Botulism Type F: Foodborne or Adult Intestinal Colonization?

A 45-year-old woman presented to urgent care suspecting an allergic reaction to foods that were consumed the previous evening. Her condition rapidly deteriorated to include cranial nerve palsies followed by a descending symmetric muscle weakness requiring mechanical ventilation. Botulism was suspected, and after consultation with public health experts at the state health department and Centers for Disease Control and Prevention, treatment with botulism antitoxin was initiated. The patient required prolonged ventilation and rehabilitation but achieved near-complete recovery after several weeks. Botulinum neurotoxin type F was detected in the patient's serum. Serial testing of the patient's clinical specimens was not performed. The patient's rapid progression to severe paralysis with a relatively swift recovery resembles previously described botulism type F cases. Public health investigations were unable to determine whether the patient had foodborne or adult intestinal colonization botulism.