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Harris RA, Dabritz HA. Infant Botulism: In Search of Clostridium botulinum Spores. Curr Microbiol 2024; 81:306. [PMID: 39138824 PMCID: PMC11322261 DOI: 10.1007/s00284-024-03828-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/31/2024] [Indexed: 08/15/2024]
Abstract
Infant botulism is now the most common form of human botulism in Canada and the United States. Infant botulism is a severe neuroparalytic disease caused by ingestion of the spore-forming neurotoxic clostridia, including Clostridium botulinum that colonize the large intestine and subsequently produce botulinum neurotoxin in situ. It has been over a century since the first surveys documenting the ubiquitous prevalence of C. botulinum in soils around the world. Since then, honey has been identified as the only well-known risk factor for infant botulism despite a multitude of international environmental surveys isolating C. botulinum spores from ground soil, aquatic sediments, and commonly available infant foods. Associations of infant botulism cases with confirmed sources of C. botulinum exposure have primarily implicated outdoor soil and indoor dust, as well as commonly ingested foods including honey, dry cereals, and even powdered infant formula. Yet the origin of infection remains unknown for most infant botulism cases. This review summarizes the various surveys from around the world for C. botulinum in environmental soils and sediments, honey, and other infant foods, as well as laboratory-confirmed associations with documented infant botulism cases. Additional factors are also discussed, including the composition of infant gut microbiota and the practice of breastfeeding. We make several recommendations to better identify sources of exposure to C. botulinum spores that could lead to effective preventive measures and help reduce the incidence of this rare but life-threatening disease.
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Affiliation(s)
- Richard A Harris
- Botulism Reference Service for Canada, Health Canada, Ottawa, ON, Canada.
| | - Haydee A Dabritz
- Infant Botulism Treatment and Prevention Program, California Department of Public Health, Richmond, CA, USA
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Ishikawa K, Hasegawa R, Shibutani K, Mikami Y, Kawai F, Matsuo T, Uehara Y, Mori N. Probiotic-related Clostridium butyricum bacteremia: a case report and literature review. Anaerobe 2023; 83:102770. [PMID: 37544356 DOI: 10.1016/j.anaerobe.2023.102770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/08/2023]
Abstract
We report three cases of Clostridium butyricum bacteremia associated with taking C. butyricum-related probiotics. We performed a literature review and found 11 cases of C. butyricum bacteremia including our cases. Nine cases related to probiotics. We should consider that probiotics may infect clinically unstable patients.
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Affiliation(s)
- Kazuhiro Ishikawa
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan.
| | - Ryo Hasegawa
- Department of General Internal Medicine and Clinical Laboratory Medicine, Akita University Graduate School of Medicine, Akita, Japan
| | - Koko Shibutani
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
| | - Yumiko Mikami
- Department of Clinical Laboratory, St. Luke's International Hospital, Tokyo, Japan
| | - Fujimi Kawai
- Library, Center for Academic Resources, St. Luke's International University, Japan
| | - Takahiro Matsuo
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan; Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yuki Uehara
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan; Department of Infectious Diseases, Fujita Health University School of Medicine, Aichi, Japan
| | - Nobuyoshi Mori
- Department of Infectious Diseases, St. Luke's International Hospital, Tokyo, Japan
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3
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Dabritz HA, Payne JR, Khouri JM. Duration of Fecal Excretion of Clostridium Botulinum and Botulinum Neurotoxin in Patients Recovering from Infant Botulism. J Pediatr 2023; 258:113396. [PMID: 37004956 DOI: 10.1016/j.jpeds.2023.113396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/06/2023] [Accepted: 03/25/2023] [Indexed: 04/04/2023]
Abstract
This study sought to determine duration of fecal excretion of Clostridium botulinum organisms and neurotoxin after onset of infant botulism in 66 affected infants. Median excretion was longer for type A than type B patients (organisms: 5.9 vs 3.5 weeks, toxin: 4.8 vs 1.6 weeks, respectively). Toxin excretion always ceased before organism excretion. Antibiotic therapy did not affect duration of excretion.
