Epidemiologic Case Studies
Botulism in argentina, target audience, available for download.
- Instructor's Version [PDF - 2 MB]
- Student's Version [PDF - 189 B]
- Versión para el instructor [PDF - 162 KB]
- Versión para el alumno [PDF - 59 B]
Public health practitioners with knowledge of basic epidemiologic concepts and experience in data collection and analysis.
Learning Objectives
After completing this case study, the student should be able to:
- Describe outbreak situations in which acute control measures should be undertaken.
- Communicate information on an outbreak or outbreak investigation and write a press release.
- Given the leading hypothesis(es) in an outbreak, develop a questionnaire.
- Given details on the origin, distribution, and preparation of an implicated food item, identify critical points for the control of contamination and microbial survival and growth.
- Discuss possible barriers to implementation of specific interventions following an outbreak investigation.
- Describe measures that can be used to monitor the success of an intervention.
- Describe the occurrence, signs and symptoms, and control of foodborne botulism.
Prerequisites
Successful completion of training in descriptive epidemiology, epidemic curves, measures of association, stratified analysis, study design, and outbreak investigation.
English and Spanish
Intermediate
3 to 4 hours
Continuing Education
Continuing education credits are not available for completing this case study.
Developed By
Jeanette K. Stehr-Green, MD developed this case study in close collaboration with staff from the Centers for Disease Control and Prevention:
- National Center for Infectious Diseases (Division of Bacterial and Mycotic Diseases/Foodborne and Diarrheal Diseases Branch and Food Safety Office)
- Epidemiology Program Office (Division of International Health)
- Public Health Practice Program Office (Division of Professional Development and Evaluation)
Original Investigation Team
The following individuals investigated the original outbreak of botulism in Argentina: Rodrigo G. Villar, Roger L. Shapiro, Silvina Busto, Clara Rive-Posse, Guadalupe Verdejo, Maria Isabel Farace, Francisco Rosetti, Jorge A. San Juan, Carlos Maria Julia, John Becher, Susan E. Maslanka, and David Swerdlow.
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- Page last reviewed: April 7, 2016
- Page last updated: April 7, 2016
- Office of Public Health Scientific Services ;
- Center for Surveillance, Epidemiology, and Laboratory Services ;
- Division of Scientific Education and Professional Development
Botulism: Clinician Training
- EID: Use of Automated Ambulatory-Care Encounter Records for Detection of Acute Illness Clusters, Including Potential Bioterrorism Events
- MMWR: Recognition of Illness Associated with the Intentional Release of a Biologic Agent
- JAMA: Botulinum Toxin as a Biological Weapon external icon
- Video: “The History of Bioterrorism: Botulism” media icon
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Foodborne disease outbreak investigation, epidemiologic case study. Botulism in Argentina
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 In hypothesis-generating interviews with cases and other bus drivers, being a driver on the morning shift of the bus route and eating at the terminal home of the route were the only common exposures among cases. No cases of botulism occurred among bus drivers from the afternoon or evening shift of the route. Bus drivers from those shifts did not usually eat at the terminal home because it was only open for lunch.
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 Foodborne Botulism, I Only Had Nacho Cheese: A Case ReportSaad a choudhry. 1 Internal Medicine, University of California Davis Muhammad Jahanzaib Anwar2 Department of Internal Medicine, Rush University Medical Center Muhammad Afzal3 Pulmonary and Critical Care, Sutter Medical Center Sacramento 4 Intermountain Healthcare A 32-year-old female presented to the emergency department with complaints of diplopia, followed by dyspnea, chest tightness, congestion, and dysphagia. The patient was resuscitated and initial investigations were done. Within a few hours of the admission, she started developing signs of respiratory failure and was intubated and placed on the mechanical ventilator. The patient denied any ingestion of exotic food, shellfish, raw meat, or raw fish. The patient also denied traveling to any exotic place or recent camping trips. The edrophonium tensilon test and lumbar puncture came out to be negative. The botulinum toxin test was positive, the patient was started on botulinum antitoxin, and the rest of symptomatic treatment was continued. The Centre for Disease Control (CDC) tracked the events related to the presentation and found she had eaten nacho cheese from a gas station the day before the appearance of the symptoms. A total of 10 cases were associated with this source within days and one death was reported. IntroductionFoodborne botulism has been reported since as early as the eighteenth century when some ancient case reports described patients with a combination of dilated pupils and fatal muscle paralysis. The eighteenth century ended with some well-documented cases of outbreaks of “sausage poisoning” in Southern Germany that led to the need for early systematic botulinum toxin research. The first complete report with