Background. Northern Thailand's biggest botulism outbreak to date occurred on 14 March 2006
and affected 209 people. Of these, 42 developed respiratory failure, and 25 of those who
developed respiratory failure were referred to 9 high facility hospitals for treatment of
severe respiratory failure and autonomic nervous system involvement. Among these patients, we
aimed to assess the relationship between the rate of ventilator dependence and the occurrence
of treatment by day 4 versus day 6 after exposure to bamboo shoots (the source of the
botulism outbreak), as well as the relationship between ventilator dependence and negative
inspiratory pressure.
Methods. The investigators reviewed the circumstances and timing of symptoms following
exposure. Mobile teams treated patients with botulinum antitoxin on day 4 or day 6 after
exposure in Nan Hospital (Nan, Thailand). Eighteen patients (in 7 high facility hospitals)
with severe respiratory failure received a low- and high-rate repetitive nerve stimulation
test, and negative inspiratory pressure was measured.