Clinical cases of atypical and severe botulism


  • O. L. Ivakhiv I. Horbachevsky Ternopil National Medical University, Ukraine,
  • N. Yu. Vyshnevska I. Horbachevsky Ternopil National Medical University, Ukraine,



botulism, ophthalmoplegia, diagnosis, antitoxins, treatment



The aim of the work was to present two clinical cases of botulism: the atypical course and the severe course with late administration of heptavalent botulinum antitoxin, which still had a significant positive clinical effect and contributed to a faster recovery of patients.

The modern scientific literature regarding botulism was analyzed, hospital records of patients with botulism were presented.

Conclusions. Characteristic symptoms of botulism are sometimes absent, for example, the inability to read the fine print, which is a significant challenge in diagnosing the disease. Atonic tetraparesis, dysmetabolic polyneuropathy of the lower extremities may be occasionally developed as a complication of botulism. In suspected case of botulism, even with a fuzzy epidemiological anamnesis and an unusual clinical picture, a targeted, specific examination and immediate administration of antitoxins are indicated. The heptavalent botulinum antitoxin has a significant clinical effect, contributes to recovery even at the late stages of a patient hospitalization.



Jeffery, I. A., & Karim, S. (2017). Botulism. StatPearls. [Internet]. Treasure Island (FL): StatPearls Publishing.

Schulte, M., Hamsen, U., Schildhauer, T. A., & Ramczykowski, T. (2017). Effective and rapid treatment of wound botulism, a case report. BMC Surgery, 17(1).

Jackson, L., Madan-Khetarpal, S., Naik, M., Michaels, M., & Riley, M. (2017). Infant Botulism in the Very Young Neonate: A Case Series. American Journal of Perinatology Reports, 7(3), e163-e166.

Коpchа, V. S., & Bоrаk, V. Т. (2014). Vypadok iniektsiinoho botulizmu. [Case of injection botulism]. Infektsiini khvoroby, (4), 88-90. [in Ukrainian].

You, G., Khan, A., Shor, J., & Forester, G. P. (2016). Rapidly Progressive Muscle Paralysis and Acute Respiratory Failure Following Endoscopic Botulinum Toxin Injection. ACG Case Reports Journal, 3(1), Article e166.

Rafie, S., Salmanzadeh, S., Mehramiri, A., & Nejati, A. (2017). Botulism Outbreak in a Family after Ingestion of Locally Produced Cheese. Iran Jornal of Medical Sciences, 42(2), 201-204.

Mezencev, R., & Klement, C. (2017). Foodborne botulism - a re-emerging public health challenge. Epidemiologie, Mikrobiologie, Imunologie, 66(1), 39-48. [in Czech].

Shaffer, N., Wainwright, R. B., Middaugh, J. P., & Tauxe, R. V. (1990). Botulism among Alaska Natives. The role of changing food preparation and consumption practices. Western Journal of Medicine, 153(4), 390-393.

Gao, Q. Y., Huang, Y. F., Wu, J. G., Liu, H. D., & Xia, H. Q. (1990). A review of botulism in China. Biomedical and Environmental Sciences, 3(3), 326-336.

Centers for Disease Control and Prevention (CDC). (2007). Botulism associated with commercially canned chili sauce – Texas and Indiana, July 2007. Morbidity and Mortality Weekly Report (MMWR), 56(30), 767-769.

Sobel, J., Tucker, N., Sulka, A., McLaughlin, J., & Maslanka, S. (2004). Foodborne Botulism in the United States, 1990-2000. Emerging Infectious Diseases, 10(9), 1606-1611.

Centers for Disease Control and Prevention (CDC). (2019). Botulism Annual Summary, 2017. Atlanta, Georgia: U.S. Department of Health and Human Services, CDC. Reviewed January 15, 2020.

McLauchlin, J., Grant, K. A., & Little, C. L. (2006). Food-borne botulism in the United Kingdom. Journal of Public Health, 28(4), 337-342.

HPA Centre for Infections. (2009, March 31). Guidelines for Action in the Event of a Deliberate Release: Botulism, Version 4.5.1.

Public Health England. (2014, January 31). Foodborne Botulism Laboratory reported cases of Clostridium botulinum intoxication reported to Public Health England, England and Wales 1980 – 2013.

Drivenes, B., Krause, T. G., Andersson, M., Müller, L., Fuursted, K., Pedersen, T., Hansen, A. K., & Børresen, M. L. (2017). Infant botulism in Denmark from 1995 to 2015. Danish Medical Journal, 64(9), Article A5404.

Gutmann, L., Bodensteiner, J., & Gutierrez, A. (1992). Electrodiagnosis of botulism. The Journal of Pediatrics, 121(5), Article 835.

Roman, M. G., Humber, J. Y., Hall, P. A., Reddy, N. R., Solomon, H. M., Triscott, M. X., Beard, G. A., Bottoms, J. D., Cheng, T., & Doellgast, G. J. (1994). Amplified Immunoassay ELISA-ELCA for Measuring Clostridium botulinum Type E Neurotoxin in Fish Fillets. Journal of Food Protection, 57(11), 985-990.

Arnon, S. S., Schechter, R., Maslanka, S. E., Jewell, N. P., & Hatheway, C. L. (2006). Human Botulism Immune Globulin for the Treatment of Infant Botulism. New England Journal of Medicine, 354(5), 462-471.

Nikiforov, V. V., Tomilin, Yu. N., Chernobrovkinya, T. Ya., Yankovskaya, Y. D., & Burova, S. V. (2019). Trudnosti rannei diagnostiki i lecheniya botulizma [The difficulties of early diagnosis and treatment of botulism]. Arhivʺ vnutrennej mediciny, (4), 253-259. [in Russian].

Kyrychenko, P. D., Voinalovych, O. O., & Kostur, M. Y. (2001). Profilaktyka uskladnen seroterapii pry botulizmi. [Neuroinfections. Other infectious diseases]. Neiroinfektsii. Inshi infektsiini khvoroby. Proceedings of the Scientific and Practical Conference and Plenum of Ukrainian Association of Infectionists (pp. 70-71). Ukrmedknyha. [in Ukrainian].

Pak, S. G., Коkоrеvа, L. N., & Shuba, L. I. (2005). Botulizm [Botulism]. Meditsinskaya pomoshch', (1), 43-45. [in Russian].

Маliy, V. P. (2012). Pishchevoi botulizm. [Food botulism]. Klinichna imunolohiia. Alerholohiia. Infektolohiia, (3), 15-25. [in Russian].


How to Cite

Ivakhiv OL, Vyshnevska NY. Clinical cases of atypical and severe botulism. Zaporozhye Medical Journal [Internet]. 2020Apr.13 [cited 2024Jul.17];22(2). Available from:



Case Reports