PMID- 24331717
OWN - NLM
STAT- MEDLINE
DCOM- 20140825
LR  - 20140621
IS  - 1097-6760 (Electronic)
IS  - 0196-0644 (Linking)
VI  - 64
IP  - 1
DP  - 2014 Jul
TI  - Emergency department identification and critical care management of a Utah prison 
      botulism outbreak.
PG  - 26-31
LID - S0196-0644(13)01546-1 [pii]
LID - 10.1016/j.annemergmed.2013.10.027 [doi]
AB  - STUDY OBJECTIVE: We report botulism poisoning at a state prison after ingestion 
      of homemade wine (pruno). METHODS: This is an observational case series with data 
      collected retrospectively by chart review. All suspected exposures were referred 
      to a single hospital in October 2011. RESULTS: Twelve prisoners consumed pruno, a 
      homemade alcoholic beverage made from a mixture of ingredients in prison 
      environments. Four drank pruno made without potato and did not develop botulism. 
      Eight drank pruno made with potato, became symptomatic, and were hospitalized. 
      Presenting symptoms included dysphagia, diplopia, dysarthria, and weakness. The 
      median time to symptom onset was 54.5 hours (interquartile range [IQR] 49-88 
      hours) postingestion. All 8 patients received botulinum antitoxin a median of 12 
      hours post-emergency department admission (IQR 8.9-18.8 hours). Seven of 8 
      patients had positive stool samples for type A botulinum toxin. The 3 most 
      severely affected patients had respiratory failure and were intubated 43, 64, and 
      68 hours postingestion. Their maximal inspiratory force values were -5, -15, 
      and -30 cm H2O. Their forced vital capacity values were 0.91, 2.1, and 2.2 L, 
      whereas the 5 nonintubated patients had median maximal inspiratory force of -60 
      cm H2O (IQR -60 to -55) and forced vital capacity of 4.5 L (IQR 3.7-4.9). 
      Electromyography abnormalities were observed in 1 of the nonintubated and 2 of 
      the intubated patients. CONCLUSION: A pruno-associated botulism outbreak resulted 
      in respiratory failure and abnormal pulmonary parameters in the most affected 
      patients. Electromyography abnormalities were observed in the majority of 
      intubated patients. Potato in the pruno recipe was associated with botulism.
CI  - Copyright (c) 2013 American College of Emergency Physicians. Published by Mosby, 
      Inc. All rights reserved.
FAU - Williams, Benjamin T
AU  - Williams BT
AD  - Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
FAU - Schlein, Sarah M
AU  - Schlein SM
AD  - Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
FAU - Caravati, E Martin
AU  - Caravati EM
AD  - Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
FAU - Ledyard, Holly
AU  - Ledyard H
AD  - Division of Emergency Medicine, University of Utah, Salt Lake City, UT.
FAU - Fix, Megan L
AU  - Fix ML
AD  - Division of Emergency Medicine, University of Utah, Salt Lake City, UT. 
      Electronic address: megan.fix@hsc.utah.edu.
LA  - eng
PT  - Journal Article
DEP - 20131210
PL  - United States
TA  - Ann Emerg Med
JT  - Annals of emergency medicine
JID - 8002646
RN  - 0 (Botulinum Antitoxin)
SB  - IM
MH  - Botulinum Antitoxin/therapeutic use
MH  - Botulism/*epidemiology/*therapy
MH  - *Critical Care
MH  - *Disease Outbreaks
MH  - Humans
MH  - Male
MH  - *Prisons
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Solanum tuberosum/*microbiology
MH  - Utah/epidemiology
MH  - Wine/*microbiology
EDAT- 2013/12/18 06:00
MHDA- 2014/08/26 06:00
CRDT- 2013/12/17 06:00
PHST- 2013/06/12 00:00 [received]
PHST- 2013/10/07 00:00 [revised]
PHST- 2013/10/24 00:00 [accepted]
PHST- 2013/12/17 06:00 [entrez]
PHST- 2013/12/18 06:00 [pubmed]
PHST- 2014/08/26 06:00 [medline]
AID - S0196-0644(13)01546-1 [pii]
AID - 10.1016/j.annemergmed.2013.10.027 [doi]
PST - ppublish
SO  - Ann Emerg Med. 2014 Jul;64(1):26-31. doi: 10.1016/j.annemergmed.2013.10.027. Epub 
      2013 Dec 10.