A rare symptom of foodborne botulism: dysgeusia. Case report and clinical review


Submitted: 30 January 2024
Accepted: 26 March 2024
Published: 9 April 2024
Abstract Views: 88
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Authors

Clostridium botulinum has become one of the most well-known microorganisms in medical history, thanks to both fatal botulism epidemics and the recent medical use of botulinum neurotoxin. It is a Gram-positive, anaerobic, spore-forming bacterium that causes classic foodborne botulism, infant botulism, wound botulism, and intestinal colonization botulism, a serious neuroparalytic disease. The most common type of botulism is foodborne botulism, which is caused by eating botulinum toxin-contaminated foods. Just a few micrograms of toxin are enough to cause symptoms and, if untreated, death. Rapid diagnosis of the condition is critical to avoiding fatal outcomes. This article describes a clinical case of a patient who presented to us in June with typical symptoms of botulism. Early clinical diagnosis is based on a thorough medical history, including a meticulous reconstruction of the patient's food history in the days preceding symptom onset, as well as a careful physical examination, which can be highly suggestive of botulinum intoxication. Botulism treatment consists of symptom control, mechanical respiratory support, and Botulinum Antitoxin (BAT) administered intravenously. Epidemiological investigation is critical for quickly identifying the food vehicle causing the intoxication.


Scalfaro C, Auricchio B, De Medici D, Anniballi F. Foodborne botulism: an evolving public health challenge. Infect Dis 2019;51:97-101. DOI: https://doi.org/10.1080/23744235.2018.1524584

Anniballi F, Auricchio B, Fiore A, et al. Botulism in Italy, 1986 to 2015. Euro Surveill 2017;22:30550. DOI: https://doi.org/10.2807/1560-7917.ES.2017.22.24.30550

Anniballi F, Bella A, Scalfaro C, et al. Il sistema di sorveglianza nazionale del botulismo: i dati in Italia dal 2001 al 2020. Boll Epidemiol Naz 2022;3:39-46.

Rawson AM, Dempster AW, Humphreys CM, Minton NP. Pathogenicity and virulence of Clostridium botulinum. Virulence 2023;14:2205251. DOI: https://doi.org/10.1080/21505594.2023.2205251

Tiwari A, Nagalli S. Clostridium botulinum Infection. 2023 Aug 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31971722.

Sobel J. Botulism. Clin Infect Dis 2005;41:1167–73. DOI: https://doi.org/10.1086/444507

Bintsis T. Foodborne pathogens. AIMS Microbiol 2017;3:529-63. DOI: https://doi.org/10.3934/microbiol.2017.3.529

Ni SA, Brady MF. Botulism Antitoxin. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–.

Rossetto O, Pirazzini M, Fabris F, Montecucco C. Botulinum neurotoxins: mechanism of action. Handb Exp Pharmacol 2021;263:35-47. DOI: https://doi.org/10.1007/164_2020_355

Josko D. Botulin toxin: a weapon in terrorism. Clin Lab Sci 2004;17:30-4.

Patocka J, Splino M, Merka V. Botulism and bioterrorism: how serious is this problem? Acta Medica (Hradec Kralove) 2005;48:23-8. DOI: https://doi.org/10.14712/18059694.2018.24

Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA 2001;285:1059-70. Erratum in: JAMA 2001:285:2081. DOI: https://doi.org/10.1001/jama.285.8.1059

Janik E, Ceremuga M, Saluk-Bijak J, Bijak M. Biological toxins as the potential tools for bioterrorism. Int J Mol Sci 2019;20:1181. DOI: https://doi.org/10.3390/ijms20051181

Anderson PD. Bioterrorism: toxins as weapons. J Pharm Pract 2012;25:121-9. DOI: https://doi.org/10.1177/0897190012442351

Peck MW. Biology and genomic analysis of Clostridium botulinum. Adv Microb Physiol 2009;55:183-265, 320. DOI: https://doi.org/10.1016/S0065-2911(09)05503-9

Shukla HD, Sharma SK. Clostridium botulinum: a bug with beauty and weapon. Crit Rev Microbiol 2005;31:11-8. DOI: https://doi.org/10.1080/10408410590912952

Nigam PK, Nigam A. Botulinum toxin. Indian J Dermatol 2010;55:8-14. DOI: https://doi.org/10.4103/0019-5154.60343

Rossetto O, Pirazzini M, Montecucco C. Botulinum neurotoxins: genetic, structural and mechanistic insights. Nat Rev Microbiol 2014;12:535-49. DOI: https://doi.org/10.1038/nrmicro3295

Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical guidelines for diagnosis and treatment of botulism, 2021. MMWR Recomm Rep 2021;70:1-30. DOI: https://doi.org/10.15585/mmwr.rr7002a1

Rao AK, Lin NH, Jackson KA, et al. Clinical characteristics and ancillary test results among patients with botulism-United States, 2002-2015. Clin Infect Dis 2017;66:S4-S10. DOI: https://doi.org/10.1093/cid/cix935

Chatham-Stephens K, Fleck-Derderian S, Johnson SD, et al. Clinical features of foodborne and wound botulism: a systematic review of the literature, 1932-2015. Clin Infect Dis 2017;66:S11-6. DOI: https://doi.org/10.1093/cid/cix811

