Foodborne botulism in southwest Romania during the post-communism period 1990–2007

Epidemiology of botulism in the north-western Romania-a 7-year survey

Botulism is a rare, acute, life-threatening neuro-paralysis. The digestive onset may raise diagnostic issues. The objective of our study was to analyze the clinical and epidemiological data of patients diagnosed with botulism and hospitalized in "Gavril Curteanu" Municipal Clinical Hospital (Oradea, Romania). Detection of the Clostridium botulinum neurotoxin (type B) in the laboratories of the National Institute of Medical-Military Research Development "Cantacuzino", Bucharest, Romania (using the mouse bioassays method) confirmed the diagnostics. The statistical analysis was performed using the IBM SPSS software. Forty-eight patients with the diagnosis of foodborne botulism were hospitalized between 2012 and 2018 (36.92% of the total number of cases of botulism reported in Romania). The winter-spring period was the period when most cases were registered (36 patients, p=0.020). Women from rural areas were predominant (but not statistically significant), and the patients' mean age was 39.93±12.59 years. The most common source/cause of botulism was the consumption of homemade ham. The incubation period was 26.68±22.94 h, and 2.25±1.68 days passed from the clinical onset to diagnosis. The results prove that botulism is still a public health issue, especially in areas where homemade products are prepared using inappropriate/unsafe recipes/procedures.

Foodborne Botulism in Western Romania: Ten Years' Experience at a Tertiary Infectious Disease Hospital

OBJECTIVES

The purpose of this study was to analyze epidemiological data concerning foodborne botulism in Western Romania over the last decade. Botulism, the toxin formed by the bacterium Clostridium botulinum, results in a neuroparalytic disorder capable of severe clinical progression that begins in the cranial nerves and progressively descends. Preventing progression to a severe case entails timely diagnosis since curative assets are restricted. Ingesting food containing a preformed toxin (foodborne botulism) is the most typical form.

METHODS

Medical records were retrospectively analyzed from 2010 to 2020 for all food botulism cases. A seroneutralization test was performed with type A, B and E anti-botulinum sera to establish the kind of toxin involved.

RESULTS

Overall, 18 cases of foodborne botulism were admitted to the hospital during this period and confirmed by laboratory analysis. Most of the participants in our study were men (61.1%), and 77.8% of the total lived in rural areas. All the participants showed classic symptoms of botulism, and dysphagia was present in all cases. The trivalent ABE antitoxin was administered by the hospital, and toxin type B was isolated in all patients. The main sources of the toxin were pork, ham and canned pork meat.

CONCLUSIONS

Stronger efforts are needed to foster community awareness of foodborne botulism, particularly in home-preserved food.

Pyrosequencing analysis of microbial community and food-borne bacteria on restaurant cutting boards collected in Seri Kembangan, Malaysia, and their correlation with grades of food premises

This study adopts the pyrosequencing technique to identify bacteria present on 26 kitchen cutting boards collected from different grades of food premises around Seri Kembangan, a city in Malaysia. Pyrosequencing generated 452,401 of total reads of OTUs with an average of 1.4×10(7) bacterial cells/cm(2). Proteobacteria, Firmicutes and Bacteroides were identified as the most abundant phyla in the samples. Taxonomic richness was generally high with >1000 operational taxonomic units (OTUs) observed across all samples. The highest appearance frequencies (100%) were OTUs closely related to Enterobacter sp., Enterobacter aerogenes, Pseudomonas sp. and Pseudomonas putida. Several OTUs were identified most closely related to known food-borne pathogens, including Bacillus cereus, Cronobacter sakazaki, Cronobacter turisensis, Escherichia coli, E. coli O157:H7, Hafnia alvei, Kurthia gibsonii, Salmonella bongori, Salmonella enterica, Salmonella paratyphi, Salmonella tyhpi, Salmonella typhimurium and Yersinia enterocolitica ranging from 0.005% to 0.68% relative abundance. The condition and grade of the food premises on a three point cleanliness scale did not correlate with the bacterial abundance and type. Regardless of the status and grades, all food premises have the same likelihood to introduce food-borne bacteria from cutting boards to their foods and must always prioritize the correct food handling procedure in order to avoid unwanted outbreak of food-borne illnesses.

Inhibition of toxigenesis of group II (nonproteolytic) Clostridium botulinum type B in meat products by using a reduced level of nitrite

The effect of three different concentrations of sodium nitrite (0, 75, and 120 mg/kg) on growth and toxigenesis of group II (nonproteolytic) Clostridium botulinum type B was studied in Finnish wiener-type sausage, bologna-type sausage, and cooked ham. A low level of inoculum (2.0 log CFU/g) was used for wiener-type sausage and bologna-type sausage, and both low (2.0 log CFU/g) and high (4.0 log CFU/g) levels were used for cooked ham. The products were formulated and processed under simulated commercial conditions and stored at 8°C for 5 weeks. C. botulinum counts were determined in five replicate samples of each nitrite concentration at 1, 3, and 5 weeks after thermal processing. All samples were positive for C. botulinum type B. The highest C. botulinum counts were detected in nitrite-free products. Toxigenesis was observed in nitrite-free products during storage, but products containing either 75 or 120 mg/kg nitrite remained nontoxic during the 5-week study period, suggesting that spores surviving the heat treatment were unable to germinate and develop into a toxic culture in the presence of nitrite. The results suggest that the safety of processed meat products with respect to group II C. botulinum type B can be maintained even with a reduced concentration (75 mg/kg) of sodium nitrite.

Epidemiology of foodborne botulism in Romania 1980-2009

In 2007, Romania, the largest southeastern European country, reported the highest notification rate of botulism cases in the European Union (0.18 per 100,000 inhabitants), which was 18 times higher than the reported rate in the United States (0.01 per 100,000 inhabitants). This report aims to analyze published and unpublished surveillance data on foodborne botulism in Romania from 1980 to 2009 in the context of political and economical changes that occurred in the former communist countries. The mean annual incidence rate of botulism cases was significantly lower during the late communist period, 1980-1989 (0.06±0.03 cases per 100,000 inhabitants), than during the years 1990-1999 (0.1±0.04 cases per 100,000 inhabitants, p=0.01) and 2000-2009 (0.12±0.04 cases per 100,000 inhabitants, p<0.01). The highest incidence rates were registered in 1998 and 2007 (0.18 cases per 100,000 inhabitants), whereas the lowest incidence rate was registered in 1983 (0.02 cases per 100,000 inhabitants). The disease was usually associated with the consumption of home prepared meat products (mainly raw sausages, smoked-dried meat). Most of the laboratory-confirmed cases tested positive for type B toxin (99%). During 2007-2009, the incidence was particularly high in northwestern and western Romania (0.5 and 0.3 cases per 100,000 inhabitants, respectively). The fatality rate was 60% before 1995 and decreased to 12.2±8.5% during 1999-2009. The general ascending trend of infection rates throughout the period studied demonstrates the need for the implementation of correct public health and educational measures to fully prevent this severe disease.