title: [Familial microepidemic of food-borne botulism in the Region of Madrid].
abstract: BACKGROUND
  Botulism is a syndrome caused by the toxin of the bacillus Clostridium botulinum. The toxin acts by blocking the presynaptic cholinergic endings of the neuromuscular junction and of the parasympathetic nervous system, and gives rise to a flaccid paralysis and parasympathetic failure. The most common way to catch the disease is by ingestion of the preformed toxin present in badly sterilised home-made preserves, although other mechanisms are also possible. Its incidence in Spain today is very low.
  
  
  METHODS
  We report the case of three members of a family living together who presented a clinical picture of food-borne botulism. The initial clinical symptoms showed a predilection for ocular paresis and for dysautonomic symptoms of little specificity, and the familial aggregation was the fundamental evidence that suggested the diagnosis. Later, the patients' state got worse and two of them presented involvement of the respiratory function and required a lengthy stay in the intensive care unit. After a period of convalescence the three patients recovered without any sequelae. Botulinum toxin was detected by bioassay in some food samples, which allowed the diagnosis to be categorised as confirmed.
  
  
  CONCLUSIONS
  The familial microepidemic reported here is a case of predominantly ocular and dysautonomic involvement. Likewise, it illustrates several aspects that are typical of the disease: the suspected diagnosis in cohabiting patients who visit at the same time for a similar clinical picture, the characteristic complications of the process and its treatment, the laboratory diagnosis and its natural history towards resolution.
authors.affiliation: Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, Espana.
authors.forename: D
authors.initials: D
authors.lastname: Jalda
authors.affiliation: Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, Espana.
authors.forename: A
authors.initials: A
authors.lastname: Junco
authors.affiliation: Universidad Rey Juan Carlos, 28922 Madrid, Espana.
authors.forename: M
authors.initials: M
authors.lastname: Alvarez-Moreno
authors.affiliation: Consejeria de Sanidad, Madrid, Espana.
authors.forename: I
authors.initials: I
authors.lastname: Rodero
authors.affiliation: Hospital Universitario Puerta de Hierro-Majadahonda, 28035 Majadahonda, Espana.
authors.forename: J
authors.initials: J
authors.lastname: Carneado-Ruiz
mesh_terms: D001681:Biological Assay; D001905:Botulinum Toxins / Q000032:analysis; D001906:Botulism / Q000175:diagnosis*; D003014:Clostridium botulinum; D005506:Food Contamination; D006801:Humans; D007902:Length of Stay; D013030:Spain
chemical_list: D001905:Botulinum Toxins