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Affiliation(s)
- Haydee A Dabritz
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratories Division, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA
| | - Jessica R Payne
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratories Division, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA
| | - Jessica M Khouri
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratories Division, Center for Laboratory Sciences, California Department of Public Health, Richmond, CA.
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Aminian KSG, Gulati P. Recurrent Infant Botulism Complicated by Necrotizing Enterocolitis. Pediatr Neurol 2023; 143:77-78. [PMID: 37028265 DOI: 10.1016/j.pediatrneurol.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 02/09/2023] [Accepted: 03/13/2023] [Indexed: 04/09/2023]
Affiliation(s)
| | - Pratima Gulati
- Division of Pediatric Neurology, IWK Health Centre, Halifax, Nova Scotia, Canada
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Genomic and Phenotypic Characterization of Clostridium botulinum Isolates from an Infant Botulism Case Suggests Adaptation Signatures to the Gut. mBio 2022; 13:e0238421. [PMID: 35499308 PMCID: PMC9239077 DOI: 10.1128/mbio.02384-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
In early life, the immature human gut microbiota is prone to colonization by pathogens that are usually outcompeted by mature microbiota in the adult gut. Colonization and neurotoxin production by a vegetative Clostridium botulinum culture in the gut of an infant can lead to flaccid paralysis, resulting in a clinical outcome known as infant botulism, a potentially life-threatening condition. Beside host factors, little is known of the ecology, colonization, and adaptation of C. botulinum to the gut environment. In our previous report, an infant with intestinal botulism was shown to be colonized by neurotoxigenic C. botulinum culture for 7 months. In an effort to gain ecological and evolutionary insights into this unusually long gut colonization by C. botulinum, we analyzed and compared the genomes of C. botulinum isolates recovered from the infant feces during the course of intoxication and isolates from the infant household dust. A number of observed mutations and genomic alterations pinpointed at phenotypic traits that may have promoted colonization and adaptation to the gut environment and to the host. These traits include motility, quorum-sensing, sporulation, and carbohydrate metabolism. We provide novel perspectives and suggest a tentative model of the pathogenesis of C. botulinum in infant botulism.
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Li T, Ning N, Iacobino A, Zhang L, Wang H, Franciosa G. Novel Putative Transposable Element Associated with the Subtype E5 Botulinum Toxin Gene Cluster of Neurotoxigenic Clostridium butyricum Type E Strains from China. Int J Mol Sci 2022; 23:906. [PMID: 35055088 PMCID: PMC8776182 DOI: 10.3390/ijms23020906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 02/04/2023] Open
Abstract
Previously, a whole-genome comparison of three Clostridium butyricum type E strains from Italy and the United States with different C. botulinum type E strains indicated that the bont/e gene might be transferred between the two clostridia species through transposition. However, transposable elements (TEs) have never been identified close to the bont/e gene. Herein, we report the whole genome sequences for four neurotoxigenic C. butyricum type E strains that originated in China. An analysis of the obtained genome sequences revealed the presence of a novel putative TE upstream of the bont/e gene in the genome of all four strains. Two strains of environmental origin possessed an additional copy of the putative TE in their megaplasmid. Similar putative TEs were found in the megaplasmids and, less frequently, in the chromosomes of several C. butyricum strains, of which two were neurotoxigenic C. butyricum type E strains, and in the chromosome of a single C. botulinum type E strain. We speculate that the putative TE might potentially transpose the bont/e gene at the intracellular and inter-cellular levels. However, the occasional TE occurrence in the clostridia genomes might reflect rare transposition events.
