1887

Abstract

Infant botulism is a rare disease in the UK, with the first case being recognized in 1978 and only five subsequent cases being reported before 2007. This study reports two unlinked cases of infant botulism, caused by two distinct strains of (toxin types A and B, respectively), that occurred within a single month in the south-east of England in October 2007. The use of real-time PCR to detect neurotoxin genes in clinical specimens to improve the diagnostic procedure and to follow carriage of the causative organism in the infant gut is described. The laboratory investigation of these two cases demonstrated that a combination of the mouse bioassay, real-time PCR assays and conventional microbiological culture can provide rapid confirmation of a clinical diagnosis and affect patient management. Both infants (aged 4 and 8 months) were previously healthy prior to the onset of symptoms, and in both cases, a diagnosis of infant botulism was delayed for at least 10 days after initial admission to hospital. Once diagnosed, one of the infants was the first in the UK to be treated with human-derived botulism immunoglobulin. Real-time PCR was used to demonstrate that was excreted in the infants' faeces for up to 68 and 81 days, respectively. Despite the infrequency of infant botulism in the UK, clinicians should be aware of this rare but serious condition and should seek microbiological advice when presented with young infants with compatible symptomologies.

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2009-12-01
2019-11-13
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References

  1. Akbulut, D., Grant, K. A. & McLauchlin, J. ( 2004; ). Application and development of real-time PCR assays to detect fragments of the Clostridium botulinum types A, B and E neurotoxin genes for investigation of human foodborne and infant botulism. Foodborne Pathog Dis 1, 247–257.[CrossRef]
    [Google Scholar]
  2. Akbulut, D., Grant, K. A. & McLauchlin, J. ( 2005; ). Improvement in laboratory diagnosis of wound botulism and tetanus amongst illegal injecting drug users by use of real-time PCR assays for neurotoxin gene fragments. J Clin Microbiol 43, 4342–4348.[CrossRef]
    [Google Scholar]
  3. Anonymous ( 2008; ). Infant Botulism Treatment Program. Division of Communicable Disease Control, California Department of Public Health. Available from: http://www.infantbotulism.org/. Accessed April 2008.
  4. Arnon, S. S. ( 1992; ). Infant botulism. In Textbook of Pediatric Infectious Diseases, pp. 1095–1102. Edited by R. D. Feigin & J. D. Cherry. Philadelphia: W. B. Saunders.
  5. Arnon, S. S. ( 1995; ). Botulism as an intestinal toxaemia. In Infections of the Gastrointestinal Tract, pp. 257–271. Edited by M. J. Blaser, P. D. Smith, J. I. Ravdin, H. B. Greenberg & R. L. Guerrant. New York: Raven Press.
  6. Arnon, S. S., Midura, T. F., Damus, K., Thompson, B., Wood, R. M. & Chin, J. ( 1979; ). Honey and other environmental risk factors for infant botulism. J Pediatr 94, 331–336.[CrossRef]
    [Google Scholar]
  7. Arnon, S. S., Schechter, R., Maslanka, S. E., Jewell, N. P. & Hatheway, C. L. ( 2006; ). Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 354, 462–471.[CrossRef]
    [Google Scholar]
  8. Brett, M. M., McLauchlin, J., Harris, A., O'Brien, S., Black, N., Roberts, D. & Bolton, F. J. ( 2005; ). A case of infant botulism with a possible link to infant formula milk powder: evidence for the presence of more than one strain of Clostridium botulinum in clinical specimens and food. J Med Microbiol 54, 769–776.[CrossRef]
    [Google Scholar]
  9. CDC ( 1997; ). Case definitions for infectious conditions under public health surveillance. Morb Mortal Wkly Rep 46, RR10. 1–55.
    [Google Scholar]
  10. CDC ( 1998; ). Botulism in the United States, 1899–1996. Handbook for Epidemiologists, Clinicians and Laboratory Workers. Atlanta: Centers for Disease Control and Prevention.
  11. CDSC ( 1993; ). A case of infant botulism. Commun Dis Rep CDR Wkly 3, 129
    [Google Scholar]
  12. CDSC ( 1994; ). A case of infant botulism. Commun Dis Rep CDR Wkly 4, 53
    [Google Scholar]
  13. Crawford, D. & Gorrell, J. G. ( 2002; ). Infant botulism and corn syrup: a case report. J Pediatr Pharmacol Ther 7, 64–67.
    [Google Scholar]
  14. Dezfulian, M., McCroskey, L. M., Hatheway, C. L. & Dowell, V. R. ( 1981; ). Selective medium for isolation of Clostridium botulinum from human feces. J Clin Microbiol 13, 526–531.
    [Google Scholar]
  15. Fox, C. K., Keet, C. A. & Strober, J. B. ( 2005; ). Recent advances in infant botulism. Pediatr Neurol 32, 149–154.[CrossRef]
    [Google Scholar]
  16. Jones, S., Huma, Z., Haugh, C., Young, Y., Starer, F. & Sinclair, L. ( 1990; ). Central nervous system involvement in infantile botulism. Lancet 335, 228
    [Google Scholar]
  17. Nevas, M., Lindstrom, M., Virtanen, A., Hielm, S., Kuusi, M., Arnon, S. S., Vuori, E. & Korkeala, H. ( 2005; ). Infant botulism acquired from household dust presenting as sudden infant death syndrome. J Clin Microbiol 43, 511–513.[CrossRef]
    [Google Scholar]
  18. Smart, J. L., Jones, T. O., Clegg, F. G. & McMurty, M. J. ( 1987; ). Poultry waste associated type C botulism in cattle. Epidemiol Infect 98, 73–79.[CrossRef]
    [Google Scholar]
  19. Smith, G. E., Hinde, F., Westmoreland, D., Berry, P. R. & Gilbert, R. J. ( 1989; ). Infantile botulism. Arch Dis Child 64, 871–872.[CrossRef]
    [Google Scholar]
  20. Turner, H. D., Brett, E. M., Gilbert, R. J., Ghosh, A. C. & Liebeschuetz, H. J. ( 1978; ). Infant botulism in England. Lancet 1, 1277–1278.
    [Google Scholar]
  21. Valsangiacomo, C., Baggi, F., Gaia, V., Balmelli, T., Peduzzi, R. & Piffaretti, J. C. ( 1995; ). Use of amplified fragment length polymorphism in molecular typing of Legionella pneumophila and application to epidemiological studies. J Clin Microbiol 33, 1716–1719.
    [Google Scholar]
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