July 27, 2007

This Health Advisory describes the risk of exposure to botulinum toxin from canned food products (and dog food) produced by Castleberry's Food Company of Augusta, Ga. Botulism is a neuroparalytic illness caused by neurotoxins produced by the spore−forming bacterium Clostridium botulinum. Prompt diagnosis, early treatment, and rapid reporting to public health officials are essential to minimize the severity of the illness and the number of persons affected. All suspected cases of botulism should be immediately reported to the Missouri Department of Health and Senior Services (DHSS) at 800/392-0272 (24 hours a day − 7 days a week). If indicated, DHSS will immediately contact the Centers for Disease Control and Prevention (CDC) to report the suspected case(s), arrange for a clinical consultation by telephone and, if appropriate, request release of botulinum antitoxin from CDC. Also, if indicated, arrangements will be made for the shipment of samples to CDC for testing.

The U.S. Food and Drug Administration (FDA) is warning consumers and pet owners regarding canned food products and dog food produced by Castleberry's Food Company of Augusta, Ga., due to the risk of botulinum toxin. Two children in Texas and an Indiana couple who ate some of these products became seriously ill and have been hospitalized. A news release from FDA, last revised on July 23, 2007, is provided on pages 3−4. Specific food products under FDA jurisdiction that have been recalled are listed. Additional products under the jurisdiction of the U.S. Department of Agriculture/Food Safety and Inspection Service (USDA/FSIS) have also been recalled. For a complete list of all recalled products (as of July 23, 2007), go to the DHSS Food Recalls website. If additional information subsequently becomes available, it will be provided on this site. New information may also become available on the FDA website and the USDA/FSIS website.

CDC has developed a series of questions and answers for consumers related to this situation, including recommendations for those who may have consumed a recalled product. Please see the FAQ page here.

Foodborne botulism follows ingestion of botulinum toxin produced in food by C. botulinum. There is no person−to−person transmission. The incubation period for foodborne botulism is typically 12−36 hours after toxin ingestion, but in rare cases as early as 6 hours or as late as 10 days after ingesting the toxin.

Signs/symptoms include symmetric cranial neuropathies such as diplopia, drooping eyelids, difficulty swallowing, dry mouth, altered voice, or difficulty speaking. There is symmetric descending flaccid paralysis in a proximal to distal pattern. Abdominal pain, nausea, vomiting, and diarrhea may, or may not, be seen. The disease process may progress to respiratory dysfunction from respiratory muscle paralysis. Note that botulism differs from other flaccid paralyses in that it always manifests initially with prominent cranial paralysis and its invariable descending progression, in its symmetry, and in its absence of sensory nerve damage.

Clinical diagnosis of botulism is confirmed by specialized laboratory testing that often requires days to complete. Routine laboratory test results are usually unremarkable. CSF studies are essentially normal although occasionally a borderline elevation in protein level is seen. A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. Normal CTs and MRIs help to rule out CVA.

Initial diagnosis and appropriate treatment depend on clinical diagnosis through a thorough history and physical examination. Treatment and management decisions should be made based on clinical diagnosis without waiting for laboratory confirmation.

Laboratory confirmation is done by demonstrating the presence of toxin in serum, stool, or food, or by culturing C. botulinum from stool, a wound or food.

Patients with botulism should receive botulinum antitoxin as soon as possible. Antitoxin does not reverse paralysis but arrests its progression. Medical care providers who suspect botulism in a patient should immediately call the Missouri Department of Health and Senior Services' (DHSS') emergency telephone number (800/392-0272, 24 hours a day − 7 days a week). If indicated, DHSS will immediately contact CDC to report the suspected case(s), arrange for a clinical consultation by telephone and, if indicated, request release of botulinum antitoxin from CDC. Also, if indicated, arrangements will be made for the shipment of samples to CDC for testing (the Missouri State Public Health Laboratory is not equipped to process specimens for botulinum toxin).

Meticulous intensive care should be exercised, including monitoring of respiratory function and, when required, artificial ventilation. Recovery follows the regeneration of new neuromuscular connections, and 2−8 weeks of ventilatory support may be required in more severe cases.

More information on botulism is available at the DHSS website here. Questions should be directed to DHSS' Bureau of Communicable Disease Control and Prevention at 573/751-6113 or 866/628-9891.

Listing of Contaminated Products