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During November 1997, the Illinois Department of Public Health was notified by a local physician about a possible case of foodborne botulism. This report summarizes the case investigation, which implicated home-pickled eggs as the cause.
We report epidemiological investigations of 2 outbreaks of foodborne botulism following consumption of home-canned bamboo shoots in northern Thailand. The first outbreak affecting 4 female and 2 male cases occurred in Mae Sot District, Tak Province, in December 1997. All 6 cases were hospitalized, 4 of whom required mechanical ventilation. All cases experienced neurological features and 4 had gastrointestinal symptoms. One case died, giving a case-fatality rate of 16.7 per cent. A case-control study revealed a significant association (p < 0.01) between the disease and consumption of home-canned bamboo shoots purchased from the same foodshop in the village. The second outbreak of a similar clinical syndrome occurred in Thawangpha District, Nan Province, in April 1998. A total of 13 cases were identified, 9 (69.2%) of whom were female. Nine cases (69.2%) were hospitalized, 4 (30.8%) of whom required mechanical ventilation. Two early hospitalized cases died due to ventilatory failure, giving a case-fatality rate of 15.4 per cent. A case-control study indicated that home-canned bamboo shoots prepared by a local foodshop served as the vehicle for the disease transmission. One bamboo shoot specimen from one affected house was positive for botulinum toxin type A by enzyme-linked immunosorbent assay and mouse antitoxin bioassay. Improper home-canning procedures for bamboo shoot preservation were similarly detected in both outbreaks although performed by different merchants. Prompt recognition and treatment of the disease are essential in reducing the fatality rate. Safe home-canning procedures should be widely distributed and instructed to persons who perform bamboo shoot preservation for sale.
We report a case of a 5-week-old infant admitted with respiratory arrest. He had been fed with honey for two weeks. Infant botulism was suspected and confirmed by the finding of Clostridium botulinum toxin in the serum and faeces, and in the honey. The infant needed 7.5 months of ventilatory support.
Total 97 cases of botulism were registered in 1999 in Poland with incidence 0.25/100,000. In the rural area were registered 61 (incidence 0.41/100,000), and in the urban regions 36 (incidence 0.15) cases. The incidence among men (0.32) outnumbered the incidence among women (0.18). In 1999 there were 68 outbreaks of one person noted, 6 outbreaks of two people, 3 of three people and 2 of four people. Dishes from meat were the main vehicle of the botulinum toxin (58 cases; 59.8%). In this number prevailed home made conserves (wecks) from pork meat (26.8%). No deaths were registered in 1999.
In skeletal muscle under a local botulinic intoxication and denervation the alterations in metabolism of glycogen, phosphocreatine, lactic and pyruvic acids were studied. The data obtained suggest that the dissimilarity in impairments of carbohydrate-energy metabolism in botulism and denervation was due to existence of variable types of impairments in the nerves.
The neurotoxin of Clostridium butyricum strain LCL155 (BuNT/LCL155) associated with type E food-borne botulism showed antigenic and biological properties different from those of C. botulinum type E (BoNT/E) andC. butyricum strain BL5262 (BuNT/BL5262). The specific toxicity of BuNT/LCL155 was found to be about 10% those of BoNT/E and BuNT/BL5262. Immunological analysis with monoclonal antibodies against BoNT/E showed that the heavy chain of BuNT/LCL155 differs partially from those of BoNT/E and BuNT/BL5262. Binding experiments with rat brain synaptic membrane revealed that BuNT/LCL155 possesses a binding activity lower than either BoNT/E or BuNT/BL5262. There was no difference in the catalytic activity of the three neurotoxins, which had been determined with a recombinant of the intracellular target protein SNAP-25. These data suggest that the BuNT/LCL155 shares the receptor-recognition site structurally different from BoNT/E and BuNT/BL5262, perhaps causing a decreased specific toxicity.
Since 1970 our laboratory is specialized in diagnosis of clostridial diseases, including Clostridium botulinum and botulism. Since 1995, samples from more than 900 suspected botulinal cases were received, mainly in cattle, horses and men. 524 outbreaks were diagnosed as clearly positive by toxin neutralisation; 83 cases remained inconclusive with the toxin neutralisation. The geographical distribution of the positive cases in Germany is demonstrated for cattle and horses. Dispatch and treatment of specimens and interpretation of results are discussed.
During August 22-26, 2003, four injection-drug users (IDUs) in Yakima County, Washington, sought medical care at the same hospital with complaints of several days of weakness, drooping eyelids, blurred vision, and difficulty speaking and swallowing. All four were regular, nonintravenous injectors of black tar heroin (BTH), and one also snorted BTH. This report summarizes the investigation of these cases, which implicated wound botulism (WB) as the cause of illness.
The authors presented symptoms of botulism, diagnostics and treatment. In this case there was a necessity of urgent tracheotomy. The authors had good results because of early treatment with serum antibotulism A+B+C and symptomatic treatment. Decannulation was only after 45 days because the paralytic symptoms declined very slowly.
Two previously healthy infants, a boy of 10 weeks and a girl of 4 months presented with apathy and muscle weakness. A third previously healthy child, a girl of 6 weeks old was admitted with respiratory insufficiency. None of the three had had a bowel movement for a number of days. After extensive investigations which revealed few abnormalities Clostridium botulinum toxin was obtained in serum from all three children. Type-B-toxin was shown in the faeces of the older girl and boy; both recovered quickly. The other girl had type-A toxin; she died. Two of the three children were given honey to comfort them. Infantile botulism must be considered in every infant with symptoms of constipation and hypotonia. The diagnosis can quickly be confirmed by electromyography with repetitive 50-Hz-stimulation. Honey is a well-known source of the C. botulinum spore and should not be given to children under the age of 12 months. These three children are the first cases to be described in the Netherlands.
