‘Challenging’ botulism case highlighted in Australia; country reports remind of information

More details have been shared about the diagnosis of a patient who became seriously ill after drinking almond milk in Australia.

A 61-year-old man developed severe symptoms of botulism in 2023 after drinking a dairy alternative.

According to an article in The Medical Journal of AustraliaIt was the first case of botulism in the country since 2007 linked to a commercially prepared product.

Because no suspected food poisoning was initially revealed, brainstem stroke was the primary differential diagnosis.

On day 2, the patient experienced vomiting, difficulty swallowing, and severe respiratory distress, requiring intubation. He subsequently developed complete ophthalmoplegia (weakness or paralysis of the eye muscles).), descending flaccid paralysis and required ventilation. A diagnosis of Miller-Fisher syndrome was subsequently considered.

Link to almond milk
Further history taking on day 15 revealed that the man had consumed foul-tasting almond milk 12 to 36 hours before the onset of symptoms. Botulism was then suspected.

Clostridium botulinum culture and test results were negative on a retained milk sample and stool. Results of the direct toxin test of Clostridium botulinum using the mouse bioassay showed the presence of botulinum toxin in a retained milk sample. Another test on a retained milk sample detected botulinum toxin A nucleic acid.

On day 16, the patient received botulinum antitoxin. Five months after admission to the intensive care unit, he was stopped on mechanical ventilation.

After notification of the suspected case of foodborne botulism, Inside Out Nutritious Goods issued a national recall due to missing storage information: it was not labeled with instructions on how to keep it refrigerated. The product was sold chilled and had to be kept in the refrigerator.

“This case was diagnostically challenging due to an initially limited history with rapidly progressive symptoms overlapping between botulism, Miller-Fisher syndrome, and brainstem stroke. If botulism is suspected, antitoxin should be administered urgently,” researchers said.

Call up data
In other news, Food Standards Australia New Zealand (FSANZ) revealed there were 87 recalls in 2023, up from 75 in 2022 but down from 109 in 2020.

Undeclared allergens were the cause of 41 recalls in 2023. The problem was brought to light 19 times by a consumer complaint. Routine government or corporate testing was used several times to detect the problem. Microbial contamination led to 23 recalls, seven of which were caused by foreign objects.

The most common reasons for recalls between 2019 and 2023 were undeclared allergen and microbial contamination, while biotoxins and packaging errors accounted for a smaller share.

Although a single undeclared allergen led to most recalls, some were due to multiple allergens. The most common were milk, nuts, wheat/gluten and eggs.

In terms of root cause, packaging errors were the leading cause of allergen-related recalls, but there were also issues with supplier verification.

From 2019 to 2023, there were 83 food recalls due to microbial contamination. Thirty were caused by Listeria monocytogenes, 27 by Salmonella and 18 by E. coli. There were also another 20 recalls due to possible microbial contamination.

There were 39 recalls due to foreign substances, such as plastic and metal. Fourteen recalls were due to biotoxins such as patulin and histamine. Chemical contamination led to 24 recalls, with thebaine and ethylene oxide being the most common.

During this period, the most frequently recalled products were mixed and/or processed foods. This category includes most packaged foods with long shelf lives and manufactured items with multiple ingredients. Dairy products, bread and bakery products, fruits and vegetables and confectionery were also frequently recalled.

Key corrective actions included staff training, modified handling procedures and improved communication processes. Other steps included increased testing and halting production or supply. The majority of food businesses reported taking more than one corrective action.

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