[Botulism in Poland in 2010]

OBJECTIVE

The main objective of this article is to assess the epidemiology of foodborne botulism in Poland in 2010, using national surveillance data. In Poland, botulism is a mandatory notifiable disease based on the European Union case definition (probable or confirmed), however given limited laboratory capacity, in national surveillance we also use "possible" case definition for cases reported by physicians based on clinical symptoms (with no laboratory confirmation).

RESULTS

The number of botulism cases reported has decreased over the past years. Between 2004-2008 the median annual number of cases in years 2004-2008 was 49, whereas in 2009 alone, was only 31 cases. In 2010 a total 32 botulism cases (0.08 per 100,000 inhabitants)--including 22 confirmed cases (in 20 cases--toxin type B, and in 2 -toxin type B / E was found) were reported. There was only one--'probable case'--reported on the basis of clinical symptoms and the presence of an 'epidemiological link' (exposure from the same source). Other cases (9 patients) were reported, on the basis of clinical diagnosis without laboratory confirmation and registered as 'possible cases'. Incidence in rural areas (0.18) was 9-fold higher than the incidence in urban areas. Men had higher (0.12) incidence than women (0.05); the highest incidence (0.17) was observed among people aged 50-59 years. All cases were people aged over 25 years of age. In 28% of all cases--homemade canned pork was implicated. Canned fish were also a common vehicle. All patients were hospitalized--for between 5 and 35 days (median 11 days). No deaths related to the disease were reported.

CONCLUSIONS

Botulism in Poland is still an important epidemiological problem. A large number of poisonings is primarily due to consumption of homemade canned foods.

[Botulism in Poland in 2009]

Atotal number of 31 foodborne botulism cases were registered in Poland in 2009 (incidence rate 0.08 per 100,000 population), in rural areas--22 cases (incidence 0.15) and in urban areas--9 cases (incidence 0.04). There were 22 sporadic cases (71%), 3 outbreaks of two persons and 1 outbreak involving three persons. Tinned pork meat (especially homemade) was the main vehicle of infection botulin toxin. One death due to foodborne botulism was reported.

Clostridium botulinum in the post-genomic era

Foodborne botulism is a severe neuroparalytic disease caused by consumption of botulinum neurotoxin formed by strains of proteolytic Clostridium botulinum and non-proteolytic C. botulinum during their growth in food. The botulinum neurotoxin is the most potent substance known, with as little as 30-100 ng potentially fatal, and consumption of just a few milligrams of neurotoxin-containing food is likely to be sufficient to cause illness and potentially death. In order to minimise the foodborne botulism hazard, it is necessary to extend understanding of the biology of these bacteria. This process has been recently advanced by genome sequencing and subsequent analysis. In addition to neurotoxin formation, endospore formation is also critical to the success of proteolytic C. botulinum and non-proteolytic C. botulinum as foodborne pathogens. The endospores are highly resistant, and enable survival of adverse treatments such as heating. To better control the botulinum neurotoxin-forming clostridia, it is important to understand spore resistance mechanisms, and the physiological processes involved in germination and lag phase during recovery from this dormant state.

Preliminary study of mucosal IgA in the equine small intestine: specific IgA in cases of acute grass sickness and controls

REASONS FOR PERFORMING STUDY

There is much evidence to suggest that group III Clostridium botulinum (types C and D) are involved in the aetiology of equine grass sickness (EGS). Antibodies have been detected previously in the blood and high levels associated with resistance to disease. Specific mucosal antibodies in the gastrointestinal (GI) tract are likely to be important in protection, and this study was performed to ascertain if such antibodies could be detected and if their levels were related to disease state.

OBJECTIVES

To develop a method for quantifying IgA antibodies to C. botulinum types C and D in the GI tract of horses and to relate antibody levels to disease status.

METHODS

Samples of tissue (n = 25: 6 duodenum, 7 jejunum and 12 ileum) were taken from acute grass sickness (AGS) cases and from control horses (n = 12; 4 samples from each site) at post mortem. They were extracted with the detergent saponin in the presence of protease inhibitors and assayed for total IgA, for specific IgA against botulinum neurotoxins types C and D (BoNT/C or BoNT/D), and against surface antigens of a BoNT/C negative strain of C. botulinum type C (SA) and of Clostridium tetani (TetSA), as a control. Specific IgA was expressed as percentage total IgA.

