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Title: An outbreak of botulism in Thailand: Clinical manifestations and management of severe respiratory failure
Authors: Subsai Kongsaengdao
Kanoksri Samintarapanya
Siwarit Rusmeechan
Adisorn Wongsa
Chaicharn Pothirat
Chairat Permpikul
Sunsanee Pongpakdee
Wilai Puavilai
Piraj Kateruttanakul
Uthai Phengtham
Kanlaya Panjapornpon
Jirayut Janma
Kunchit Piyavechviratama
Pasiri Sithinamsuwan
Athavudh Deesomchok
Surat Tongyoo
Warakarn Vilaichone
Kanokwan Boonyapisit
Saengduan Mayotarn
Benjamas Piya-Isragul
Aran Rattanaphon
Poj Intalapaporn
Petcharat Dusitanond
Piyathida Harnsomburana
Worapojn Laowittawas
Parnsiri Chairangsaris
Jithanorm Suwantamee
Wanna Wongmek
Ranistha Ratanarat
Akekarinth Poompichate
Hathai Panyadilok
Niwatchai Sutcharitchan
Apinya Chuesuwan
Petchdee Oranrigsupau
Chumpita Sutthapas
Surat Tanprawate
Jakapong Lorsuwansiri
Naritchaya Phattana
Keywords: Medicine
Issue Date: 15-Nov-2006
Abstract: Background. Northern Thailand's biggest botulism outbreak to date occurred on 14 March 2006 and affected 209 people. Of these, 42 developed respiratory failure, and 25 of those who developed respiratory failure were referred to 9 high facility hospitals for treatment of severe respiratory failure and autonomic nervous system involvement. Among these patients, we aimed to assess the relationship between the rate of ventilator dependence and the occurrence of treatment by day 4 versus day 6 after exposure to bamboo shoots (the source of the botulism outbreak), as well as the relationship between ventilator dependence and negative inspiratory pressure. Methods. We reviewed the circumstances and timing of symptoms following exposure. Mobile teams treated patients with botulinum antitoxin on day 4 or day 6 after exposure in Nan Hospital (Nan, Thailand). Eighteen patients (in 7 high facility hospitals) with severe respiratory failure received a low- and high-rate repetitive nerve stimulation test, and negative inspiratory pressure was measured. Results. Within 1-65 h after exposure, 18 of the patients with severe respiratory failure had become ill. The typical clinical sequence was abdominal pain, nausea and/or vomiting, diarrhea, dysphagia and/or dysarthria, ptosis, diplopia, generalized weakness, urinary retention, and respiratory failure. Most patients exhibited fluctuating pulse and blood pressure. Repetitive nerve stimulation test showed no response in the most severe stage. In the moderately severe stage, there was a low-amplitude compound muscle action potential with a low-rate incremented/high-rate decremented response. In the early recovery phase, there was a low-amplitude compound muscle action potential with low- and high-rate incremented response. In the ventilator-weaning stage, there was a normal-amplitude compound muscle action potential. Negative inspiratory pressure variation among 14 patients undergoing weaning from mechanical ventilation was observed. Kaplan-Meier survival analysis identified a shorter period of ventilator dependency among patients receiving botulinum antitoxin on day 4 (P = .02). Conclusions. Patients receiving botulinum antitoxin on day 4 had decreased ventilator dependency. In addition, for patients with foodborne botulism, an effective referral system and team of specialists are needed. © 2006 by the Infectious Diseases Society of America. All rights reserved.
ISSN: 10584838
Appears in Collections:CMUL: Journal Articles

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