Late Effects of Botulinum Intoxication

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To the Editor.— After reading the article by Barker et al (237:456,1977) regarding the outbreak of bolulism and the subsequent management of the involved patients, we had occasion to examine their case 1 3 1/2 years after his intoxication. He was seen because of persistent fatigue, intermittent diplopia, and decreased sexual ability. Prior to the patient's botulism intoxication, he was physically and sexually active for his age; subsequent to this, although not incapacitating, these symptoms remain substantially distressing and have resulted in multiple consultations with different specialists. Barker et al reported good, immediate response to the trivalent botulism antitoxin and further commented that all cases of intoxication returned to normal after a few weeks. Although this is usually the case with botulism intoxication, we believe it is quite easy to overlook, at times, the subtle disturbances that may persist but are not incapacitating. Cherington1notes, for example, that recovery

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