RESULTS

Compared to controls, significantly higher levels of specific IgA against BoNT/C were detected in the jejunum (P = 0.04) and ileum (P = 0.02) of AGS cases. Similarly, higher specific levels against BoNT/D were demonstrated in duodenum (P = 0.01) and jejunum (P = 0.02). Significantly higher levels of IgA against SA were demonstrated only in duodenal samples (P = 0.01).

CONCLUSIONS

Levels of IgA antibody to BoNTs in control horses were at near undetectable levels, suggesting no recent exposure to toxins. In AGS cases, significantly higher levels of specific IgA were detected predominantly in jejunum and ileum.

POTENTIAL RELEVANCE

If specific IgA is protective then any successful vaccine for EGS should induce a mucosal response.

[Botulism in Poland in 2008]

A total number of 46 foodborne botulism cases were registered in Poland in 2008 (incidence rate 0.12 per 100,000 population), in rural areas--28 cases (incidence 0.19) and in urban areas--18 cases (incidence 0.08). There were 36 sporadic cases (78%), 2 outbreaks of two persons and 2 outbreaks involving three persons. Tinned meat (especially home made) was the main vehicle of infection botulin toxin. There were no deaths reported due to botulism.

An outbreak of botulism in a family in Eastern Anatolia associated with eating süzme yoghurt buried under soil

Cases of botulism in a family in eastern Anatolia were studied. In late September 2005, an outbreak of botulism developed in our region, first in 2 patients, a teenage boy and his mother, in whom the disease culminated in respiratory insufficiency and death. An additional 8 cases of botulism were identified later; most of them presented to our medical centre the next d. These patients with milder symptoms recovered gradually. All the patients received anti-botulinum toxin. The investigation of the source of the outbreak showed an unexpected vehicle for botulism infection in the these patients, süzme (condensed) yoghurt buried under soil. Type A botulinal toxin was detected in the yoghurt sample. The clinical diagnosis was also confirmed by a mouse bioassay performed with the serum samples of the patients. The most common symptoms were dry mouth, difficulty in speaking and swallowing, and change in voice quality. The 10 identified patients with botulism constitutes the largest-ever outbreak of botulism reported in Turkey to date. The present study shows the importance of considering a diagnosis of botulism soon after patients present with acute cranial nerve dysfunction and of promptly treating suspected cases with antitoxin.

Phenotypic characterization of Clostridium botulinum strains isolated from infant botulism cases in Argentina

Infant botulism is the most common form of human botulism; however, its transmission has not been completely explained yet. Some of the most recognized potential sources of Clostridium botulinum spores are the soil, dust, honey and medicinal herbs. In Argentina, 456 cases of infant botulism were reported between 1982 and 2007. C. botulinum type A was identified in 455 of these cases whereas type B was identified in just one case. However, in Argentina, types A, B, E, F, G, and Af have been isolated from environmental sources. It is not clearly known if strains isolated from infant botulism cases have different characteristics from strains isolated from other sources. During this study, 46 C. botulinum strains isolated from infant botulism cases and from environmental sources were typified according to phenotypic characteristics. Biochemical tests, antimicrobial activity, and haemagglutinin-negative botulinum neurotoxin production showed uniformity among all these strains. Despite the variability observed in the botulinum neurotoxin's binding to cellular receptors, no correlation was found between these patterns and the source of the botulinum neurotoxin. However, an apparent geographical clustering was observed, since strains isolated from Argentina had similar characteristics to those isolated from Italy and Japan, but different to those isolated from the United States.

[Botulism in Poland in 2007]

A total number of 49 foodborne botulism cases were registered in Poland in 2007 (incidence rate 0.13 per 100,000 population), in rural areas--37 cases (incidence 0.25) and in urban areas--12 cases (incidence 0.05). There were 31 sporadic cases (60%), 6 outbreaks of two persons and 2 outbreaks involving three persons. Tinned meat (especially home made) was the main vehicle of botulin toxin. One death from foodborne botulism was registered.

