Delayed Botulism Outbreak Detection – Bakht Village, Tajikistan, 2022

  • Water or foodborne
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On February 17, 2022, the Sughd Regional Center for State Sanitary and Epidemiological Surveillance received a call about 3 people hospitalized with suspected food-borne botulism. Botulism is a rare but severe nerve disease caused by exposure to botulinum neurotoxins. Home canning is the leading cause of botulism in Tajikistan. We conducted an outbreak investigation to determine the source and prevent more cases.
We defined cases as residents from Bakht Village, Devashtichsky district, seeking care from February 10-12th with 3 or more symptoms of nausea, vomiting, weakness, diarrhea, diplopia, visual impairment, ptosis, dry mouth, or dysphagia. We collected clinical and laboratory data from medical records and conducted structured interviews with patients.
We identified 3 cases. All were adults from the same family. On February 11th, Patient A initially sought care for headaches and nausea and received outpatient treatment for exhaustion. On February 13th, Patient A sought care again after developing difficulty swallowing, and continued outpatient treatment. On February 15th, Patient A was diagnosed with myasthenia gravis after developing diplopia and tachycardia and was hospitalized. On February 17th, Patients B and C developed similar symptoms and ptosis were hospitalized with similar symptoms. Botulism was suspected; all patients received botulism antitoxin. Botulism testing is limited in Tajikistan and was not performed. Patients had dined together on February 9th and ate home-canned foods. All homecanned food had been consumed and unavailable for inspection. Only Patient A had severe disease; no fatalities occurred.
Botulism diagnosis is often delayed or missed. Myasthenia gravis is a common misdiagnosis. Early detection of botulism can be strengthened in Tajikistan. Botulism should be considered in patients with symptoms of myasthenia gravis, and their food history recorded. An outbreak investigation and administration of botulism antitoxin can reduce morbidity and mortality.

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