Published Date: 2011-07-07 17:29:09
Subject: PRO/EDR> Botulism, commercial potato soup - USA: (OH,GA)
Archive Number: 20110707.2058
BOTULISM, COMMERCIAL POTATO SOUP - USA: (OHIO, GEORGIA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Thu 7 Jul 2011
Source: MMWR Morb Mortal Weekly Rep 2011; 60: 890 [edited]
In January and April 2011, the Centers for Disease Control and
Prevention (CDC) provided antitoxin for treatment of 2 people with
toxin type A botulism associated with consumption of potato soup
produced by 2 companies.
On 28 Jan 2011, an Ohio resident, aged 29 years, was hospitalized
after 5 days of progressive dizziness, blurred vision, dysphagia, and
difficulty breathing. The patient required mechanical ventilation and
botulism antitoxin. On 28 Jan 2011, he had tasted potato soup from a
bulging plastic container, noted a bad taste, and discarded the
remainder. The soup had been purchased on 7 Dec 2010, from the
refrigerated section of a local grocer, but it had been kept
unrefrigerated for 42 days. He was hospitalized for 57 days and then
was transferred with residual weakness to a rehabilitation facility.
On 8 Apr 2011, a Georgia resident, aged 41 years, was hospitalized
after 4 days of progressive dizziness and dysphagia. The patient
developed respiratory distress, required mechanical ventilation, and
was treated with botulism antitoxin. On 3 Apr 2011, she had tasted
potato soup purchased from a local grocer, noted a sour taste, and
discarded the remainder. The soup, stored in a plastic container
labeled "keep refrigerated" in letters 1/8 inch tall, had been
purchased on 16 Mar 2011, but had been left unrefrigerated for 18
days. She was hospitalized for 16 days and then was transferred with
residual weakness to a rehabilitation facility.
Botulism is caused by a paralyzing toxin produced by _Clostridium
botulinum_ bacteria. _C. botulinum_ spores are present in soil and can
be found on raw produce, especially potatoes and other root vegetables
(1). If a low-acid food such as potato soup is stored un-refrigerated
in an anaerobic environment (for example, a sealed container), without
a barrier to bacterial growth, spores can germinate, resulting in
bacterial growth and botulinum toxin production (2). Because heating
food to a temperature of 185 F (85 degrees C) for 5 minutes
inactivates the toxin, proper preparation also is an important
Improper storage has been documented in previous botulism outbreaks
associated with commercially produced, chilled foods. Since 1975, 19
American botulism cases were linked to 6 such products. Demand for
prepared, chilled foods is increasing (4). Labels advising
refrigeration might be ignored or not noticed and do not warn about
the danger of consuming unrefrigerated food. The FDA is reexamining
labeling requirements. Storage at an improper temperature also can
occur before products reach consumers (5). To inhibit the growth of
_C. botulinum_ and other microbes, an acidifying agent or other
microbial inhibitor, such as citric or phosphoric acid, can be added
to prepared, chilled foods before they are sealed in a package. This
procedure was used successfully to reduce the danger of botulism from
commercial garlic-in-oil products after 2 outbreaks (6).
[authors: Seaman MP, Sulka AC, D'Angelo MT, et al]
1. Angulo FJ, Getz J, Taylor JP, et al. A large outbreak of botulism:
the hazardous baked potato. J Infect Dis 1998; 178: 172-7.
2. Sheth AN, Wiersma P, Atrubin D, et al. International outbreak of
severe botulism with prolonged toxemia caused by commercial carrot
juice. Clin Infect Dis 2008; 47: 1245-51.
3. Sobel J. Botulism. Clin Infect Dis 2005; 41: 1167-73.
4. Peck MW. _Clostridium botulinum_ and the safety of minimally
heated, chilled foods: an emerging issue? J Appl Microbiol 2006; 101:
5. Kalluri P, Crowe C, Reller M, et al. An outbreak of foodborne
botulism associated with food sold at a salvage store in Texas. Clin
Infect Dis 2003; 37: 1490-5.
6. Morse DL, Pickard LK, Guzewich JJ, Devine BD, Shayegani M.
Garlic-in-oil associated botulism: episode leads to product
modification. Am J Public Health 1990; 80: 1372-3.
[Lessons for the consumer from these cases:
1. Commercially prepared foods are not exempt from the risk of
2. If the product is sold from the refrigerated section, there is a
reason to continue this storage technique when the product enters the
3. Cans or plastic containers that are bulging should NEVER be opened
by the consumer, let alone consuming the contents.
4. The contents of such bulging containers should not even be
sniffed, as the toxin can be aerosolized.
Classically, botulism is a foodborne disease caused by the ingestion
of preformed toxin, although there also exists wound botulism (in
which _C. botulinum_ spores germinate in a wound), and infant botulism
(in which the spores germinate in the intestinal tract). There are a
number of types of botulism toxins that are immunologically distinct
and work at a variety of sites of the neuromuscular junction to block
acetylcholine neuromuscular transmission. - Mod.LL]