New York City Health Department is currently investigating two cases of foodborne botulism linked to fresh bulk tofu sold at a store in Flushing.  As reported by WABC, New York City has reported only one other foodborne-linked botulism over the past 15 years.

The two reported cases are Chinese-speaking residents of Queens who recently purchased the unrefrigerated bulk tofu from the same store.  According to reports, the tofu was not made at the store and its source is under investigation.

As the investigation continues, the Health Department is advising all individuals to discard all fresh bulk tofu purchased from any New York City store that has been kept at room temperature at the time of purchase.

The Health Department is also warning consumers to throw away tofu that has not been stored in a refrigerator at home.

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition. Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient. The food consumed by the patient can also be tested for the presence of toxins. Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism. This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days. Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome. 

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.