[Botulism in Japan].

Botulism is a paralytic disease caused by the neurotoxin mainly produced by Clostridium botulinum. Botulism is classified as infant, foodborne, wound, adult intestinal toxemia, iatrogenic, and inhalation botulism. In Japan, type E botulism associated with the consumption of "izushi," a traditional fermented fish product, was prevalent before 2000. Since the 2000s, type A botulism has become more common. In some cases, foodborne botulism was suspected, but no incriminating food or sporadic cases were identified. Therefore, foodborne botulism should be considered even in the absence of a clear history of high-risk food consumption or a mass outbreak. Differential diagnoses of botulism include Guillain-Barré syndrome, Miller-Fisher syndrome, myasthenia gravis, and Lambert-Eaton myasthenic syndrome. Although botulism is rare, it is clinically important. In patients presenting with acute flaccid paralysis accompanied by brainstem symptoms, botulism should be considered as a differential diagnosis. When botulism is suspected, the local public health authorities should be promptly notified to prevent additional cases. To improve clinical outcomes, early administration of botulinum antitoxin is essential.