A case of infant botulism in a 4-month-old baby

This case-report highlights: i) the difficulty of IB diagnosis as it is a rare syndrome with subclinical onset, ii) the need for an accurate training for physicians involved in IB management, iii) the efficacy and safety of TEqA in IB treatment, iv) homemade honey is not the only cause of IB

Foodborne botulism associated with home-preserved turnip tops in Italy

In Italy, foodborne botulism is a rare disease mainly due to home-preserved food. Inthe case reported here, clinical diagnosis was performed on the basis of clinical signsand referred consumption of home-preserved turnip tops in oil. Definitive diagnosis wasperformed by detection of botulinum toxin in sera and neuro-toxigenic organisms instools and leftover food. This case report highlights the need of a high medical awareness,prompt clinical diagnosis, and synergic collaboration among the health authorities for acorrect management of botulism as well as disease containment

Management of Animal Botulism Outbreaks: From Clinical Suspicion to Practical Countermeasures to Prevent or Minimize Outbreaks

Botulism is a severe neuroparalytic disease that affects humans, all warm-blooded animals, and some fishes. The disease is caused by exposure to toxins produced by Clostridium botulinum and other botulinum toxin–producing clostridia. Botulism in animals represents a severe environmental and economic concern because of its high mortality rate. Moreover, meat or other products from affected animals entering the food chain may result in a public health problem. To this end, early diagnosis is crucial to define and apply appropriate veterinary public health measures. Clinical diagnosis is based on clinical findings eliminating other causes of neuromuscular disorders and on the absence of internal lesions observed during postmortem examination. Since clinical signs alone are often insufficient to make a definitive diagnosis, laboratory confirmation is required. Botulinum antitoxin administration and supportive therapies are used to treat sick animals. Once the diagnosis has been made, euthanasia is frequently advisable. Vaccine administration is subject to health authorities' permission, and it is restricted to a small number of animal species. Several measures can be adopted to prevent or minimize outbreaks. In this article we outline all phases of management of animal botulism outbreaks occurring in wet wild birds, poultry, cattle, horses, and fur farm animals

The First Case of Botulism in a Donkey

Botulism, a severe neuroparalytic disease that can affect humans, all warm-blooded animals, and some fishes, is caused by exotoxins produced by ubiquitous, obligate anaerobic, spore-forming bacteria belonging to the genus Clostridium and named botulinum neurotoxin (BoNT)-producing clostridia. This report presents the case of a 3-year-old donkey mare referred for progressive and worsening dysphagia of four days’ duration. Her voluntary effort in eating and drinking was conserved, and she was able to slow chew without swallowing. A complete neurological examination was performed, and botulism was strongly suspected. The ability to swallow feed and water returned on the tenth day of hospitalization and improved progressively. The jenny was discharged from the hospital after fifteen days. During the hospitalization, the Italian National Reference Centre for Botulism confirmed the diagnosis: mare’s feces were positive for BoNT/B and Clostridium botulinum type B

Probable case of botulism: treating with a grain of salt

Objective: Foodborne botulism is caused by ingestion of neurotoxins of Clostridium botulinum. Confirmed diagnosis is based on isolation of toxin in patient and/or food samples, but there are also cases with suggestive clinical symptoms associated with negative laboratory testing and responsive to specific antitoxin therapy. Case report: On December 2016, a 39-year-old woman was admitted in a clinical department of Policlinico Umberto I for diarrhea and dysarthria. Antibiotic and antiviral therapy was prescribed. Neurological exam was normal, and computerised tomography (CT) scan, magnetic resonance imaging (MRI), and cerebrospinal fluid analysis were negative. Three days later, symptoms progressed with the onset of ptosis, mydriasis, ophthalmoplegia, diplopia, xerostomia, dysphagia, and constipation, and the Poison Control Center was alerted. Foodborne botulism was suspected based on the anamnestic data, symptom onset and exclusion of other possible conditions. Rectal swabs were taken and Trivalent-Equine-Antitoxin (TEqA, 750 IU-anti-A, 500 IU-anti-B, 50 IU-anti-E per mL) was requested. Food samples consisting of inoil industrial preparations of meat and vegetables in spreadable paste (patè) consumed regularly by the patient were collected and sent for laboratory analysis. Antitoxin was then administered with a slow and progressive clinical amelioration over 48 hours. Culture of food samples revealed the presence of toxin producing Clostridium, while patient samples were negative. In the following days, ocular symptoms continued to improve, although a nasogastric tube was positioned for nutrition as liquid and solid dysphagia persisted. Fourteen days later, dysphagia for liquids and constipation resolved. Gradual improvement of symptoms continued over one month and she was discharged with a persistent diplopia. Two outpatient ophthalmological examinations at two and three months showed a gradual resolution of diplopia. On telephone follow-up, the patient reported facial muscles weakness four months after recovery. Conclusion: This case allows the following considerations: (i) given that bacterial isolation in food does not constitute a valid laboratory diagnostic criterion, presence of clinical and epidemiological criteria may define a probable botulism case [1]; (ii) neuromuscular sequelae several years after the critical phase have been reported [2], and may escape recognition if long-term follow-up sessions are not scheduled

