title: A massive outbreak of type E botulism associated with traditional salted fish in Cairo.
abstract: In April 1991, 91 hospitalized patients in Cairo were reported to the Egyptian Ministry of Health with botulism intoxication. To define the spectrum of illness and identify a food vehicle, 45 patients were interviewed and a case-control investigation was conducted among families of 5 hospitalized patients. Clinical specimens and specimens of implicated food were tested for toxin and cultured for Clostridium botulinum. Hospitalized patients had symptoms consistent with botulism; 18 (20%) of 91 reported patients died. Illness was associated with eating faseikh (uneviscerated, salted mullet fish; lower 95% confidence limit of odds ratio = 6.6, P < .001). All 5 case-families purchased faseikh from one shop. Very high levels of type E botulinal toxin were detected in faseikh reported to be purchased from the implicated shop; C. botulinum type E was isolated from cultures of clinical specimens and from the faseikh. This is the first documented outbreak of botulism in Egypt and the largest type E outbreak ever reported.
authors.affiliation: Enteric Diseases Branch, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: J T
authors.initials: JT
authors.lastname: Weber
authors.forename: R G
authors.initials: RG
authors.lastname: Hibbs
authors.forename: A
authors.initials: A
authors.lastname: Darwish
authors.forename: B
authors.initials: B
authors.lastname: Mishu
authors.forename: A L
authors.initials: AL
authors.lastname: Corwin
authors.forename: M
authors.initials: M
authors.lastname: Rakha
authors.forename: C L
authors.initials: CL
authors.lastname: Hatheway
authors.forename: S
authors.initials: S
authors.lastname: el Sharkawy
authors.forename: S A
authors.initials: SA
authors.lastname: el-Rahim
authors.forename: M F
authors.initials: MF
authors.lastname: al-Hamd
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001905:Botulinum Toxins / Q000032:analysis; D001906:Botulism / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003014:Clostridium botulinum / Q000302:isolation & purification; D004196:Disease Outbreaks; D004534:Egypt / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005396:Fish Products / Q000506:poisoning*; D005766:Gastrointestinal Contents / Q000737:chemistry / Q000382:microbiology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010473:Perciformes
chemical_list: D001905:Botulinum Toxins