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Botulism Outbreak in Thailand (Episode II)

This study has been completed.
Rajavithi Biomolecular Research Center
Information provided by:
Rajavithi Hospital Identifier:
First received: July 2, 2006
Last updated: November 7, 2006
Last verified: November 2006

A second botulism outbreak in Northern Thailand was reported in 2006. 192 people were exposed to raw meat and the gut of deer, 83 suffered from diarrhea. Of these 5 developed respiratory failure, 1 impending respiratory failure.

We analysed the clinical findings and electrophysiologic findings in this second episode of large botulism outbreak in northern Thailand.

Condition Intervention Phase
Drug: Botulinum AntiToxin
Procedure: neuro-electrophysiologic study, repetitive nerve stimulation
Procedure: : Protocol early weaning ventilator after recovery of repetitive nerve stimulation and stable negative inspiratory pressure
Phase 4

Study Type: Observational
Study Design: Observational Model: Defined Population
Observational Model: Natural History
Time Perspective: Longitudinal
Time Perspective: Prospective
Official Title: Clinical Manifestations of Botulism Outbreak in Northern Thailand: A Case Series of Botulism Treated With Botulinum Anti-Toxin.

Resource links provided by NLM:

Further study details as provided by Rajavithi Hospital:

Estimated Enrollment: 200
Study Start Date: June 2006
Estimated Study Completion Date: September 2006
Detailed Description:
PRELIMINARY REPORT Northern Thailand's big botulism outbreak occurred again on 30 June 14, 2006, [16.00pm] affecting 83 from 192 people who exposed to raw dear meat and gut [1 night preserved with ice pack of whole body of dear before disection and distribution ]. Of these, 3 developed respiratory failure, 1 developed impending respiratory failure, 83 of 192 whom developed fatique and diarrhea after ingestion of raw dear meat and gut on 26-30 June 2006. 3 patients were refered to 2 high facility hospitals for severe respiratory failure. Physical examination of 3 patients in ICU of Chiang Kum general hospital revealed ptosis [3/3] mild ophthalmoparesis [2/3] Proximal muscle weakness [2/3] abdominal paradoxical respiration [3/3] pupil dilate [1/3] and negative inspiratory pressure [NIP] less than 15 mmHg [3/3] were observed. Neurological electrophysiologic study of 2 patients revealed low amplitude compound muscle action potential [CMAP] of Abductor digiti minimi [ADM] muscle with decrement response after repetitive stimulation with low frequency [3Hz], increment response of ADM muscle after stimulation with high frequency [10Hz, 20Hz, and 30Hz.].The electrophysiologic findings support diagnosis of presynaptic neuromuscular dysfunction with respiratory failure, Botulism is most likely diagnosis. After treated with botulinum antitoxin [on July,1 ,2006 [mixed-type botulinum antitoxin --donated from Japan at Nan Hospital's botulisum outbreak on March 14,2006], 3 patients in ICU showed improvement of over all clinical outcomes. Active survey by Ministry of Public Health of Thailand and CDC-USA to identify the high risk patient who may develop respiratory failure , and immunologucal vs microbiological diagnosis were performed. This outbreak may be the second hit of botulisum in the northern Thailand but less amount of severe cases was observed.

Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Ate the deer meat and/or the gut from Chiang Kum district, after June 26,2006
  • Clinical botulism or respiratory failure who need ventilator assistance
  • The staff of referring hospital willing to participate in the Thai Botulism study group

Exclusion Criteria:

• Patients who did not eat deer meat and or the gut from Chiang Kum district

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Please refer to this study by its identifier: NCT00348426

Chiang Kum Hospital
Payao, Thailand
Sponsors and Collaborators
Rajavithi Hospital
Rajavithi Biomolecular Research Center
Principal Investigator: Subsai Kongsaengdao, M.D. Rajavithi Hospital
  More Information

World Health Organization .Botulism in Thailand: Epidemic and Pandemic Alert and Response (EPR). (Accessed March 22, 2006, at
P Wongwatcharapaiboon, L Thaikruea, and K Ungchusak et. al. Foodborne Botulism Associated With Home-Canned Bamboo Shoots,Thailand, 1998. ). (Accessed March 22, 2006, at Identifier: NCT00348426     History of Changes
Other Study ID Numbers: RVH_CER_002
Study First Received: July 2, 2006
Last Updated: November 7, 2006

Keywords provided by Rajavithi Hospital:
Food Borne Botulism

Additional relevant MeSH terms:
Clostridium Infections
Gram-Positive Bacterial Infections
Bacterial Infections
Neuromuscular Junction Diseases
Neuromuscular Diseases
Nervous System Diseases
Neurotoxicity Syndromes
Foodborne Diseases
Chemically-Induced Disorders
Botulinum Antitoxin
Immunologic Factors
Physiological Effects of Drugs processed this record on April 24, 2017