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Àngels Gispert Ametller, Patricia Ortiz Ballujera, Raquel Aguilar Salmerón" "autores" => array:3 [ 0 => array:4 [ "nombre" => "M. Àngels" "apellidos" => "Gispert Ametller" "email" => array:1 [ 0 => "magisp77@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Patricia" "apellidos" => "Ortiz Ballujera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Raquel" "apellidos" => "Aguilar Salmerón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Urgencias, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Farmacia Hospitalaria, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Brote de botulismo por consumo de alubias" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Food-borne botulism is a potentially life-threatening poisoning due to neuromuscular paralysis caused by the <span class="elsevierStyleItalic">Clostridium botulinum</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> toxin.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There are 8 types of toxins described, of which A, B and E are the most common cause of disease in humans.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Diagnosis is clinical, based on epidemiological history and physical examination.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The classic form of presentation consists of symmetric and descending flaccid paralysis, beginning with bilateral involvement of cranial nerves.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Trivalent equine serum is the only specific treatment in our healthcare environment.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Early admission to an intensive care unit (ICU) in case of respiratory deterioration improves the prognosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">We report the multidisciplinary work that was carried out to diagnose 2 male patients aged 55 and 50 years, affected by botulism due to the consumption of tinned beans and cod, in the form of a cold salad, during a lunch-break at work.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In this meal there were 7 more people, who had the same type of salad, with ingredients from other food containers.</p><p id="par0045" class="elsevierStylePara elsevierViewall">At 6<span class="elsevierStyleHsp" style=""></span>h of intake, the first patient started to experience blurred vision and muffled speech. The second patient perceived the symptoms 14<span class="elsevierStyleHsp" style=""></span>h after eating, with dizziness and heavy eyelids.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The following morning, the patients went to the Emergency Department of Hospital Palamós, where the clinical suspicion was established, reporting the 2 possible cases to the Emergency Epidemiological Surveillance Service of Catalonia (SUVEC) and referred the patients to the Josep Trueta reference hospital.</p><p id="par0055" class="elsevierStylePara elsevierViewall">The clinical toxicology unit (CTU) proceeded to obtain botulism antitoxin, as it was not available in our center. The antidote network of Catalonia was activated,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> requesting to borrow 5 antidote units. Simultaneously, more antitoxin units were found in other centers, in case their use was necessary.</p><p id="par0060" class="elsevierStylePara elsevierViewall">On arrival at our center, cranial nerves III, IV, VI, XII were involved in the case of the first patient, with a forced expiratory flow (FEF) of 97% of the predicted value. The second patient had cranial nerves III, IV and VI involved, conjunctival erythema, dry mouth and FEF of 73%.</p><p id="par0065" class="elsevierStylePara elsevierViewall">They were admitted to the ICU for treatment and monitoring. 29<span class="elsevierStyleHsp" style=""></span>h after ingestion, they were given the first 250<span class="elsevierStyleHsp" style=""></span>ml dose of trivalent antitoxin.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">From CTU, in coordination with the SUVEC, blood and stool samples were sent to the National Center of Microbiology of the Instituto de Salud Carlos III in Madrid, for the microbiological analysis and identification of the causative toxin. Also, the tins of beans and the cod containers from which the patients had eaten.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mouse bioassay was positive for patient stool samples and for one of the cans of beans, without identifying the causative toxin.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The Public Health Agency of Catalonia identified the batches of cod and beans that could be affected, forcing their market withdrawal and establishing a health alert to inform the population.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The second patient was discharged 45 days after admission and the first at day 112, both with minimal sequelae.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Although a rare disease, botulism can be fatal.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> Preventive strategies are the most important measures to avoid contamination and are focused on adequate food conservation and handling.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Under optimum environmental conditions (anaerobiosis, low acid medium and temperature between 25 and 37<span class="elsevierStyleHsp" style=""></span>°C) spores can germinate, thus becoming bacilli producing toxins.</p><p id="par0095" class="elsevierStylePara elsevierViewall">The outbreak we have described is the first one registered in Catalonia caused by tinned foods, as it is usually associated with homemade food preparations.</p><p id="par0100" class="elsevierStylePara elsevierViewall">The diagnosis is clinical. Intensive monitoring is necessary if suspected, with constant evaluation of the ventilatory status.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">It is a notifiable disease. Coordination with epidemiological surveillance services is essential to establish the origin of the outbreak and to take appropriate preventive measures.</p><p id="par0110" class="elsevierStylePara elsevierViewall">The availability of botulism antitoxin in hospitals is low. The existence of an antidote network expedites finding the antitoxin and facilitates its early administration.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The creation of CTU to coordinate the various stakeholders involved in the diagnosis and treatment of botulism-poisoned patients is paramount.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gispert Ametller MÀ, Ortiz Ballujera P, Aguilar Salmerón R. Brote de botulismo por consumo de alubias. Med Clin (Barc). 2017;149:511–512.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Nogué S. Intoxicaciones agudas. Bases para el tratamiento en un servicio de urgencias. [consulted 12 May 2017]. Available in: <a href="http://www.fetoc.es/asistencia/Intoxicaciones%20Agudas%20Protocolos%202010.pdf">http://www.fetoc.es/asistencia/Intoxicaciones%20Agudas%20Protocolos%202010.pdf</a>" ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Pegram PS, Stone SM. Botulism literature review current through: Jan 06, 2017. [consulted 12 May 2017]. 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García-Peláez" 3 => "A. Broto-Sumalla" 4 => "L. Martínez-Sánchez" 5 => "S. Nogué-Xarau" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7399/fh.2017.41.3.10507" "Revista" => array:6 [ "tituloSerie" => "Farm Hosp" "fecha" => "2017" "volumen" => "41" "paginaInicial" => "317" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28478747" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014900000011/v1_201712130718/S2387020617307088/v1_201712130718/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014900000011/v1_201712130718/S2387020617307088/v1_201712130718/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020617307088?idApp=UINPBA00004N" ]
Journal Information
Vol. 149. Issue 11.
Pages 511-512 (December 2017)
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Vol. 149. Issue 11.
Pages 511-512 (December 2017)
Letter to the Editor
Outbreak of botulism due to consumption of beans
Brote de botulismo por consumo de alubias
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