Infant botulism

Infant botulism is a rare disease that affects infant less than 12 months of age. The illness results from absorption of botulinum toxin produced in situ by neurotoxigenic clostridia that can temporarily colonize the intestinal tract of infants. To date, all inhabited continents except Africa have reported cases of infant botulism. Recognition of cases seem directly related to physician awareness and clinical suspicion. This review summarizes microbiological, clinical and epidemiological features of infant botulism.

Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism

Nowadays, infant botulism is the most important form of human botulism in some countries. This illness affects infants younger than 52 weeks of age. The infection occurs in the intestinal tract; therefore, ingestion of Clostridium botulinum spores with food is proposed. In some countries, people use chamomile tea as a household remedy for intestinal colics and given this tea to infants. Chamomile can be contaminated with C. botulinum and could be a vehicle of its spores. Our aim was to study the prevalence and spore-load of C. botulinum in chamomile. We analysed 200 samples; the 7.5% of them were contaminated with botulinum spores. However, prevalence of these spores was significantly higher in chamomile sold by weight in herbal stores (unwrapped chamomile) than prevalence in chamomile sold in tea bags (p=0.0055). The spore-load detected in all positive samples was 0.3-0.4 spores per gram of chamomile. We identified C. botulinum types A, B, and F in the 53.3%, 6.7%, and 13.3%, respectively. Chamomile (principally, unwrapped chamomile) is a potencial vehicle of C. botulinum spores, and ingestion of chamomile tea could represent a risk for infant botulism.

Variations in expression and release of botulinum neurotoxin in Clostridium botulinum type A strains

In this study, we characterized the production and release of botulinum neurotoxin during growth of two Clostridium botulinum strains, Hall A and NCTC2916, of distinct gene organizations. The intra- and extracellular fractions of the bacterial cells harvested at various stages of growth were analyzed for the neurotoxin. Both strains exhibited a temporal neurotoxin gene expression; however, these two strains differ in their patterns of growth, toxin production, toxin release, and post-translational nicking. Comparing to the NCTC2916 strain, the Hall A strain showed an extended stationary phase, delayed autolysis, and earlier expression and release of neurotoxin. Understanding the differences between these two toxin-producing strains may provide insights into the toxinogenesis of C. botulinum.

Signs and symptoms predictive of respiratory failure in patients with foodborne botulism in Thailand

We conducted a clinical study of 137 patients with home-canned bamboo shoot botulism at Nan Hospital, northern Thailand. The median age of the patients was 44 years (range = 14-74 years) and 36.2% were male. The median incubation period was 2 days (range = 1-8 days). Forty-three patients (31.4%) developed respiratory failure, but there were no deaths. Patients who did not have either nausea or vomiting and did not have urinary retention that required Foley catheterization was less likely to develop respiratory failure. This clinical predictor rule had a sensitivity of 75.5% and a specificity of 90.7%. The clinical syndrome most predictive of respiratory failure was nausea or vomiting and any cranial neuropathy with urinary retention or difficulty swallowing. This clinical syndrome had a sensitivity of 69.8% and a specificity of 93.6%. These clinical characteristics could help triage large numbers of patient in the event of a future outbreak.

[Botulism in infancy - survey of literature based on a case report]

The authors have drawn attention to a rare disease called infant botulism, which raises some difficulties with regard to differential diagnosis. In the case of the six-month-old infant portrayed, infant botulism and food-born botulism appeared together. As a result of the severity of the disease and due to its rapid course observed in the presented case as well, the diagnosis has to be raised relying on the accurate patient's history and on the clinical examination, then it should be confirmed by appropriate examinations. In relation to presenting a case, the authors examine the microbiological background of the disease, its symptomatology, its epidemiological characteristics, the appropriate methods of electrophysiological examination and laboratory analysis as recommended in current literature, together with the difficulties that arise in differential diagnosis and also the possibilities of treatment. They pay special attention to the particular characteristics of the infant form of the disease, to the difficulties of making a diagnosis due to the characteristics of the age group and also to the questions in relation to the guiding principles of therapy. The rapid and fatal process observed in the presented case warns us that serious complications can occur even when up-to-date therapy is used. Therefore, despite the improvement in prognosis we have to strive to prevent the disease by spreading the proper regulations of nutritional hygiene.

