Botulism in a Hospital

40-year-old man admitted into Hospital.
He has a splitting headache, his legs were unsteady, and his vision was blurred.
During the examination, it was obvious that something was wrong wit his throat.
The throat was not sore, but it felt stiff and tight, and it was almost impossible for him to speak.
Over the next 7 days, 28 people with similar symptoms were admitted to the hospital.
-12 of these patients required ventilatory support
-No deaths were reported.
-During the investigation it became apparent that the illness were due to meals consumed between Oct. 14-16 at one restaurant.
-Detailed food histories were obtained from the patients.
-An additional case control study was conducted on well people who had consumed food at the restaurant during the same 3-day period.
-The media helped identify 18 more people who had eaten virtually the same foods at the restaurant.

-The meals consisted of:
Patty Melt- Frozen hamburger patties purchased from a restaurant distrb. Patties were removed from the freezer and fried as ordered. Presliced pasteurized American cheese purchased from a distributor was kept refrigerated, and a slice was melted on each cooked hamburger patty. Meat and cheese were served on a rye bread purchased from a local bakery.

Sautéed Onion- Onions were purchased fresh from a farmer. Fresh whole onions were sliced and then sautéed with margarine, paprika, garlic salt, and a chicken-based powder. After the initial cooking, the onions were held uncovered in a pan on a warm stove (<60oC) along with a large volume of melted margarine; they were not reheated before serving.

French Fried potatoes- Pre-cut frozen potatoes were deep-fried in two or three serving batches as needed.

Potato Salad- Potatoes were purchased from a farmer. They had been stored in a root cellar and were transported loose in a pickup truck. The potatoes were washed, peeled, diced, and boiled. Cooled, drained, potato cubes were mixed with oil, vinegar, dry mustard, and garlic salt, and kept refrigerated. Individual servings were removed from the container as needed.

Lettuce and Tomato salad- Produce was delivered every other day, Lettuce and tomatoes were cut in the morning, refrigerated, and mixed with oil and vinegar for serving.