Hughes JM, Blumenthal JR, Merson MH, et al. Clinical features of types A and B food-borne botulism. Ann Intern Med 1981;95:442-5. DOI: https://doi.org/10.7326/0003-4819-95-4-442

Johnson EA, Montecucco C. Botulism. In: Andrew GE, editor. Handbook of Clinical Neurology. Vol. 91. Amsterdam, NL: Elsevier; 2008. p. 333–368. DOI: https://doi.org/10.1016/S0072-9752(07)01511-4

Lund BM, Peck MW. Heat resistance and recovery of spores of non-proteolytic Clostridium botulinum in relation to refrigerated, processed foods with an extended shelf-life. Soc Appl Bacteriol Symp Ser 1994;23:115S-28S. DOI: https://doi.org/10.1111/j.1365-2672.1994.tb04363.x

Munir MT, Mtimet N, Guillier L, et al. Physical Treatments to Control Clostridium botulinum Hazards in Food. Foods 2023;12:1580. DOI: https://doi.org/10.3390/foods12081580

Centurioni DA, Egan CT, Perry MJ. Current developments in diagnostic assays for laboratory confirmation and investigation of botulism. J Clin Microbiol 2022;60:e0013920. DOI: https://doi.org/10.1128/jcm.00139-20

Kalb SR, Baudys J, Wang D, Barr JR. Recommended mass spectrometry-based strategies to identify botulinum neurotoxin-containing samples. Toxins (Basel) 2015;7:1765-78. DOI: https://doi.org/10.3390/toxins7051765

O'Horo JC, Harper EP, El Rafei A, et al. Efficacy of antitoxin therapy in treating patients with foodborne botulism: a systematic review and meta-analysis of cases, 1923-2016. Clin Infect Dis 2017;66:S43-S56. DOI: https://doi.org/10.1093/cid/cix815

Lonati D, Schicchi A, Crevani M, et al. Foodborne Botulism: Clinical Diagnosis and Medical Treatment. Toxins (Basel) 2020;12:509. DOI: https://doi.org/10.3390/toxins12080509

Griese SE, Kisselburgh HM, Bartenfeld MT, et al. Pediatric botulism and use of equine botulinum antitoxin in children: a systematic review. Clin Infect Dis 2017;66:S17-S29. DOI: https://doi.org/10.1093/cid/cix812

Yu PA, Lin NH, Mahon BE, et al. Safety and improved clinical outcomes in patients treated with new equine-derived heptavalent botulinum antitoxin. Clin Infect Dis 2017;66:S57-S64. DOI: https://doi.org/10.1093/cid/cix816

Tacket CO, Shandera WX, Mann JM, et al. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med 1984;76:794-8. DOI: https://doi.org/10.1016/0002-9343(84)90988-4

Schussler E, Sobel J, Hsu J, et al. Workgroup Report by the Joint Task Force Involving American Academy of Allergy, Asthma & Immunology (AAAAI); Food Allergy, Anaphylaxis, Dermatology and Drug Allergy (FADDA) (Adverse Reactions to Foods Committee and Adverse Reactions to Drugs, Biologicals, and Latex Committee); and the Centers for Disease Control and Prevention Botulism Clinical Treatment Guidelines Workgroup-Allergic Reactions to Botulinum Antitoxin: A Systematic Review. Clin Infect Dis 2017;66:S65-S72. DOI: https://doi.org/10.1093/cid/cix827

Anderson DM, Kumar VR, Arper DL, et al. Cost savings associated with timely treatment of botulism with botulism antitoxin heptavalent product. PLoS One 2019;14:e0224700. DOI: https://doi.org/10.1371/journal.pone.0224700

Black RE, Gunn RA. Hypersensitivity reactions associated with botulinal antitoxin. Am J Med 1980;69:567-70. DOI: https://doi.org/10.1016/0002-9343(80)90469-6

Fleck-Derderian S, Shankar M, Rao AK, et al. The epidemiology of foodborne botulism outbreaks: a systematic review. Clin Infect Dis 2017;66:S73-S81. DOI: https://doi.org/10.1093/cid/cix846

Harvey RR, Cooper R, Bennett S, et al. Outbreak of foodborne botulism in an immigrant community: overcoming delayed disease recognition, ambiguous epidemiologic links, and cultural barriers to identify the cause. Clin Infect Dis 2017;66:S82-S84 DOI: https://doi.org/10.1093/cid/cix817

Sheth AN, Wiersma P, Atrubin D, et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis 2008;47:1245-51. DOI: https://doi.org/10.1086/592574

Sobel J. Diagnosis and treatment of botulism: a century later, clinical suspicion remains the cornerstone. Clin Infect Dis 2009;48:1674-5. DOI: https://doi.org/10.1086/599030

Esposito, S., Coletta, F., Di Maiolo, G., Lo Chiatto, F., Rinaldi, P., Lanza, A., Panico, G., Sala, C., Tomasello, A., & Villani, R. (2024). A rare symptom of foodborne botulism: dysgeusia. Case report and clinical review. Emergency Care Journal. https://doi.org/10.4081/ecj.2024.12322

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