a complete description of the symptoms of foodborne botulism was reported between 1817 and 1822 by a German poet and district medical officer, Justin Kerner. At that time, he called it the “sausage poison” or the “fatty poison.” After 80 years of Kerner's work, in 1895, an outbreak of botulism in a Belgian town led to the discovery of the causative organism, Clostridium botulinum, by a professor of bacteriology at the University of Ghent―Dr. Emile Pierre van Ermengem. The Latin word for sausage is botulus, naming the bacterium as botulinum [ 1 ]. Recent studies and clinical experiences show that the most common source of foodborne botulism is often the canning of foods at home, which has a low acid content, such as green beans, corn, and beets. A common source of the illness in cold climate areas is fermented seafood. However, the use of oil-infused garlic, chili peppers, and baked potatoes, especially the foil-wrapped ones, are also found to be associated with the disease [ 2 - 3 ]. Case presentationA 32-year-old female presented to the emergency department with a few hours' history of shortness of breath and weakness associated with chest tightness, congestion, hoarseness of voice, and difficulty swallowing. The patient had presented 24 hours earlier with the complaint of diplopia for one day. The patient denied any ingestion of exotic food, shellfish, raw meat, raw fish, or other foods generally associated with botulism. The patient also denied traveling to any exotic place or recent camping trips. The general workup, including biochemical and hematological investigations, came out to be normal except for a mildly decreased serum calcium (7.9 mg/dl). The magnetic resonance imaging (MRI) scan of the brain was also normal. That day, she was discharged with an outpatient consultation with neurology, but she continued to have persistent diplopia. After a few hours of admission, her breathing started to get worse, she was intubated, placed on mechanical ventilation, and was admitted to the intensive care unit (ICU). On examination, she had a symmetrical weakness in all four limbs, with more in the upper limbs compared to the lower limbs. The tensilon test was performed, which was negative. A lumbar puncture was performed, which also came out to be normal. Blood was sent to be tested for botulinum toxin. In the meantime, symptomatic treatment was started and disease control authorities were involved. Her weakness progressively increased and while she was being treated, another case arrived at the hospital with a very similar presentation. Four days later, the botulinum toxin test came positive and the patient was started on botulinum antitoxin and the rest of symptomatic treatment was continued. The Centre for Disease Control (CDC) tracked the events related to both these patients and found out that they both had eaten nacho cheese from a gas station the day before the appearance of their symptoms. A total of 10 cases were associated with this source within days and one death was reported. Botulism is a rare, neuroparalytic, potentially life-threatening disease caused by toxins released by a gram-positive spore-forming bacteria, the Clostridium botulinum. The toxin blocks acetylcholine receptors at neuromuscular junctions, which result in a descending type of flaccid paralysis of voluntary muscles. The first symptoms to appear are ptosis, diplopia, and dysarthria, eventually leading to full-body paralysis, including of the respiratory muscles. While the affected patients are fully alert and their sensory system is intact throughout the period of illness, the disease is lethal due to the involvement of respiratory muscles, which might lead to respiratory failure and death [ 4 ]. Recovery usually takes weeks to months. The patients should be admitted to the ICU and the availability of mechanical ventilation should be ensured promptly if needed. The antitoxin should be administered early in the disease to decrease the natural course of the disease. The prognosis depends on early diagnosis and administration of the antitoxin, which may reduce the further deterioration of muscle weakness and the severity of the disease [ 5 ]. Foodborne botulism occurs when food containing preformed toxin is ingested. Clostridium botulinum spores are present in the environment [ 6 ] but the growth and development of the toxins only occur under specific conditions such as an anaerobic, low salt, and low acid environment. “Bacterial growth is inhibited by refrigeration below 4°C, heating above 121°C, high water activity, or acidity (pH <4.5)” [ 7 ]. “The toxin is destroyed by heating to 85°C for at least five minutes and spores are inactivated by heating to 121°C under pressure of 15–20 lb/in 2 for at least 20 minutes” [ 7 ]. Improper food handling practices are the most important cause of foodborne botulism in the United States as well as the rest of the world. Between 1990 and 2000, 160 cases of foodborne botulism were reported, in which 263 people were affected. According to the available data, eight deaths were recorded. Out of the 160 events, 58 occurred in Alaska, affecting 103 people. In most of these cases, the identified food source was fermented aquatic mammal tissue, beaver tails, seal flippers, and seal oil. Another source identified was fish and fish products such as fermented salmon head, white fish, and fish eggs [ 