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Affiliation(s)
- Tao Li
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China; (T.L.); (N.N.); (L.Z.)
| | - Nianzhi Ning
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China; (T.L.); (N.N.); (L.Z.)
| | - Angelo Iacobino
- Department of Infectious Diseases, Istituto Superiore di Sanità, 00161 Rome, Italy;
| | - Liangyan Zhang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China; (T.L.); (N.N.); (L.Z.)
| | - Hui Wang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China; (T.L.); (N.N.); (L.Z.)
| | - Giovanna Franciosa
- National Center for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, 00161 Rome, Italy
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Dilena R, Pozzato M, Baselli L, Chidini G, Barbieri S, Scalfaro C, Finazzi G, Lonati D, Locatelli CA, Cappellari A, Anniballi F. Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review. Toxins (Basel) 2021; 13:toxins13120860. [PMID: 34941698 PMCID: PMC8703831 DOI: 10.3390/toxins13120860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
Infant botulism is a rare and underdiagnosed disease caused by BoNT-producing clostridia that can temporarily colonize the intestinal lumen of infants less than one year of age. The diagnosis may be challenging because of its rareness, especially in patients showing atypical presentations or concomitant coinfections. In this paper, we report the first infant botulism case associated with Cytomegalovirus coinfection and transient hypogammaglobulinemia and discuss the meaning of these associations in terms of risk factors. Intending to help physicians perform the diagnosis, we also propose a practical clinical and diagnostic criteria checklist based on the revision of the literature.
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Affiliation(s)
- Robertino Dilena
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
- Correspondence:
| | - Mattia Pozzato
- Neurology Unit & MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Lucia Baselli
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Sergio Barbieri
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
| | - Concetta Scalfaro
- National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.S.); (F.A.)
| | - Guido Finazzi
- Department of Food Control, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna, 25124 Brescia, Italy;
| | - Davide Lonati
- Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (D.L.); (C.A.L.)
| | - Carlo Alessandro Locatelli
- Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (D.L.); (C.A.L.)
| | - Alberto Cappellari
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
| | - Fabrizio Anniballi
- National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.S.); (F.A.)
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Descriptive Epidemiology of Infant Botulism in California: The First 40 Years. J Pediatr 2020; 227:247-257.e3. [PMID: 32800814 DOI: 10.1016/j.jpeds.2020.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/11/2020] [Accepted: 08/06/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To ascertain the descriptive epidemiology of infant botulism, the flaccid paralysis that results when neurotoxigenic Clostridium species produce botulinum toxin (BoNT) in the infant colon, in its first 40 years following initial recognition in California in 1976. STUDY DESIGN Cases were defined by laboratory identification of BoNT and/or neurotoxigenic Clostridium species in patients' feces. Parents were interviewed using a structured questionnaire. Descriptive epidemiologic characteristics were compared between 1976-1996 and 1997-2016. RESULTS From 1976-2016, 1345 cases of infant botulism occurred in 45 of 58 California counties (6.5 cases/100 000 live-births/year) caused by BoNT types A, B, Ba, Bf, and F; 88% of cases were ≤6 months of age and 51% were female. Cases were white (84.2%), Asian (8.9%), other races (3.8%), and African American (2.8%); 29.4% of cases were Hispanic. More than 99% of cases were hospitalized. Case occurrence peaked in summer-fall. Of 8 designated geographic regions, the Central Coast counties had 3 times the statewide incidence in both 20-year time periods. Breast-fed patients (83%) were more than twice as old at onset as formula-fed patients (median, 4.4 vs 1.7 months, respectively; P < .001). BoNT/A cases were older at onset than BoNT/B cases (median, 3.8 vs 2.9 months, respectively; P < .001). CONCLUSIONS Comprehensive continuous surveillance of infant botulism for 40 years in a large, diversely populated state identified fundamental epidemiologic characteristics of this uncommon illness. Unusual features included greater than 99% case hospitalization, absence of male preponderance, and a distinctive age distribution.
