphagia, dyspnea, ptosis, extraocular palsy, quadriparesis, intubation for respiratory failure	None identified	N.D.	Died from ventilator-associated pneumonia on day 109	A	Botulinum toxin type A in serum and stool	[82]
2018	N.S.	66/F	Initially lower back pain, difficulty raising arms and walking up stairs, “thick tongue”, progressive dysphagia and dysarthria, bloating, abdominal pain, and constipation; followed by worsening tachypnea and dysarthria, bilateral ptosis, descending symmetrical flaccid paralysis, complete ophthalmoplegia, ptosis, dilated pupils, absent gag reflex, dysphagia, dysarthria, inability to lift her head, and an intact sensory nervous system	Chronically immunosuppressed with oral corticosteroids; short bowel syndrome following complications of a cholecystectomy leading to ileal resection	N.D.	Discharged after 16 days; ultimately died of deep venous thrombosis, a complication of prolonged illness.	A	Botulinum toxin type A in serum and stool	[39]
2018	N.S.	27/M	Constipation, abdominal pain, blurry vision, bilateral ptosis, slurred speech, dysphagia, opthalmoplegia, unreactive pupils	Cyclosporine, recipient of allogeneic hematopoietic stem cell transplant	3 weeks after botulism symptom onset	Died 42 days after botulism symptom onset	A	Stool	[47]

¹ The time given for length of colonization is the minimum. ² Not determined. ³ Not specified. ⁴ The finding of a toxic food indicates this may be a foodborne botulism case. The authors suggest adult intestinal toxemia botulism because the patient had received previous antibiotic therapy and other individuals in the household consumed the same food but did not show symptoms.