Intestinal toxemia botulism in Italy, 1984–2005

Abstract

Botulism in humans is caused by botulinum neurotoxins, produced in most cases by Clostridium botulinum, although other Clostridia species are implicated as well. Of the five forms of botulism in humans, three are referred to as "infective": wound botulism, infant botulism, and adult intestinal botulism; the latter two forms are also referred to as "intestinal toxemia botulism" because the organism colonizes the lumen of the intestinal tract and produces botulinum neurotoxin in vivo. Twenty-three cases of infant botulism and three cases of adult intestinal botulism occurred in Italy between 1984 and 2005. Microbiological analyses of clinical, environmental, and food samples and analysis of clinical and epidemiological data revealed two main characteristics of intestinal toxemia botulism in Italy that are not common in cases in other countries: the isolation of a strain of C. butyricum that produced botulinum neurotoxin type E in 6 of 26 cases, including two cases of adult intestinal toxemia botulism, and the onset of botulism in these cases with concomitant severe gastrointestinal symptomatology. This report summarizes the microbiological, clinical, and epidemiological data of all cases of intestinal toxemia botulism that have occurred in Italy in the period 1984-2005.

First Report Worldwide of an Infant Botulism Case Due to Clostridium botulinum Type E

“…The fecal sample collected on 4 June was positive for BoNT type E, with approximately 113 50% lethal doses (LD 50 )/ml. This level of toxin was lower than the levels reported for infant botulism types A and B but similar to those reported for type E cases (9). The serum sample collected on 4 June and the stool sample collected on 7 June were both negative for BoNT.…”

Botulism in Italy, 1986 to 2015

“…As reported by Fenicia and colleagues [20], abnormality of the gastrointestinal tract following inflammatory intestinal diseases or surgery, and alterations produced by broad-spectrum antibiotics in the endogenous microbiota, which act as the natural barrier to intestinal colonisation, are the only predisposing factor recognised to date. However, the patients from whom C. butyricum type E was recovered had Meckel’s diverticulum, which may be considered as a possible predisposing factor for this form of botulism.…”

Laboratory Investigation of the First Case of Botulism Caused by Clostridium butyricum Type E Toxin in the United States

“…Procedures were conducted in accordance with Association for Assessment and Accreditation of Laboratory Animal Care guidelines and institutionally approved protocols for the ethical use of laboratory animals. The amount of BoNT type E detected in the stool was 126,400 mLD 50 /g (mLD 50 , 50% mouse lethal dose), which is Ͼ150 times higher than that previously reported for type E infant botulism cases (4). The stool sample was cultured for the growth of BoNT-producing clostridia using standard laboratory methods (9).…”