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Yi Z, Sadiq FA, Wang H, Zhao J, Zhang H, Lu W, Chen W. Establishment and evaluation of a method for efficient screening of Clostridium butyricum. Folia Microbiol (Praha) 2020; 65:917-924. [PMID: 32621129 DOI: 10.1007/s12223-020-00803-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022]
Abstract
At present, the traditional methods for the screening of Clostridium butyricum are not sufficiently selective and efficient. Therefore, it is necessary to establish a targeted and efficient screening method for the detection of C. butyricum. Bioinformatics was used in this study to find C. butyricum specific genes, and species-specific primers were designed based on the conserved regions of the targeted genes, followed by optimization of the PCR conditions. Methodological evaluation was carried out, and the results were compared with the traditional screening method based on Trypticase Sulfite Neomycin (TSN) selective medium. A high-efficiency PCR screening method, targeting C. butyricum species-specific primers, was established. The method was confirmed to have high specificity and sensitivity towards C. butyricum cut-off CFU 103. Compared with the traditional method, the screening success rate of C. butyricum strains increased from 0.61 to 81.91%. The PCR screening method could quickly and accurately detect C. butyricum in samples and dramatically improve screening efficiency.
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Affiliation(s)
- Zhi Yi
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
| | - Faizan A Sadiq
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
| | - Hongchao Wang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- Wuxi Translational Medicine Research Center and Jiangsu Translational Medicine Research Institute Wuxi Branch, Wuxi, 214122, Jiangsu Province, China
| | - Wenwei Lu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China.
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China.
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, Jiangsu Province, China.
- Wuxi Translational Medicine Research Center and Jiangsu Translational Medicine Research Institute Wuxi Branch, Wuxi, 214122, Jiangsu Province, China.
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- School of Food Science and Technology, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, 214122, Jiangsu Province, China
- Beijing Innovation Centre of Food Nutrition and Human Health, Beijing Technology and Business University (BTBU), Beijing, 100048, China
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Rasetti-Escargueil C, Lemichez E, Popoff MR. Public Health Risk Associated with Botulism as Foodborne Zoonoses. Toxins (Basel) 2019; 12:E17. [PMID: 31905908 PMCID: PMC7020394 DOI: 10.3390/toxins12010017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/23/2019] [Accepted: 12/25/2019] [Indexed: 12/03/2022] Open
Abstract
Botulism is a rare but severe neurological disease in man and animals that is caused by botulinum neurotoxins (BoNTs) produced by Clostridium botulinum and atypical strains from other Clostridium and non-Clostridium species. BoNTs are divided into more than seven toxinotypes based on neutralization with specific corresponding antisera, and each toxinotype is subdivided into subtypes according to amino acid sequence variations. Animal species show variable sensitivity to the different BoNT toxinotypes. Thereby, naturally acquired animal botulism is mainly due to BoNT/C, D and the mosaic variants CD and DC, BoNT/CD being more prevalent in birds and BoNT/DC in cattle, whereas human botulism is more frequently in the types A, B and E, and to a lower extent, F. Botulism is not a contagious disease, since there is no direct transmission from diseased animals or man to a healthy subject. Botulism occurs via the environment, notably from food contaminated with C. botulinum spores and preserved in conditions favorable for C. botulinum growth and toxin production. The high prevalence of botulism types C, D and variants DC and CD in farmed and wild birds, and to a lower extent in cattle, raises the risk of transmission to human beings. However, human botulism is much rarer than animal botulism, and botulism types C and D are exceptional in humans. Only 15 cases or suspected cases of botulism type C and one outbreak of botulism type D have been reported in humans to date. In contrast, animal healthy carriers of C. botulinum group II, such as C. botulinum type E in fish of the northern hemisphere, and C. botulinum B4 in pigs, represent a more prevalent risk of botulism transmission to human subjects. Less common botulism types in animals but at risk of transmission to humans, can sporadically be observed, such as botulism type E in farmed chickens in France (1998-2002), botulism type B in cattle in The Netherlands (1977-1979), botulism types A and B in horses, or botulism type A in dairy cows (Egypt, 1976). In most cases, human and animal botulisms have distinct origins, and cross transmissions between animals and human beings are rather rare, accidental events. But, due to the severity of this disease, human and animal botulism requires a careful surveillance.
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Affiliation(s)
| | | | - Michel R. Popoff
- Institut Pasteur, Département de Microbiologie, Unité des Toxines Bactériennes, CNRS ERL6002, 75724 Paris, France; (C.R.-E.); (E.L.)
