# Foodborne Botulism Caused by Clostridium botulinum Subtype A5(b3) by Self-Packaged Vacuum Spicy Rabbit Heads

## TL;DR

A case of foodborne botulism caused by Clostridium botulinum subtype A5(b3) from vacuum-packed spicy rabbit heads highlights the risks of self-packaged meat products and the need for better medical training.

## Contribution

This study identifies a novel subtype of Clostridium botulinum (A5(b3)) as a cause of foodborne botulism and highlights misdiagnosis challenges in clinical settings.

## Key findings

- The botulism case was caused by Clostridium botulinum subtype A5(b3) from improperly stored vacuum-packed spicy rabbit heads.
- Genomic analysis confirmed the presence of toxin A and a non-functional toxin B due to a truncated bont/B gene.
- The case highlights the need for improved diagnostic training to prevent misdiagnosis and clinical deterioration.

## Abstract

Botulism is a severe muscle paralysis disease mediated by the botulinum toxin. Here, we reported a foodborne botulism case caused by Clostridium botulinum subtype A5(b3) from self-packaged vacuum spicy rabbit heads. Treatment for this case was delayed due to misdiagnosis and insufficient diagnostic capacity in three hospitals, which resulted in progressive clinical deterioration, and eventually, the patient was transferred to Shandong Public Health Clinical Center for specialized therapy. The case was suspected as foodborne botulism by the Qilu Medical-Prevention Innovation Integration pathway and multi-disciplinary consultation. An epidemiological investigation and laboratory confirmation revealed that the botulinum neurotoxin originated from vacuum-packaged spicy rabbit heads distributed via interprovincial cold chain logistics. After treatment with botulism antiserum, the patient’s condition significantly improved, and they were discharged after recovery. We revealed that this foodborne botulism outbreak was caused by the Clostridium botulinum A5(b3) subtype from food by whole-genome sequencing and SNP typing. All the strains belonged to Group I carrying the botulinum neurotoxin gene classified as the ha cluster. Toxin A was confirmed by MBA and other methods, while toxin B was non-functional due to the truncated bont/B gene. Other virulence genes and antibiotic resistance genes were also detected. Our findings indicate that self-packaged vacuum meat products represent an emerging risk factor for botulism transmission when stored improperly. Importantly, the recurrent misdiagnosis in this case underscored the urgent need to enhance the training of healthcare professionals in medical institutions to improve the diagnostic accuracy and clinical management of botulism.