A Religious Experience?
Source: Hashimoto H, et al. N Engl J Med 1998;339:203-204.
Hashimoto and colleagues describe the occurrence of botulism in three of 13 Native American church members who shared a communal peyote-based tea at a ceremony. Within 2-4 days, three men developed bilateral symmetric flaccid weakness without sensory deficits, two of whom also developed nasal speech, dysphagia, and diplopia. EMGs supported the diagnosis of botulism.
The tea had been prepared from Peyote cactus buttons which had been covered with water and refrigerated for two months before ingestion. Type B botulinum toxin was found in peyote recovered from the ceremony, although two of three patients tested had negative serologies (not an uncommon finding). All three recovered without incidence within 4-12 weeks, although one required lengthy hospitalization.
Hashimoto et al speculated that the peyote cactus, which is alkaline, was permissive for Clostridium botulinum growth and spore formation. Of note, type B botulinum toxin, which is supposedly more commonly found in the eastern United States, is generally less toxic than type A toxin, which is more common in the west and typically results in more serious illness (Shapiro RL, et al. Ann Intern Med 1998;129:221-228).