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11
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Halpin AL, Khouri JM, Payne JR, Nakao JH, Cronquist A, Kalas N, Mohr M, Osborne M, O'Dell S, Luquez C, Klontz KC, Sobel J, Rao AK. Type F Infant Botulism: Investigation of Recent Clusters and Overview of This Exceedingly Rare Disease. Clin Infect Dis 2019; 66:S92-S94. [PMID: 29293930 DOI: 10.1093/cid/cix818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
From 1976 to 2016, neurotoxigenic Clostridium baratii type F caused 18 (<0.5%) reported US infant botulism cases. Six cases occurred during 2012-2013; no common source was identified. Type F infant botulism mostly occurs in very young infants and typically presents more rapidly and severely than illness caused by types A and B botulinum neurotoxin.
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Affiliation(s)
- Alison Laufer Halpin
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Scientific Education and Professional Development Program, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica M Khouri
- Infant Botulism Treatment and Prevention Program, California Department of Public Health, Richmond
| | - Jessica R Payne
- Infant Botulism Treatment and Prevention Program, California Department of Public Health, Richmond
| | - Jolene H Nakao
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Scientific Education and Professional Development Program, Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | - Sharon O'Dell
- Waynesboro-Augusta Health Department, Waynesboro, Virginia
| | - Carolina Luquez
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karl C Klontz
- Center for Food Safety and Applied Nutrition, Food and Drug Administration, College Park, Maryland
| | - Jeremy Sobel
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam K Rao
- Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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12
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Type E Botulinum Neurotoxin-Producing Clostridium butyricum Strains Are Aerotolerant during Vegetative Growth. mSystems 2019; 4:mSystems00299-18. [PMID: 31058231 PMCID: PMC6495232 DOI: 10.1128/msystems.00299-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/10/2019] [Indexed: 11/21/2022] Open
Abstract
Botulinum neurotoxins, the causative agents of the potentially fatal disease of botulism, are produced by certain Clostridium strains during vegetative growth, usually in anaerobic environments. Our findings indicate that, contrary to current understanding, the growth of neurotoxigenic C. butyricum strains and botulinum neurotoxin type E production can continue upon transfer from anaerobic to aerated conditions and that adaptation of strains to oxygenated environments requires global changes in proteomic and metabolic profiles. We hypothesize that aerotolerance might constitute an unappreciated factor conferring physiological advantages on some botulinum toxin-producing clostridial strains, allowing them to adapt to otherwise restrictive environments. Clostridium butyricum, the type species of the genus Clostridium, is considered an obligate anaerobe, yet it has been shown to grow in the presence of oxygen. C. butyricum strains atypically producing the botulinum neurotoxin type E are the leading cause of type E human botulism in Italy. Here, we show that type E botulinum neurotoxin-producing C. butyricum strains growing exponentially were able to keep growing and producing toxin in vitro upon exposure to air, although less efficiently than under ideal oxygen-depleted conditions. Bacterial growth in air was maintained when the initial cell density was higher than 103 cells/ml. No spores were detected in the cultures aerated for 5 h. To understand the biological mechanisms allowing the adaptation of vegetative cells of C. butyricum type E to oxygen, we compared the proteome and metabolome profiles of the clostridial cultures grown for 5 h under either aerated or anaerobic conditions. The results indicated that bacterial cells responded to oxygen stress by slowing growth and modulating the expression of proteins involved in carbohydrate uptake and metabolism, redox homeostasis, DNA damage response, and bacterial motility. Moreover, the ratio of acetate to butyrate was significantly higher under aeration. This study demonstrates for the first time that a botulinum neurotoxin-producing Clostridium can withstand oxygen during vegetative growth. IMPORTANCE Botulinum neurotoxins, the causative agents of the potentially fatal disease of botulism, are produced by certain Clostridium strains during vegetative growth, usually in anaerobic environments. Our findings indicate that, contrary to current understanding, the growth of neurotoxigenic C. butyricum strains and botulinum neurotoxin type E production can continue upon transfer from anaerobic to aerated conditions and that adaptation of strains to oxygenated environments requires global changes in proteomic and metabolic profiles. We hypothesize that aerotolerance might constitute an unappreciated factor conferring physiological advantages on some botulinum toxin-producing clostridial strains, allowing them to adapt to otherwise restrictive environments.
