Botulism Outbreak in Thailand (Episode II)

Study Overview
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Brief Summary
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A second botulism outbreak in Northern Thailand was reported in 2006. 192 people were exposed to raw meat and the gut of deer, 83 suffered from diarrhea. Of these 5 developed respiratory failure, 1 impending respiratory failure. We analysed the clinical findings and electrophysiologic findings in this second episode of large botulism outbreak in northern Thailand.

Detailed Description
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PRELIMINARY REPORT Northern Thailand's big botulism outbreak occurred again on 30 June 14, 2006, [16.00pm] affecting 83 from 192 people who exposed to raw dear meat and gut [1 night preserved with ice pack of whole body of dear before disection and distribution ]. Of these, 3 developed respiratory failure, 1 developed impending respiratory failure, 83 of 192 whom developed fatique and diarrhea after ingestion of raw dear meat and gut on 26-30 June 2006. 3 patients were refered to 2 high facility hospitals for severe respiratory failure. Physical examination of 3 patients in ICU of Chiang Kum general hospital revealed ptosis [3/3] mild ophthalmoparesis [2/3] Proximal muscle weakness [2/3] abdominal paradoxical respiration [3/3] pupil dilate [1/3] and negative inspiratory pressure [NIP] less than 15 mmHg [3/3] were observed. Neurological electrophysiologic study of 2 patients revealed low amplitude compound muscle action potential [CMAP] of Abductor digiti minimi [ADM] muscle with decrement response after repetitive stimulation with low frequency [3Hz], increment response of ADM muscle after stimulation with high frequency [10Hz, 20Hz, and 30Hz.].The electrophysiologic findings support diagnosis of presynaptic neuromuscular dysfunction with respiratory failure, Botulism is most likely diagnosis. After treated with botulinum antitoxin [on July,1 ,2006 [mixed-type botulinum antitoxin --donated from Japan at Nan Hospital's botulisum outbreak on March 14,2006], 3 patients in ICU showed improvement of over all clinical outcomes. Active survey by Ministry of Public Health of Thailand and CDC-USA to identify the high risk patient who may develop respiratory failure , and immunologucal vs microbiological diagnosis were performed. This outbreak may be the second hit of botulisum in the northern Thailand but less amount of severe cases was observed.

Official Title
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Clinical Manifestations of Botulism Outbreak in Northern Thailand: A Case Series of Botulism Treated With Botulinum Anti-Toxin.

Conditions
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Botulism

Intervention / Treatment
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* Drug: Botulinum AntiToxin
* Procedure: neuro-electrophysiologic study, repetitive nerve stimulation
* Procedure: : Protocol early weaning ventilator after recovery of repetitive nerve stimulation and stable negative inspiratory pressure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Ate the deer meat and/or the gut from Chiang Kum district, after June 26,2006 Clinical botulism or respiratory failure who need ventilator assistance The staff of referring hospital willing to participate in the Thai Botulism study group Exclusion Criteria: • Patients who did not eat deer meat and or the gut from Chiang Kum district
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Botulinum AntiToxin|nan|
|Procedure: neuro-electrophysiologic study, repetitive nerve stimulation|nan|
|Procedure: : Protocol early weaning ventilator after recovery of repetitive nerve stimulation and stable negative inspiratory pressure|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Food Borne Botulism