Food-borne Botulism Type B Outbreak associated with Fermented Soybeans, Maehongson Province, Thailand, December 2010
Keywords:
Food-borne, botulism, fermented, home-made, soybeans, cooking process, ThailandAbstract
Background: Fermented soybeans have never been linked with botulism in Thailand. In December 2010, 3 patients with acute gastroenteritis and descending paralysis were notified from Maehongson, a northern province with concentrated hilltribe population. An investigation was conducted to determine etiology, identify source of infection, and implement control measures.
Methods: We reviewed medical records of admitted patients and performed active case finding. A suspected case was defined as a resident in a hilltribe village who developed at least two of the following symptoms: diplopia/blurred vision, ptosis, dry mouth, dysarthia, dysphagia, dyspnea, or extremity weakness during November 15-December 15, 2010. A laboratory-confirmed case was identified by presence of botulinum toxin or positive culture for C.botulinum. Environmental inspection and review of cooking process of the suspected food was performed.
Results: Of 9 villagers who ate fermented soybeans, 3(33.3%) met a suspected case definition. They ingested >50 grams of fermented soybeans before developing symptoms. All cases were hospitalized; one required ventilator; no deaths occurred. Other two (22.2%) persons who ingested <50 grams developed gastroenteritis only. Leftover fermented soybeans and stool specimens collected from 2 cases were tested positive for botulinum toxin type B. Investigation revealed the index case cooked fermented soybeans first time ever and her cooking process was different from experienced cooks including: short boiling time <2 hours, low salt addition level, and no draining of fluid by products.
Conclusions: A point source outbreak of food-borne botulism type B was associated with home-made fermented soybeans. Improper cooking by inexperienced villager may have fostered C.botulinum growth and toxin formation. To prevent future botulism outbreak, raising awareness of botulism related to home-made fermented food and proper cooking process should be widely promoted.
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