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13
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Schönherr-Hellec S, Aires J. Clostridia and necrotizing enterocolitis in preterm neonates. Anaerobe 2019; 58:6-12. [PMID: 30980889 DOI: 10.1016/j.anaerobe.2019.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 02/08/2023]
Abstract
Necrotizing enterocolitis (NEC) is the most severe life threatening gastrointestinal disease among preterm neonates. NEC continues to account for substantial morbidity and mortality in neonatal intensive care units worldwide. Although its pathogenesis remains incompletely elucidated, NEC is recognized as a multifactorial disease involving intestinal unbalanced inflammatory response, feeding strategies, and bacterial colonization. Epidemiological studies, clinical signs, and animal models support the participation of anaerobic bacteria, particularly clostridia species, in NEC development. Colonization by clostridia seems particularly deleterious. The present review is the opportunity to propose an update on the role of clostridia and NEC.
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Affiliation(s)
| | - J Aires
- EA 4065, Faculty of Pharmacy, Paris Descartes University, Paris, France.
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Sarita R, Ponmariappan S, Sharma A, Kamboj DV, Jain AK. Development of immunodetection system for botulinum neurotoxin serotype E. Indian J Med Res 2018; 147:603-610. [PMID: 30168493 PMCID: PMC6118135 DOI: 10.4103/ijmr.ijmr_1375_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background & objectives Botulism, a potentially fatal paralytic illness, is caused by the botulinum neurotoxins (BoNTs) secreted by Clostridium botulinum. It is an obligate anaerobic, Gram-positive, spore-forming bacterium. BoNTs are classified into seven serotypes based on the serological properties. Among these seven serotypes, A, B, E and, rarely, F are responsible for human botulism. The present study was undertaken to develop an enzyme-linked immunosorbent assay (ELISA)-based detection system for the detection of BoNT/E. Methods The synthetic gene coding the light chain of BoNT serotype E (BoNT/E LC) was constructed using the polymerase chain reaction primer overlapping method, cloned into pQE30UA vector and then transformed into Escherichia coli M15 host cells. Recombinant protein expression was optimized using different concentrations of isopropyl-β-D-1-thiogalactopyranoside (IPTG), different temperature and the rBoNT/E LC protein was purified in native conditions using affinity column chromatography. The purified recombinant protein was checked by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) and further confirmed by western blot and matrix-assisted laser desorption ionization-tandem time-of-flight (MALDI-TOF). Polyclonal antibodies were generated against rBoNT/E LC using Freund's adjuvant in BALB/c mice and rabbit. Sandwich ELISA was optimized for the detection of rBoNT/E LC and native crude BoNT/E, and food matrix interference was tested. The developed antibodies were further evaluated for their specificity/cross-reactivity with BoNT serotypes and other bacterial toxins. Results BoNT/E LC was successfully cloned, and the maximum expression was achieved in 16 h of post-induction using 0.5 mM IPTG concentration at 25°C. Polyclonal antibodies were generated in BALB/c mice and rabbit and the antibody titre was raised up to 128,000 after the 2nd booster dose. The developed polyclonal antibodies were highly specific and sensitive with a detection limit about 50 ng/ml for rBoNT/E LC and 2.5×10[3] MLD50 of native crude BoNT/E at a dilution of 1:3000 of mouse (capturing) and rabbit (revealing) antibodies. Further, different liquid, semisolid and solid food matrices were tested, and rBoNT/E LC was detected in almost all food samples, but different levels of interference were detected in different food matrices. Interpretation & conclusions There is no immune detection system available commercially in India to detect botulism. The developed system might be useful for the detection of botulinum toxin in food and clinical samples. Further work is in progress.
