Volume 77, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


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.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. Arnon S, Schechter C, Inglesby TV, Henderson DA, Bartlett JG, Axcher MS, Eitzen E, Fine AD, Hauer J, Laytoon M, Lillbridge S, Osterholm MT, O’Toole T, Parker G, Perl TM, Russell PK, Swerdlow DL, Tonat K; Working Group on Civilian Biodefense, 2001. Botulinum toxin as a biological weapon: medical and public health management. JAMA 285 : 1059–1070. [Google Scholar]
  2. Shapiro RL, Hatheway C, Becher J, Swerdlow DL, 1997. Botulism surveillance and emergency response: a public health strategy for a global challenge. JAMA 278 : 433–435. [Google Scholar]
  3. Cherington M, 2004. Botulism: update and review. Semin Neurol 24 : 155–163. [Google Scholar]
  4. Tacket CO, Shandera WX, Mann JM, Hargrett NT, Blake PA, 1984. Equine antitoxin used and other factors that predict outcome in type A foodborne botulism. Am J Med 76 : 794–798. [Google Scholar]
  5. Varma JK, Katsitadze G, Moiscrafishvili M, Zardiashvili T, Chokheli M, Tarkhashvili N, Jhorjholiani E, Chubinidze M, Kukhalashvili T, Khmaladze I, Chakvetadze N, Imnadze P, Hoekstra M, Sobel J, 2004. Signs and symptoms predictive of death in patients with foodborne botulism-Republic of Georgia, 1980– 2002. Clin Infect Dis 39 : 357–362. [Google Scholar]
  6. Centers for Diseases Control and Prevention, 2006. Botulism from home-canned bamboo shoots – Nan Province, Thailand, March 2006. MMWR Morb Mortal Wkly Rep 55 : 389–392. [Google Scholar]
  7. Kongsaengdao S, Samintarapanya K, Rusmeechan S, Wongsa A, Pothirat C, Permpikul C, Pongpakdee S, Puavilai W, Kateruttanakul P, Phengtham U, Panjapornpon P, Janma J, Piyavechviratana K, Sithinamsuwan P, Deesomchok A, Tongyoo S, Vilaichone W, Boonyapisit K, Mayotarn S, Piya-Isragul B, Rattanaphon A, Intalapaporn P, Dusitanond P, Harnsomburana P, Laowittawas W, Chairangsaris P, Suwantamee J, Wongmek W, Ratanarat R, Poompichate A, Panyadilok H, Sutcharitchan N, Chuesuwan A, Oranrigsupau P, Sutthapas C,Tanprawate S, Lorsuwansiri J, Phattana N; Thai Botulism Study Group, 2006. An outbreak of botulism in Thailand: clinical manifestations and management of severe respiratory failure. Clin Infect Dis 43 : 1247–1256. [Google Scholar]
  8. Breiman L, Friedman JH, Olshen RA, Stone CJ, 1984. Classification and Regression Tree. Belmont, CA: Wadsworth International.
  9. Schmidt-Nowara WW, Samet JM, Rosario PA, 1983. Early and late complications of botulism. Arch Intern Med 143 : 451–456. [Google Scholar]
  10. Paust J, 1971. Respiratory care in acute botulism: a report of four cases. Anesth Analg 50 : 1003–1009. [Google Scholar]
  11. Christian E, Murin S, Murin S, 2001. Clinical predictors of respiratory failure and long-term outcomes in black tar heroin-associated wound botulism. Chest 120 : 562–566. [Google Scholar]
  12. Swaddiwudhipong W, Wongwatcharapaiboon P, 2000. Food-borne botulism outbreaks following consumption of home-canned bamboo shoots in northern Thailand. J Med Assoc Thai 83 : 1021–1025. [Google Scholar]
  13. Centers for Disease Control and Prevention, 1999. Foodborne botulism associated with home-canned bamboo shoots— Thailand. MMWR Morb Mortal Wkly Rep 48 : 437–439. [Google Scholar]

Data & Media loading...

  • Received : 22 Jan 2007
  • Accepted : 01 May 2007

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error