Botulinum neurotoxin C1 (BoNt C1) and its corresponding gene were detected in seven aquatic habitats covering a range of low (LR) to high risk (HR) avian botulism outbreak areas during a study period of 10 months. Toxin and gene in sediment and avian faecal samples were analysed before (in situ) and after cultivation (in vitro) by a newly adapted ELISA, the common mouse bioassay and by a recently described nested PCR protocol. BoNt C1 gene fragments were detected in 74% and 83% of all investigated sediment samples by in situ PCR and in vitro PCR, respectively, at comparable frequencies in HR and LR areas. Similar high values were also observed for faecal samples. No BoNt C1 could be detected in the sediment in situ, while 53% and 56% of all cultivated samples contained BoNt C1 as detected in the mouse bioassay and the ELISA, respectively. The percentage of BoNt C1 positive cultivated samples was significantly higher (2-fold) in HR areas than in LR areas. Hence, our data clearly indicate an increased ratio of potentially BoNt C1 producing clostridia to BoNt C1 genes as the frequency or likelihood of botulinum epizootics increases in the environment. In addition, the good correlation between the results from the ELISA and the mouse bioassay for all sediment and faecal samples (r=0.90, p<0.001, n=121) indicates a high potential for the ELISA to reduce/replace the mouse bioassay for the detection of BoNt C1 in environmental samples.
On September 8, 2006, the Georgia Division of Public Health (GDPH) and CDC were notified of three suspected cases of foodborne botulism in Washington County, Georgia. On September 25, the Florida Department of Health and CDC were notified of an additional suspected case in Tampa, Florida. This report describes the joint investigation and control measures undertaken by state and local health departments, CDC, and the Food and Drug Administration (FDA).
Fifty-seven patients with infant botulism were cared for at The Children's Hospital of Philadelphia between 1976 and 1987. The ages of the children ranged from 18 days to slightly more than 7 months. The average duration of hospitalization was 44 +/- 34 days, with the average intensive care unit stay lasting 29 +/- 25 days (54 of 57 patients). The majority (77%) of the patients were ultimately intubated and mechanically ventilated (68%). The principal indication for intubation was loss of protective airway reflexes and not hypercarbia or hypoxemia. In those patients who required mechanical ventilation the average duration was 23 +/- 22 days, with the 10 most severely affected patients (greater than or equal to 28 days of mechanical ventilation) averaging 53 +/- 25 days. Excluding patients ventilated for more than a month, those who underwent tracheostomy were hospitalized nearly twice as long as those who were managed by nasotracheal intubation only (33.5 days vs 63.2 days). The use of continuous nasogastric feedings has supplied most infants with sufficient enteral feedings to avoid weight loss and the need for central intravenous alimentation.
Botulism was believed to be the cause of progressive symmetric myasthenia in 8 horses on a farm in North Carolina. One horse was found dead, 6 were euthanatized after becoming recumbent, and 1 affected horse recovered. Cecal and colonic contents of 2 horses were determined to contain Clostridium botulinum spores. Alfalfa hay that was fed to the horses contained spores and toxin.
Clinical features are described for 35 cases of endemic food-borne botulism managed at a single medical center over 14 years. Important diagnostic findings included dryness of mucous membranes (90%), weakness (84%), and abnormal pupillary reaction (79%). Sensory examination was normal. Dizziness, dyspnea, and weakness of the extremities were significantly more common in patients requiring assisted ventilation. Transitory neurological deterioration occurred in 38% of patients despite the early administration of trivalent (ABE) equine antitoxin. The short course of respiratory failure suggests that toxin effect is unusually ephemeral with a mean intubation interval of only 8.6 days. Rapid recovery of strength without relapsing respiratory failure followed extubation. Tracheostomy was associated with a high complication rate and was abandoned. Extremely thick, tenacious sputum probably contributed to the high nosocomial pneumonia rate. Empirical antibiotic use to eliminate persistent C. botulinum was associated with unacceptably high nosocomial infection rates (p less than .01). Unexpected significant elevations of blood leukocyte and neutrophil band forms were noted.
Clostridium botulinum toxin, type C, could be demonstrated by means of temperature induced microcomplement fixation in blood serum and in aspirated rumen fluid of cattle suffering from botulism. The results were already available after seven hours. Botulinum toxin likewise could be identified from hair of a suspicious carcass. The investigations confirm the high sensitivity of this method.
Botulism is a severe neuroparalytic disease caused by the neurotoxins of Clostridium botulinum which exert their effects on peripheral nerve junctions. Guillain-Barre syndrome, Myasthenia Gravis, acute Poliomyelitis and diphtheria must be considered in the differential diagnosis. In this study we have discussed two patients who were treated in our clinic, the differential diagnosis and the role of anti-Cholinesterase drugs in the treatment.
The survival of Clostridium botulinum spores in improperly processed foods varies considerably with pH and temperature. The greatest risk arises from commercial or home-prepared condiments, vegetables, non-acid fruits and preserved raw fish. Clinical problems with botulism arise from the rapidity of development, unexpected manifestations involving the autonomic nervous system, including paralytic ileus, gastric dilatation and hypotension, and the need to ensure ventilation.