Indian Journal of Public Health

LETTER TO THE EDITOR
Year
: 2010  |  Volume : 54  |  Issue : 1  |  Page : 45--46

A paralytic disease with presentation of food poisoning affecting three members of a family at Khammam, Andhra-Pradesh


S Suguna Hemachander, Debkishore Gupta 
 Department of Microbiology, Mamata Medical College, Khamam, Andhra Pradesh, India

Correspondence Address:
Debkishore Gupta
Department of Microbiology, Mamata Medical College, Khamam, Andhra Pradesh
India




How to cite this article:
Hemachander S S, Gupta D. A paralytic disease with presentation of food poisoning affecting three members of a family at Khammam, Andhra-Pradesh.Indian J Public Health 2010;54:45-46


How to cite this URL:
Hemachander S S, Gupta D. A paralytic disease with presentation of food poisoning affecting three members of a family at Khammam, Andhra-Pradesh. Indian J Public Health [serial online] 2010 [cited 2019 Sep 20 ];54:45-46
Available from: http://www.ijph.in/text.asp?2010/54/1/45/70555


Full Text

Sir,

We report three cases of paralytic disease with a presentation of food-poisoning. On 21 st July, 2009, three patients came to Casualty of General Hospital, Khammam, A.P with presenting symptoms of vomiting and difficulty in opening the eyes. The patients were a male child of six years, 30 years old female (mother of the child) and her brother of 35 years. All of them ate dhal, curry and pickle etc. at a roadside dhaba on the previous evening (20.07.09) at around 7 p.m. Vomiting developed at 5 a.m. on the next day morning and they came to Casualty at 9 a.m. with features of ocular paresis, hypotonia, respiratory distress etc. but no diarrhoea. The child died some time after entering the hospital. The other two with respiratory distress were put on mechanical ventilators. They were taken out of hospital by the family members against medical advice and died a few days later at Hyderabad. Their autopsy findings were uncharacteristic [Table 1].{Table 1}

A febrile patients with progressive descending paralysis in the presence of gastrointestinal manifestations (with vomiting but no diarrhoea) lead to the clinical diagnosis of food-borne botulism which is a rare illness caused by eating foods contaminated with botulinum toxin produced by anaerobic spore-forming Gram positive bacilli. Not only Clostridium botulinum, other species namely C.butyricum and C.baratii can also produce neurotoxin causing similar illness. Absence of fever and presence of progressive descending paralysis associated with gastrointestinal manifestations (with vomiting but no diarrhoea) clinch the clinical diagnosis of food-borne botulism. Other conditions for differential diagnosis like organophosphorus poisoning, snake bite etc. have been excluded (absence of miosis of pupils, salivation, lacrimation, urinary incontinence, bite marks etc.). Although ptosis and dysarthria may be signs of encephalopathy, patients were fully alert and the results of sensory examination were normal. Lack of awareness about botulism results in failure to collect the necessary samples from the patients and food materials for confirmatory tests as it happened in our cases. The aim of the study is to increase awareness about the possibility of botulism in cases of progressive descending paralysis associated with food-poisoning. Awareness increases the chances of putting on specific treatment for botulism like metronidazole and antitoxin therapy. Food-borne botulism represents a public health emergency because of the potential severity of the disease and the possibility of mass exposure of the contaminated products.