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Affiliation(s)
- R Sarita
- Biotechnology Division, Defence Research Development & Establishment, Gwalior, India
| | | | - Arti Sharma
- Biotechnology Division, Defence Research Development & Establishment, Gwalior, India
| | - Dev Vrat Kamboj
- Biotechnology Division, Defence Research Development & Establishment, Gwalior, India
| | - A K Jain
- School of Studies in Zoology, Jiwaji University, Gwalior, India
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Moneim J. Question 1: In infant botulism, is equine-derived botulinum antitoxin (EqBA) an effective alternative therapy to human-derived botulinum immune globulin (BIG)? Arch Dis Child 2018; 103:907-909. [PMID: 30007943 DOI: 10.1136/archdischild-2018-315498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Joseph Moneim
- University of Cambridge School of Clinical Medicine, Cambridge, UK
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Bernardor J, Neveu J, Haas H, Pitelet G, Popoff MR, Mazuet C, Bérard E, Boulay C, Chabrol B. Infant botulism: Two case reports and electroneuromyogram findings. Arch Pediatr 2018; 25:S0929-693X(18)30108-8. [PMID: 29887515 DOI: 10.1016/j.arcped.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 05/07/2018] [Accepted: 05/20/2018] [Indexed: 11/22/2022]
Abstract
Botulism is an uncommon severe neuromuscular disorder. We report two recent cases of confirmed infant botulism diagnosed in an 11-week and a 5-month-old infant along with electroneuromyogram (ENMG) findings. Then, we discuss the EMG features of infant botulism. In severe forms of infant botulism, presence of these features might help decide to use botulinum immune globulin. To our knowledge, case 1 is the first case reported in France based on confirmed dust contamination.
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Affiliation(s)
- J Bernardor
- Hôpitaux pédiatriques de Nice CHU, Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - J Neveu
- Hôpitaux pédiatriques de Nice CHU, Lenval, 57, avenue de la Californie, 06200 Nice, France.
| | - H Haas
- Hôpitaux pédiatriques de Nice CHU, Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - G Pitelet
- Hôpitaux pédiatriques de Nice CHU, Lenval, 57, avenue de la Californie, 06200 Nice, France
| | - M-R Popoff
- Unité des bactéries anaérobies et toxines, Institut Pasteur, 25, rue du Dr-Roux, 75724 Paris cedex 15, France
| | - C Mazuet
- Unité des bactéries anaérobies et toxines, Institut Pasteur, 25, rue du Dr-Roux, 75724 Paris cedex 15, France
| | - E Bérard
- Hôpital de l'Archet, CHU de Nice, 151, route de St-Antoine, 06200 Nice, France
| | - C Boulay
- Service de neuropédiatrie, hôpital La Timone-Enfants, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
| | - B Chabrol
- Service de neuropédiatrie, hôpital La Timone-Enfants, AP-HM, 264, rue St-Pierre, 13385 Marseille cedex 5, France
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Scalfaro C, Iacobino A, Grande L, Morabito S, Franciosa G. Effects of Megaplasmid Loss on Growth of Neurotoxigenic Clostridium butyricum Strains and Botulinum Neurotoxin Type E Expression. Front Microbiol 2016; 7:217. [PMID: 26941734 PMCID: PMC4766289 DOI: 10.3389/fmicb.2016.00217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/10/2016] [Indexed: 11/13/2022] Open
Abstract
Clostridium butyricum strains that atypically produce the botulinum neurotoxin type E (BoNT/E) possess a megaplasmid of unknown functions in their genome. In this study, we cured two botulinum neurotoxigenic C. butyricum type E strains of their megaplasmids, and compared the obtained megaplasmid-cured strains to their respective wild-type parental strains. Our results showed that the megaplasmids do not confer beta-lactam resistance on the neurotoxigenic C. butyricum type E strains, although they carry several putative beta-lactamase genes. Instead, we found that the megaplasmids are essential for growth of the neurotoxigenic C. butyricum type E strains at the relatively low temperature of 15°C, and are also relevant for growth of strains under limiting pH and salinity conditions, as well as under favorable environmental conditions. Moreover, the presence of the megaplasmids was associated with increased transcript levels of the gene encoding BoNT/E in the C. butyricum type E strains, indicating that the megaplasmids likely contain transcriptional regulators. However, the levels of BoNT/E in the supernatants of the cured and uncured strains were similar after 24 and 48 h culture, suggesting that expression of BoNT/E in the C. butyricum type E strains is not ultimately controlled by the megaplasmids. Together, our results reveal that the C. butyricum type E megaplasmids exert pleiotropic effects on the growth of their microbial hosts under optimal and limiting environmental conditions, and also highlight the possibility of original regulatory mechanisms controlling the expression of BoNT/E.
