The changing epidemiology of adult botulism in the United States.

All forms of botulism are rare in the United States, and, as a result, descriptions of the pertinent epidemiologic features and clinical spectrum of illness are limited. This review describes the epidemiologic characteristics of the 355 cases of botulism in adults reported in the United States between 1976 and 1984, outlines current therapy, and emphasizes newly recognized features of the disease. Evaluation of recent data for botulism demonstrates several new associations and trends. These include the occurrence of large restaurant-associated outbreaks, several newly identified vehicles for foodborne botulism, wound botulism in parenteral drug abusers, and botulism from an unknown source in patients with underlying gastrointestinal disease. Recognition of these unusual features can lead to more effective preventive measures and to early diagnosis, which is essential for effective treatment.