3 ]. In the rest of the states, including Hawaii, 102 events occurred, affecting 160 people. The food sources identified were diverse, including homemade canned foods, commercial foods, as well as restaurant-prepared foods [ 3 ]. But the reason remained―improper storage and preservation like inadequate refrigeration, use of sealed plastic bags and cans, and their exposure to sunlight and inability to heat the foods to a temperature that might kill the toxin. In this time period, there were 37 cases in which no identifiable food source could be attributed to the disease [ 3 ]. According to the CDC reports between 2001 and 2015, a total of 278 cases of foodborne botulism and 23 deaths were reported. One of the biggest outbreaks occurred in Ohio in 2015, in which 27 cases were reported and the food was confirmed to be potato salad/macaroni. Other outbreaks were caused by different home-canned foods like chili sauce, prune, beans, mushrooms, and other home-canned vegetables. During this time, there were 45 cases that could not be attributed to a specific food source [ 3 ]. ConclusionsFoodborne botulism, while rare, remains a public health emergency in the United States. Due to advances in medicine, it has become treatable and manageable but still poses a huge health problem due to its severity and epidemic potential. Botulism should always be included in the differential diagnosis of a patient with similar signs and symptoms, as early diagnosis could be critical in the management and, eventually, the prognosis of an affected patient. While taking the history of the patient, all foods should be taken into account just before the development of the symptoms rather than asking about the food sources generally associated with the disease. Even when there is no history of intake of foods associated with botulism, it should remain in the differentials until proven otherwise. Home-canned foods and Alaska native foods remain the leading cause of botulism in the United States. Restaurant-associated outbreaks continue to account for numerous illnesses. There should be a tight check over the packaging of known foods that have the potential to thrive Clostridium botulinum, and all such facilities should be federally regulated. All suspected cases of botulism should be reported to public health authorities immediately. Prompt epidemiologic investigation helps prevent additional cases and can identify new risk factors for intoxication. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Human EthicsConsent was obtained by all participants in this study Case Study - Botulism Students also viewed Due to major building activity, some collections are unavailable. Please check your requests before visiting. Learn more .
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NOTE: This case study is based on a real-life outbreak investigation undertaken in Buenos Aires, Argentina, in 1998. Some aspects of the original outbreak and investigation have been altered, however, to assist in meeting the desired teaching objectives and allow completion of the case study in less than 3 hours.
After completing this case study, the student should be able to: Describe the occurrence, signs and symptoms, and control of foodborne botulism. Describe the major steps in an outbreak investigation. Critique a press release about an outbreak. Construct and interpret an epidemic curve. Given the leading hypotheses in an outbreak, develop a ...
Summary. Based on an investigation of an outbreak of botulism among bus drivers in Buenos Aires in 1998. Objectives: Describe outbreak situations in which acute control measures should be undertaken. Communicate information on an outbreak or outbreak investigation and write a press release. Given the leading hypothesis (es) in an outbreak ...
After completing this case study, the student should be able to: ... The following individuals investigated the original outbreak of botulism in Argentina: Rodrigo G. Villar, Roger L. Shapiro, Silvina Busto, Clara Rive-Posse, Guadalupe Verdejo, Maria Isabel Farace, Francisco Rosetti, Jorge A. San Juan, Carlos Maria Julia, John Becher, Susan E ...
Objectives To determine the source of the outbreak, improve botulism surveil-lance, and establish an antitoxin supply and release system in Argentina. Design, Setting, and Participants Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. Main Outcome Measure Occurrence of botulism and implication of a particular
Botulism: Clinician Training. Botulism in the United States, 1889-1996, Handbook for Epidemiologist, Clinician and Laboratory Workers. EID: Use of Automated Ambulatory-Care Encounter Records for Detection of Acute Illness Clusters, Including Potential Bioterrorism Events. Bioterrorism Readiness Plan: A Template for Healthcare Facilities.
Botulism case prompts warning in Argentina. Argentinian officials have warned people not to consume a specific product line due to the risk of botulism. The National Administration of Drugs, Foods ...
STUDENT'S VERSION Botulism in Argentina Learning objectives: After completing this case study, the student should be able to: 1. describe outbreak situations in which acute control measures should be undertaken 2. communicate information on an outbreak or outbreak investigation and write a press release 3. given the leading hypothesis(es) in an outbreak, develop a questionnaire 4. given ...
