LABORATORY DIAGNOSIS IN A LARGE OUTBREAK OF TYPE A BOTULISM

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Abstract
Coproexamination is a vital component of the laboratory evaluation of botulism and is an essentiai part of the investigation of suspected botuiism cases. In April 1978, type A botulism developed in 34 persons who had eaten at a restaurant in a town in New Mexico. Pretreatment serum specimens, along with stool specimens for toxin assay and cuiture for Clostridlum botulinum, were obtained. At ieast one specimen (serum or stooi) was avail able for each patient. Of 30 serum specimens, 16 (53%) were toxin positive; seven (32%) of 22 stools were toxin positive; and C. botullnum type A was cultured from 19(79%) of 24 stool specimens. Overaii, laboratory confirmation was avaiiabie for 26 cases (76%). Serum and stool toxin detection was related both to the time elapsed between symptom onset and specimen coiiection and to the severity of iliness, with shorter times and severe iliness associated with higher rates of toxin detection. Recovery of C. botuilnum type A did not vary appreciabiy according to these factors. in 18 cases, both serum and stooi specimens were available; the proportion of suspected cases that couid be iaboratory-proven increased by 46% when patients' feces, and not Just their sera, were subjected to botuiism testing procedures.

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