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Affiliation(s)
- Concetta Scalfaro
- Unit of Foodborne Zoonoses, Department of Food Safety and Veterinary Public Health, Istituto Superiore di Sanità Rome, Italy
| | - Angelo Iacobino
- Unit of Foodborne Zoonoses, Department of Food Safety and Veterinary Public Health, Istituto Superiore di SanitàRome, Italy; Unit of Systemic Bacterial Infections, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di SanitàRome, Italy
| | - Laura Grande
- Unit of Foodborne Zoonoses, Department of Food Safety and Veterinary Public Health, Istituto Superiore di Sanità Rome, Italy
| | - Stefano Morabito
- Unit of Foodborne Zoonoses, Department of Food Safety and Veterinary Public Health, Istituto Superiore di Sanità Rome, Italy
| | - Giovanna Franciosa
- Unit of Foodborne Zoonoses, Department of Food Safety and Veterinary Public Health, Istituto Superiore di Sanità Rome, Italy
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Dykes JK, Lúquez C, Raphael BH, McCroskey L, Maslanka SE. Laboratory Investigation of the First Case of Botulism Caused by Clostridium butyricum Type E Toxin in the United States. J Clin Microbiol 2015; 53:3363-5. [PMID: 26246485 PMCID: PMC4572528 DOI: 10.1128/jcm.01351-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022] Open
Abstract
We report here the laboratory investigation of the first known case of botulism in the United States caused by Clostridium butyricum type E. This investigation demonstrates the importance of extensive microbiological examination of specimens, which resulted in the isolation of this organism.
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Affiliation(s)
- Janet K Dykes
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolina Lúquez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian H Raphael
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Loretta McCroskey
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan E Maslanka
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Genomic Epidemiology of Clostridium botulinum Isolates from Temporally Related Cases of Infant Botulism in New South Wales, Australia. J Clin Microbiol 2015; 53:2846-53. [PMID: 26109442 DOI: 10.1128/jcm.00143-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 06/15/2015] [Indexed: 01/24/2023] Open
Abstract
Infant botulism is a potentially life-threatening paralytic disease that can be associated with prolonged morbidity if not rapidly diagnosed and treated. Four infants were diagnosed and treated for infant botulism in NSW, Australia, between May 2011 and August 2013. Despite the temporal relationship between the cases, there was no close geographical clustering or other epidemiological links. Clostridium botulinum isolates, three of which produced botulism neurotoxin serotype A (BoNT/A) and one BoNT serotype B (BoNT/B), were characterized using whole-genome sequencing (WGS). In silico multilocus sequence typing (MLST) found that two of the BoNT/A-producing isolates shared an identical novel sequence type, ST84. The other two isolates were single-locus variants of this sequence type (ST85 and ST86). All BoNT/A-producing isolates contained the same chromosomally integrated BoNT/A2 neurotoxin gene cluster. The BoNT/B-producing isolate carried a single plasmid-borne bont/B gene cluster, encoding BoNT subtype B6. Single nucleotide polymorphism (SNP)-based typing results corresponded well with MLST; however, the extra resolution provided by the whole-genome SNP comparisons showed that the isolates differed from each other by >3,500 SNPs. WGS analyses indicated that the four infant botulism cases were caused by genomically distinct strains of C. botulinum that were unlikely to have originated from a common environmental source. The isolates did, however, cluster together, compared with international isolates, suggesting that C. botulinum from environmental reservoirs throughout NSW have descended from a common ancestor. Analyses showed that the high resolution of WGS provided important phylogenetic information that would not be captured by standard seven-loci MLST.
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