Table 1.
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.