title: Two-family outbreak of botulism associated with the consumption of smoked ribs in Sichuan Province, China.
abstract: BACKGROUND
  On September 22, 2013, two patients from Sichuan Province, China presented with symptoms of food-borne botulism, a rare but fatal illness caused by the consumption of foods containing Clostridium botulinum neurotoxins.
  
  
  METHODS
  Investigators reviewed the medical charts and food consumption histories, and interviewed patients and family members. Food samples and clinical specimens were tested for botulinum toxin and neurotoxin-producing Clostridium species by standard methods.
  
  
  RESULTS
  The first two index cases presented with cranial neuropathies and flaccid paralysis, and required mechanical ventilation. There were 12 confirmed outbreak-associated cases. Botulinum toxin type A was identified in the smoked ribs, and all of the patients had consumed the smoked ribs from the same local restaurant. The smoked ribs contained no added salt, sugar, or preservative. Botulinum toxin production likely resulted from the cold-smoking preparation method and inappropriate refrigeration.
  
  
  CONCLUSIONS
  Smoked ribs produced by a local restaurant, contaminated with type A botulism, was the contributor to this outbreak. The supervision of food safety should be strengthened to prevent future outbreaks in China.
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China.
authors.forename: Xueping
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China.
authors.forename: Shujie
authors.initials: S
authors.lastname: Liu
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China.
authors.forename: Zengrong
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China. Electronic address: 441607140@qq.com.
authors.forename: Rong
authors.initials: R
authors.lastname: Yang
mesh_terms: D000293:Adolescent; D000328:Adult; D019274:Botulinum Toxins, Type A / Q000032:analysis; D001906:Botulism / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003014:Clostridium botulinum / Q000302:isolation & purification; D004196:Disease Outbreaks; D005260:Female; D005516:Food Microbiology; D006801:Humans; D008297:Male; D008460:Meat / Q000382:microbiology*; D008875:Middle Aged; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A
keywords: Botulism; Outbreaks; Smoked ribs