1293Clinical Characteristics of Botulism in the United States, 2002–2012

Background. Botulism is a rare but life-threatening paralytic illness. Effective treatment is dependent on early recognition. Early treatment with antitoxin may reduce the risk for respiratory failure and need for mechanical ventilation. We described the clinical characteristics of botulism in the United States to help improve recognition by clinicians. Methods. The Centers for Disease Control and Prevention (CDC) collects clinical data about suspected cases during clinical consultation for botulinum antitoxin. A case was defined as laboratory-confirmed botulism or illness compatible with botulism in a person epidemiologically linked to a laboratory-confirmed case during 2002-2012. We excluded infant botulism cases. We described cases by gender, age, transmission category, signs and symptoms of cranial nerve deficits, weakness patterns, and need for mechanical ventilation. Complete data was not available for all patients. Results. Clinical information was available for 236 botulism cases. Of these, 169 (72%) were male and the median age was 47 years (range 3-91); most cases were categorized as wound (49%) or foodborne (43%) botulism. At time of CDC consultation, 62% of patients were mechanically ventilated. Descending paralysis (199 [98%] of 204 patients), alert mental status (193 [92%] of 210), dysphagia (180 [88%] of 204), oculomotor palsy (193 [85%] of 226), blurred vision (170 [84%] of 203), subjective weakness (175 [84%] of 209), ptosis (175 [81%] of 215), slurred speech (165 [80%] of 206), and diplopia (154 [78%] of 198) were the most commonly reported signs and symptoms. Nearly all patients had an ocular sign or symptom (229 [98%] of 233). However, dilated pupils (66 [35%] of 187) and unreactive pupils (45 [24%] of 186) were uncommon. Some patients had CSF protein levels > 58mg/dL (10 [14%] of 72) and sensory deficits (14 [9%] of 157). Conclusion. Descending paralysis should raise suspicion for botulism, especially when accompanied by alert mental status and ocular findings or dysphagia. Although others have reported dilated and unreactive pupils as hallmark signs of botulism, they were not commonly reported. Clinical features suggestive of alternate diagnoses, including elevated CSF protein and sensory deficits were reported in a small proportion of patients with botulism. Disclosures. All authors: No reported disclosures.