Intestinal toxemia botulism in Italy, 1984–2005

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.

Clostridium botulinum and the safety of minimally heated, chilled foods: an emerging issue?

Foodborne botulism is caused by consumption of preformed botulinum neurotoxin, with as little as 30 ng of neurotoxin being potentially lethal. Consumption of minute quantities of neurotoxin-containing food can result in botulism. In view of the severity of foodborne botulism, it is essential that new foods be developed safely without an increase in incidence of this disease. Minimally heated, chilled foods are a relatively new type of food, sales of which are currently increasing by about 10% per annum. These products meet consumer demand for high-quality foods that require little preparation time. Their safety and quality depends on mild heat treatment, chilled storage, restricted shelf life and sometimes on intrinsic properties of the foods. The principal microbiological hazard is nonproteolytic Clostridium botulinum, and there is a concern that this may become an emerging issue. A considerable amount of research and development over the last 15 years has underpinned the safe production of commercial, minimally heated, chilled foods with respect to foodborne botulism, and it is essential that safe food continues to be developed. In particular, the desire to use lighter heat processes and a longer shelf life presents a challenge that will only be met by significant developments in quantitative microbiological food safety.

SYBR green real-time PCR method to detect Clostridium botulinum type A

Botulinum toxins (BoNTs) are classically produced by Clostridium botulinum but rarely also from neurotoxigenic strains of Clostridium baratii and Clostridium butyricum. BoNT type A (BoNT/A), BoNT/B, BoNT/E, and very rarely BoNT/F are mainly responsible for human botulism. Standard microbiological methods take into consideration only the detection of C. botulinum. The presumptive identification of the toxigenic strains together with the typing of BoNT has to be performed by mouse bioassay. The development of PCR-based methods for the detection and typing of BoNT-producing clostridia would be an ideal alternative to the mouse bioassay. The objective of this study was to develop a rapid and robust real-time PCR method for detecting C. botulinum type A. Four different techniques for the extraction and purification of DNA from cultured samples were initially compared. Of the techniques used, Chelex 100, DNeasy tissue kit, InstaGene matrix DNA, and boiling, the boiling technique was significantly less efficient than the other three. These did not give statistically different results, and Chelex 100 was chosen because it was less expensive than the others. In order to eliminate any false-negative results, an internal amplification control was synthesized and included in the amplification mixture according to ISO 22174. The specificity of the method was tested against 75 strains of C. botulinum type A, 4 strains of C. botulinum type Ab, and 101 nontarget strains. The detection limit of the reaction was less than 6 x 10(1) copies of C. botulinum type A DNA. The robustness of the method was confirmed using naturally contaminated stool specimens to evaluate the tolerance of inhibitor substances. SYBR green real-time PCR showed very high specificity for the detection of C. botulinum types A and Ab (inclusivity and exclusivity, 100%).

Pathobiology and management of laboratory rodents administered CDC category A agents

The Centers for Disease Control and Prevention Category A infectious agents include Bacillus anthracis (anthrax), Clostridium botulinum toxin (botulism), Yersinia pestis (plague), variola major virus (smallpox), Francisella tularensis (tularemia), and the filoviruses and arenaviruses that induce viral hemorrhagic fevers. These agents are regarded as having the greatest potential for adverse impact on public health and therefore are a focus of renewed attention in infectious disease research. Frequently rodent models are used to study the pathobiology of these agents. Although much is known regarding naturally occurring infections in humans, less is documented on the sources of exposures and potential risks of infection to researchers and animal care personnel after the administration of these hazardous substances to laboratory animals. Failure to appropriately manage the animals can result both in the creation of workplace hazards if human exposures occur and in disruption of the research if unintended animal exposures occur. Here we review representative Category A agents, with a focus on comparing the biologic effects in naturally infected humans and rodent models and on considerations specific to the management of infected rodent subjects. The information reviewed for each agent has been curated manually and stored in a unique Internet-based database system called HazARD (Hazards in Animal Research Database, http://helab.bioinformatics.med.umich.edu/hazard/) that is designed to assist researchers, administrators, safety officials, Institutional Biosafety Committees, and veterinary personnel seeking information on the management of risks associated with animal studies involving hazardous substances.

