Epidemiologic Notes and Reports Botulism from Fresh Foods -- California

In August 1984, three cases of botulism were reported in California from two episodes in which the ill persons had eaten improperly handled food made from fresh ingredients.

Episode 1: Botulism was reported in a 61-year-old Santa Cruz County woman and her 13-year-old granddaughter. The older woman had classic symptoms of bilateral ptosis, diplopia, and facial weakness; the granddaughter was less ill. Food histories revealed no recent exposures to home-canned food, but improper food handling was identified as the likely cause of illness. Three days before onset, the grandmother prepared two turkey loaves that included cereal, onion, and green pepper. One loaf was consumed without incident immediately after cooking. The other was inadvertently stored in the gas oven with the pilot light on (later measured at 32.2 C (90 F)), until the grandmother discovered it the next afternoon. She tasted a small portion before reheating it at approximately 150 C (300 F) for approximately 20 minutes and served the turkey loaf to the three other members of her household. Thirty-six hours later, she awoke with ptosis, diplopia, and facial weakness. Of the others who ate the rewarmed loaf, only the granddaughter developed symptoms. When questioned, she could not recall tasting the turkey loaf with her grandmother before reheating, but did recall eating a portion from the center of the loaf. Type A botulinal toxin was detected in the sera of both patients. Trivalent botulinum antitoxin was administered, and both recovered completely. Since the turkey loaves were completely consumed, confirmatory tests on the suspected vehicle were not possible.

Episode 2: A 22-year-old Orange County man awoke at 2 a.m. with vomiting, blurred vision, and a "thick tongue." Symptoms progressed to total quadriplegia, then respiratory failure requiring mechanical ventilation. Forty hours before onset, he had consumed stew prepared by his roommate from fresh ingredients (including meat and unpeeled potatoes and carrots), then left overnight at room temperature. The stew was cooked in a 7-inch deep pot filled to the top and simmered for 45 minutes; the gas was then turned off and the pot left on the range. The roommate ate it hot after the initial cooking, without incident. The patient tasted it without reheating 16 hours later and complained of a bad taste. The roommate confirmed a sour taste, immediately spit it out, rinsed his mouth, and remained well. The stew was then discarded and could not be tested. Type A botulinal toxin was detected in the patient's serum; he was treated with botulinal antitoxin and recovered after extended hospitalization. Adapted from California Morbidity (February 1, 1985 (4)), as reported by D Corzine, MD, Capitola, M Stroe, MD, Santa Cruz County Health Dept, CS Kim, MD, J Lysiak, MD, L Spurgeon, MD, J Wallace, MD, M Gallagher, Anaheim, T Prendergast, MD, Orange County Health Dept, SB Werner, MD, California Dept of Health Svcs; Enteric Diseases Br, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Because spores of Clostridium botulinum are ubiquitous in soil, they can contaminate fresh foods, particularly those harvested from the ground. The spores are quite heat resistant and can survive boiling for several hours. For spores to germinate and produce toxin, several conditions must be met, including appropriate temperature and pH and oxygen contents. Foodborne botulism generally results from home-canned vegetables that are contaminated with spores and are improperly prepared, thereby allowing the production of botulinal toxin. Toxin can also be elaborated in foods that are initially cooked, then held at ambient temperatures for at least 16 hours. The cases presented here are not unique, since the same mechanism of toxin production appears to have accounted for previous episodes of botulism from commercial pot pies, sauteed onions, and, in one instance, a baked potato (1-4). These foods were cooked, allowed to stand at ambient temperatures, and consumed later without reheating. Foods heated for serving should either be eaten hot or refrigerated and later reheated thoroughly (since the toxin is heat labile) before re-serving.

References

1. California Department of Health Services. Botulism and commercial pot pie. California Morbidity, November 12, 1982 (44).

2. California Department of Health Services. Type A botulism associated with commercial pot pie. California Morbidity, December 30, 1976 (51).

3. MacDonald KL, Spengler RF, Hatheway CL, Hargrett NT, Cohen ML. Type A botulism from sauteed onions. Clinical and epidemiologic observations. JAMA 1985;253:1275-8.

4. Louisiana Department of Health and Human Resources. Unpublished data.

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