Case 48-1980

Cabot, Richard C.; Scully, Robert E.; Galdabini, James J.; McNeely, Betty U.; Bradley, Walter G.; Shahani, Bhagwan T.; Hyslop, Newton E.

doi:10.1056/nejm198012043032307

Cited by 19 publications

(5 citation statements)

References 27 publications

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“…Paralysis may progress to a point where the patient appears comatose [48,66]. Alternative diagnoses may include Miller Fischer variant of Guillain-Barré syndrome [37,39,68,69], myasthenia gravis [37,39,44,68], viral encephalitis [37], meningitis [37], Eaton-Lambert syndrome [37], brain stem lesion [37], brain death [66], appendicitis [48], or Clostridium difficile associated diarrhea [47].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Adult Intestinal Toxemia Botulism

Harris

Anniballi

Austin

2020

Toxins

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Intoxication with botulinum neurotoxin can occur through various routes. Foodborne botulism results after consumption of food in which botulinum neurotoxin-producing clostridia (i.e., Clostridium botulinum or strains of Clostridium butyricum type E or Clostridium baratii type F) have replicated and produced botulinum neurotoxin. Infection of a wound with C. botulinum and in situ production of botulinum neurotoxin leads to wound botulism. Colonization of the intestine by neurotoxigenic clostridia, with consequent production of botulinum toxin in the intestine, leads to intestinal toxemia botulism. When this occurs in an infant, it is referred to as infant botulism, whereas in adults or children over 1 year of age, it is intestinal colonization botulism. Predisposing factors for intestinal colonization in children or adults include previous bowel or gastric surgery, anatomical bowel abnormalities, Crohn's disease, inflammatory bowel disease, antimicrobial therapy, or foodborne botulism. Intestinal colonization botulism is confirmed by detection of botulinum toxin in serum and/or stool, or isolation of neurotoxigenic clostridia from the stool, without finding a toxic food. Shedding of neurotoxigenic clostridia in the stool may occur for a period of several weeks. Adult intestinal botulism occurs as isolated cases, and may go undiagnosed, contributing to the low reported incidence of this rare disease.

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Section: Diagnosis and Treatmentmentioning

confidence: 99%

Adult Intestinal Toxemia Botulism

Harris

Anniballi

Austin

2020

Toxins

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“…Intestinal toxemia botulism in adults is described in detail in earlier reports ( 3 ), and Arnon summarized 10 previous cases ( 2 ). Since the summary of Arnon, 3 cases have been reported in Italy ( 11 ), and a case occurred in Japan in 1999 ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intestinal toxemia botulism is an infectious form of botulism in which illness results from ingesting spores, which is followed by spore germination and intraluminal production of botulinum neurotoxins over an extended period ( 2 ). Intestinal toxemia botulism is rarely reported in adults; <20 cases have been described in the literature since the first reports in 1980 and 1981 ( 3 , 4 ). The rarity of this condition contributes to its obscurity, an obscurity that may negatively affect those infected through a lack of rapid diagnosis and treatment.…”

mentioning

confidence: 99%

“…The rarity of this condition contributes to its obscurity, an obscurity that may negatively affect those infected through a lack of rapid diagnosis and treatment. Countries with published case reports of intestinal toxemia botulism in adults are the United States ( 3 – 10 ), Italy ( 11 , 12 ), Iceland ( 9 ), and Japan ( 13 ). The etiologic agents involved in intestinal toxemia botulism in adults are Clostridium botulinum types A, B, and F ( 6 – 9 , 13 , 14 ) and, more rarely, C. baratii type F ( 10 ), and C. butryicum type E ( 11 , 12 ).…”

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confidence: 99%

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Intestinal Toxemia Botulism in 3 Adults, Ontario, Canada, 2006–2008

Sheppard

Middleton²,

Whitfield³

et al. 2012

Emerg. Infect. Dis.

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Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41–61 days), indicative of intestinal toxemia botulism. Patients’ clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient’s feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.

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“…However, since early 1980, there have been sporadic cases of noninfant intestinal colonization, and its consequent clinical manifestations were reported from different continents of the world. 11 Since the first case description in 1986, a total of 33 cases of intestinal toxemia botulism have been described in the literature. Three species of Clostridium ( botulinum , butyricum , and baratii ) have been incriminated as the causes of clinical botulism resulting from intestinal toxemia.…”

Section: Discussionmentioning

confidence: 99%

Adult Intestinal Botulism: A Rare Presentation in an Immunocompromised Patient With Short Bowel Syndrome

Guru

Becker

Stephens

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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The cholinergic heat-labile neurotoxin produced by Clostridium species is primarily responsible for the clinical manifestations of botulism. The classic phenotypic presentation of botulism consists of subacute descending flaccid paralysis with intact sensory function. Traditionally, it is classified into 3 main forms (foodborne, wound-related, and infantile) on the basis of primary site of toxin entry into the human nervous system. Toxemia is the common pathophysiology in all forms of botulism. Adult intestinal toxemia botulism is an extremely rare form of the disease with pathogenesis similar to that of infant-type botulism. Symptomatic adults usually have an anatomic abnormality in the gastrointestinal tract leading to changes in normal gut flora. The current case is an addition to the growing literature on this unusual clinical variant of botulism.

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Case 48-1980

Cited by 19 publications

References 27 publications

Adult Intestinal Toxemia Botulism

Adult Intestinal Toxemia Botulism

Intestinal Toxemia Botulism in 3 Adults, Ontario, Canada, 2006–2008

Adult Intestinal Botulism: A Rare Presentation in an Immunocompromised Patient With Short Bowel Syndrome

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