To the Editor: In March 2004, atotal of 16 suspected cases of botulismwere reported to the Italian NationalInstitute of Health by hospitals in 3adjoining regions in central andsouthern Italy (Molise, Campania,and Puglia). Initial investigationshowed that all patients had eaten atthe same restaurant in Molise onFebruary 22 or 24, 2004. The restau-rant provided reservation lists forthose dates (the restaurant was closedon February 23). It also provided a listof foods that had been served eachevening. Persons on the reservationlists were contacted and asked to pro-vide the names of others who hadbeen at their tables to ensure that asmany diners as possible were traced.Of 73 persons who had been identi-fied as having eaten at the restauranton either evening, 66 were successful-ly contacted and interviewed in per-son or by telephone about symptomsand food consumed at the restaurant. For purposes of the investigation, aprobable case-patient was defined as aperson who had dined at the restauranton February 22 or 24 and had experienced diplopia or blurred vision and atleast 1 of the following symptoms:dysphagia, dry mouth, dysarthria,upper/lower extremity weakness, dys-pnea, and severe constipation. Thosewho met the probable case definitionand had laboratory-confirmed botu-lism were considered definite case-patients.
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