Technological advancements for the detection of and protection against biological and chemical warfare agents

There is a growing need for technological advancements to combat agents of chemical and biological warfare, particularly in the context of the deliberate use of a chemical and/or biological warfare agent by a terrorist organization. In this tutorial review, we describe methods that have been developed both for the specific detection of biological and chemical warfare agents in a field setting, as well as potential therapeutic approaches for treating exposure to these toxic species. In particular, nerve agents are described as a typical chemical warfare agent, and the two potent biothreat agents, anthrax and botulinum neurotoxin, are used as illustrative examples of potent weapons for which countermeasures are urgently needed.

[Botulism in the past and today--clinical aspects]

In this paper we review the most recent approach to clinical manifestations, diagnosis and treatment of botulism.

Ecology of Clostridium botulinum causing food-borne botulism in Thailand

The objective of this study was to determine ecology of Clostridium botulinum from previous reported outbreaks. Geographical parameters and their corresponding settings were collected and analyzed. The averages (mean +/- SD) for % soil moisture, % humus and pH were 0.6 +/- 0.1% (range 0.5-0.7), 3.0 +/- 0.2% (range 3-3.2) and 5.2 +/- 0.1 (range 5.1-5.4), respectively. All outbreak settings shared the same sandy loam soil type. It can imply that provinces with this type of ecology may have sites harboring C. botulinum.

Watershed issues associated with Clostridium botulinum: a literature review

Botulism the disease, the related organism (Clostridium botulinum) and toxin have gained renewed attention in these times of heightened homeland security and bioterrorism preparedness. Since C. botulinum is ubiquitous in nature, botulism outbreaks resulting from environmental exposure can be of concern to watershed managers and drinking water utilities. This paper reviews aspects of naturally occurring C. botulinum in light of concerns for source water watersheds. Information regarding sources and occurrence of botulism, C. botulinum and botulism toxins are discussed. Ecology and physiology of environmental C. botulinum and cycles of disease are reviewed. Finally, the effectiveness of water treatment and disinfection measures is discussed.

Watershed issues associated with Clostridium botulinum: a literature review

Botulism the disease, the related organism (Clostridium botulinum) and toxin have gained renewed attention in these times of heightened homeland security and bioterrorism preparedness. Since C. botulinum is ubiquitous in nature, botulism outbreaks resulting from environmental exposure can be of concern to watershed managers and drinking water utilities. This paper reviews aspects of naturally occurring C. botulinum in light of concerns for source water watersheds. Information regarding sources and occurrence of botulism, C. botulinum and botulism toxins are discussed. Ecology and physiology of environmental C. botulinum and cycles of disease are reviewed. Finally, the effectiveness of water treatment and disinfection measures is discussed.

A novel type A2 neurotoxin gene cluster in Clostridium botulinum strain Mascarpone

The partial nucleotide sequence ( approximately 10 kb) of the cluster of genes encoding the botulinum neurotoxin complex in Clostridium botulinum type A strain Mascarpone was determined. The analysis revealed six ORFs (orfs), which were organized as in the type A2 and type A3 botulinum neurotoxin gene clusters of strains Kyoto-F and NCTC 2916, respectively. While the orfs at the proximal and distal ends of the sequence (orfX2 and bont/A genes) shared a high level of similarity with the corresponding sequences of strain Kyoto-F, the segment encompassing the orfX1 and botR/A genes within the sequence exhibited a higher degree of homology to the related region in strain NCTC 2916. The mosaic structure of the Mascarpone neurotoxin gene cluster suggests recombinational exchanges.