Botulism case associated with consumption of a salt-cured fish product

A 41 year old New Jersey resident was hospitalized on June 3, 2004 with a confirmed case of botulism.

The patient was discharged to home on June 21 and is in good condition. The individual had eaten a cured and fermented fish product called "moloha" or "Faseikh" in the Middle Eastern community. Similar ethnic products may be called "kapchunka," "rybetz," "ribeyza," or "rostov."

The infected individual obtained the fish product from a seafood shop in Jersey City, New Jersey.

The Hudson Regional Health Commission and the Jersey City Department of Health recommend that persons who have purchased this fish product not consume it. Public health officials advise that persons who might have already consumed this product to be vigilant for symptoms that might be consistent with botulism, as described below, and contact their physicians immediately.

Symptoms of foodborne botulism usually appear within 12 to 36 hours after ingesting contaminated food, but can be as long as 8 days. Foodborne botulism typically begins with blurred or double vision, dry mouth and difficulty swallowing. Vomiting and diarrhea may be present early in the illness. The illness may progress to symmetrical flaccid (floppy) paralysis and may lead to difficulty in breathing.

Foodborne botulism is a poisoning of the nervous system caused by a toxin produced by a specific spore forming bacterium called Clostridium botulinum. Botulinum toxin is produced by the growth of Clostridium botulinum in improperly canned or cured low- acid foods kept without refrigeration. If the food is eaten without further heating or cooking, the toxin is absorbed into the bloodstream through the intestine. It travels through the blood to the nerve endings where it disrupts nerve signals to muscle tissue. Food containing botulinum toxin may not taste spoiled or different.

Clostridium botulinum requires an anaerobic (no oxygen) environment, such as that found inside a can or jar, to produce botulism toxin. Boiling will not kill Clostridium botulinum spores. The temperature required to kill the spores (250 degrees Fahrenheit) is obtainable only through the use of a pressure cooker. Most foodborne botulism poisonings in the United States are due to eating improperly processed home canned vegetables and fruits that are eaten without sufficient reheating which could have inactivated the toxin.

Foodborne botulism is diagnosed by finding the toxin in the blood or the suspect food. It may also be diagnosed by finding the Clostridium botulinum spores in the food or in a stool culture.