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Signs and Symptoms Predictive of Respiratory Failure in Patients with Foodborne Botulism in Thailand

We conducted a clinical study of 137 patients with home-canned bamboo shoot botulism at Nan Hospital, northern Thailand. The median age of the patients was 44 years (range = 14–74 years) and 36.2% were male. The median incubation period was 2 days (range = 1–8 days). Forty-three patients (31.4%) developed respiratory failure, but there were no deaths. Patients who did not have either nausea or vomiting and did not have urinary retention that required Foley catherization was less likely to develop respiratory failure. This clinical predictor rule had a sensitivity of 75.5% and a specificity of 90.7%. The clinical syndrome most predictive of respiratory failure was nausea or vomiting and any cranial neuropathy with urinary retention or difficulty swallowing. This clinical syndrome had a sensitivity of 69.8% and a specificity of 93.6%. These clinical characteristics could help triage large numbers of patient in the event of a future outbreak.

Received January 22, 2007. Accepted for publication May 1, 2007.

Acknowledgments: We thank the doctors, nurses, and medical technologists of Nan Hospital for their cooperation and help during the study, and Dr. Sumalee Kiatboonsri (Faculty of Medicine Ramathibodi, Mahidol University) for her help in management of patients during the outbreak.

^* Address correspondence to Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Bangkok-noi, Bangkok 10700, Thailand. E-mail: siysp{at}mahidol.ac.th

Authors’ addresses: Manas Wongtanate, Niwatchai Sucharitchan, Kanit Tanisiriwit, Petchdee Oranrigsupak, Aphinya Chuesuwan, and Sukumal Toykeaw, Department of Medicine, Nan Hospital, 1 Worawichai Road, Amphur Mueng, Nan 55000 Thailand, Telephone: 66-54-751-865, Fax: 66-54-710-977, E-mails: manas wongtanate{at}hotmail.com, ni_watchai{at}yahoo.co.th, kanit_tantisiriwit{at}hotmail.com, krai{at}krairoek-wsanook.com, aphinya{at}yahoo.com, and sukumal2508{at}yahoo.com. Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Bangkok-noi, Bangkok 10700, Thailand, Telephone: 66-2-419-7203, Fax: 66-2-412-5994, E-mail: siysp{at}mahidol.ac.th.

Reprint requests: Yupin Suputtamongkol, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Bangkok-noi, Bangkok 10700, Thailand.

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