Botulism is a severe neuroparalytic disease caused by Clostridium botulinum toxins. Although the disease is uncommon it is a cause of great concern due to its high rate of mortality. Food-borne outbreaks of botulism occur worldwide and require immediate public health attention and acute care resources. Analysis of outbreaks showed that the food ...
Epidemiologic case study Botulism in Argentina Note Title from title screen (viewed on Oct. 14, 2004). "April 2000." "April 2002"--Text, p. 1. Format Mode of access: Internet from the PHPPO web site.
Case study and instructor's guide created by: Jeanette K. Stehr-Green, MD NOTE: This case study is based on a real-life outbreak investigation undertaken in Buenos Aires, Argentina, in 1998. Some aspects of the original outbreak and investigation have been altered, however, to assist in meeting the desired teaching objectives and allow ...
Botulism in Argentina . Botulism in Argentina (Spanish Version) Cigarette Smoking and Lung Cancer (2003 update) Case study based on the classic studies of Doll and Hill in the 1950s. Addresses study design, interpretation of measures of association, and impact of association. Epidemic Measles in a Divided City (Texarkana) (1990)
Context: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. Objectives: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina.
Foodborne botulism: a case report. Foodborne botulism: a case report Porto Biomed J. 2021 Jan 26;6(1):e115. doi: 10.1097/j.pbj.0000000000000115. eCollection 2021 Jan-Feb. Authors Artur Manuel Costa ...
According to the CDC reports between 2001 and 2015, a total of 278 cases of foodborne botulism and 23 deaths were reported. One of the biggest outbreaks occurred in Ohio in 2015, in which 27 cases were reported and the food was confirmed to be potato salad/macaroni.
Neal Soni CHLH 101 - Botulism in Argentina TA: Wang Botulism in Argentina Case Study 1. Step One - Detect the Outbreak In this case study, epidemiologists did this by diagnosing the disease of botulism in the beginning cases. In Buenos Aires Hospital, they discovered both the beginning cases had the same symptoms which were drooping eyelids, double vision, respiratory problems, and ...
CaseStudy - Botulism in Argenna Student Version - Free download as PDF File (.pdf), Text File (.txt) or read online for free. Two bus drivers in Buenos Aires, Argentina were diagnosed with possible cases of botulism after presenting with neurological symptoms. As botulism is rare and potentially fatal if untreated, the Ministry of Health was concerned about identifying other cases and the ...
Study with Quizlet and memorize flashcards containing terms like What is Botulism caused by?, Clostridium botulinum characteristics, What is Botulism? and more. ... Soccer Mom Case Study. 22 terms. mkneidig. Preview. Short answer addition. 10 terms. Mr_Searcy. Preview. Anatomy Ch. 10 - Blood Test Notes. 12 terms. erin_zuchristian612. Preview ...
Community Health Nursing: NUR 48602 CDC Disease Investigation Case Study Botulism in Argentina ... PLEASE ANSWER THIS QUESTIONS STEP BY STEP (URGENT) : Analyzing by gas chromatography a standard solution containing cholesterol 1.2910 -5 M and 5--cholestane 5.0010 -6 M, as an internal standard, gave ...
Foodborne diseases -- Argentina -- Epidemiology -- Case studies; Other authors/contributors: Centers for Disease Control and Prevention (U.S.). Epidemiology Program Office; Centers for Disease Control and Prevention (U.S.). Public Health Practice Program Office; Also Titled: Epidemiologic case study; Botulism in Argentina; Govt. Doc. Number:
Community Health Nursing: NUR 48602 CDC Disease Investigation Case Study Botulism in Argentina (CB3058) (max 10 points) Utilize information technology to coordinate and support decision-making in the community Answer the following in a Word document based on the case study: 1.
Providing an answer to a case study query will involve botulism in argentina case study answers Significantly greater than only recounting the problems and complications established forth, it contains determining The most crucial issues, utilizing seem and reasonable Assessment, establishing an motion plan for addressing the challenge(s) and ...
Community Health Nursing: NUR 48602 CDC Disease Investigation Case Study Botulism in Argentina (CB3058) (max 10 points) The CDC Disease Investigation Case study offers the student opportunities to demonstrate critical thinking through the analysis and synthesis of current population health issues. The assignment rubric (S atisfactory = criteria met and points earned/ U nsatisfactory=content is ...