An outbreak of foodborne botulism in Rome

Objective: Foodborne botulism is caused by consumption of preformed Clostridium botulinum toxins (BoNT) in food. Although rare events, botulism outbreaks, especially those involving commercially prepared products, represent a public health emergency, given the potential for a large number of cases [1]. Case series: In November 2016, a 71-year old male (Case 1) presented to Umberto I Emergency Department (ED) with a 5-day history of diplopia, xerostomia, and constipation. He was afebrile with normal vital signs. Neurological examination confirmed left and right diplopia in the lateral vision, with no deficit in muscles tone, coordination, and osteotendon reflexes. He was held for further tests; the symptoms did not resolve. The Poison Control Center was alerted 2 days later, and a detailed anamnesis and food history revealed a meal consumed 10 days earlier with four friends in a public eatery. One of them was already hospitalized elsewhere for head trauma following a sudden fall, and showed severe weight loss (Case 2). Botulism was considered and then strongly suspected when informed by the local health department of a confirmed case in a patient who ate at the same restaurant on the same day. The remaining three diners were evaluated in our ED shortly after. Two (Case 3 and 4) reported dysphagia, diplopia, and constipation, associated with ptosis in one case. One patient was asymptomatic and discharged. An industrial preparation of vegetables in oil, used as a sandwich filling, was considered the most likely source. Trivalent-Equine Antitoxin (750 IU-anti-A, 500 IU-anti-B, and 50 IU-anti-E per mL) was administered. There was no progression of clinical signs and no one required mechanical ventilation. BoNT-producing clostridia, identified as type B, were detected in fecal samples. Patients were discharged after 12 (Case 1), 19 (Case 2) and 23 days (Case 3 and 4), respectively. In total, the outbreak produced 5 confirmed cases. Conclusion: This report allows the follow considerations: (i) mildly symptomatic botulism cases may escape recognition; (ii) clinicians should be trained to consider a diagnosis of botulism: an initial suspicion may lead to identification of other cases originally misdiagnosed; (iii) collaboration of medical and public health professionals is key to link multiple suspected cases to a common exposure. In summary, secondary prevention, which includes rapid identification, epidemiologic linkages of cases, and control of outbreaks resulting from contaminated food, is beneficialto prevent further spread and reduce morbidity and costs

Biofilm formation, pigment production and motility in Pseudomonas spp. isolated from the dairy industry

The aim of this study was to investigate the ability of Pseudomonas spp. strains isolated from milk, dairy products and dairy plants, to produce blue pigment in situ, to form biofilm onto polystyrene surfaces and to perform different types of motility. Molecular identification revealed that, out of 72 Pseudomonas spp. isolates, P. fluorescens was the most common species (50 isolates) followed by P. putida (9), P. koreensis (4), P. brenneri (4), P. aeruginosa (2), P. granadensis (2) and P. veronii (1). The evaluation of blue colour production showed that the pigment was produced at 10 °C but not at 30 °C; in addition this character was strain- and species-dependent, with only 16 P. fluorescens strains showing blue pigment production. Most of the studied strains produced biofilm although with some differences related to the strains and the incubation temperatures. Within the most abundant isolated species (P. fluorescens), about 46%, 34% and 26% of the strains were able to swim, swarm and twitch, respectively. The observed relationship between biofilm formation and blue pigment production in P. fluorescens strains was statistically significant. Since these characteristics may contribute to the persistence of microorganisms in food processing environments and therefore to the contamination of food products, our results may help to focus on the control of the strains involved in the blue discolouration of dairy products