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February 2, 1979

The Clinical Recognition of Botulism

Author Affiliations

University of Illinois at the Medical Center Chicago

JAMA. 1979;241(5):503-504. doi:10.1001/jama.1979.03290310043016

In this issue of The Journal (p 475), Terranova and colleagues describe the ocular and neurologic findings in a group of 59 persons involved in a common-source outbreak of type B botulism. This is the largest outbreak of botulism yet reported in the United States, and it afforded an opportunity for the prospective and systematic observation of the evolving signs and symptoms of the disease. In this outbreak all affected persons noted a dry mouth, and 51 (86%) had difficulty focusing to a near point or had diplopia before they visited a physician. Bilateral abducens nerve palsy developed in nearly all persons. Signs of bilateral severe third cranial nerve palsy were of prognostic importance. Among 11 persons in whom all three signs of third nerve palsy-medial rectus palsy, ptosis, and sluggishly reacting pupils developed, eight subsequently had respiratory insufficiency. Noteworthy respiratory insufficiency subsequently developed in only one patient without all