Emergency response to a cluster of suspected foodborne botulism in Abuja, Nigeria: challenges with diagnosis and treatment in a resource-poor setting

Abstract

Food-borne botulism is a rare, acute and potentially
fatal neurologic disorder that results from ingestion
of food contaminated by botulinum toxin released
from the anaerobic, spore-forming, gram-positive
bacterium Clostridium botulinum. We reported an
unusual cluster of botulism outbreak with high case
fatality affecting a family following ingestion of
home-made fish. A suspected outbreak of botulism
affecting three patients in a family of six was
reported to the Nigeria Centre for Disease Control.
A rapid response team investigated by line-listing all
the family members, interviewed extended family
members, caregivers, clinicians, and nurses to
collect socio-demographic and clinico
epidemiological information using a semistructured questionnaires. We collected blood from
patients and food samples and locally made drink
from the family home for laboratory testing. All
family members ingested the same home-made
food within the 48hrs before onset of symptoms in
the index case. The clinical presentation of the three
affected cases (AR=50.0%) was consistent with
botulinum poisoning. Two of the affected cases died
(CFR=66.7%) within 48hrs of admission, before
antitoxin was made available. The third case had a
milder presentation and survived, after
administration of appropriate antitoxin. The
remaining three children developed no symptoms.
None of the samples cultured Clostridium
botulinum. The blood samples were negative for
mouse lethality test. Our report describes the
challenges of diagnosis and management of rare
emerging infectious disease outbreaks in resourceconstrained settings.