No abstract available.
Botulism*

Laboratory-based pathogen isolation, identification, and toxicity determination were performed on samples from a suspected case of infant botulism. Mice injected with cultures generated from the enema sample and ingested Powered infant formula (PIF) presented typical signs of botulism. Antitoxins to polyvalent botulinum neurotoxins (BoNTs) and monovalent BoNT type B antitoxin had protective effects. Clostridium botulinum isolated from the enema and residual PIF samples were positive for type B toxin. Pulsed-field gel electrophoresis (PFGE) revealed that the two strains of C. botulinum isolated from the two samples produced indistinguishable pulsotypes. These findings confirmed this case of type B infant botulism associated with the ingestion of PIF contaminated by type B C. botulinum spores.
Animals ; Beijing ; epidemiology ; Botulinum Toxins ; isolation & purification ; toxicity ; Botulism ; diagnosis ; epidemiology ; Clostridium botulinum ; isolation & purification ; Gastrointestinal Tract ; microbiology ; Humans ; Infant ; Mice ; Toxicity Tests

Purpose: To report on a case of dysphagia secondary to botulinum toxin ingestion. Method: Case report Result: A 30-year-old female with no comorbidities, presented with dysphagia associated with ptosis and diplopia 12 hours after ingestion of double dead pork. Probable diagnoses of a neurologic, esophageal problem or a neoplasm were initially considered. Ancillary procedures to support diagnoses were performed including esophagogastroduodenoscopy, cranial CT scan and Facial and Extremity Nerve Conduction Velocity which all revealed unremarkable results. A possible polyneuropathy specifically foodborne toxicity was considered given a history of dysphagia, ptosis and diplopia with consumption of double dead pork. Confirmatory stool culture studies revealed Clostridium botulinum, hence appropriate antibiotics and supportive therapy were provided which led to the patient's recovery. Conclusion Early diagnosis and a high index of suspicion is important in cases with unfamiliar presentations, therefore a careful history and physical examination is warranted. Foodborne botulinum toxicity is a public health matter that should be addressed. Proper food handling and storage must always be practiced.
Public Health ; Deglutition Disorders ; Deglutition Disorders ; Botulism

OBJECTIVETo analyze the clinical characteristics and diagnosis of three cases with infant botulism.

METHODClinical data of three clinically diagnosed cases with infant botulism in May 2015 in Peking University First Hospital were retrospectively analyzed. Literature search at databases of PubMed, Wanfang, China National Knowledge Infrastructure and VIP with the key words"infant AND botulism". The date of literature retrieval was from the database founding to November 2015. The characteristics of infant botulism were summarized through review of literature.

RESULTThree patients were infants of 4-8 months of age, and all had acute onsets of anorexia and poor response. All of them had normal psychomotor development previously, and without clear history of exposure to poisons. The main findings on physical examination were reduced muscle strength and hypotonia, dullness or disappeared pupillary light reflex, reduced facial expression, weak crying and dysphagia. Unexpectedly their states of consciousness were relatively normal. Finally, through identification and PCR genotyping of bacteria in stool, 2 cases were confirmed as Clostridium (C.) botulinum type B infection. Totally 446 reports were retrieved from foreign language literature and 52 reports from Chinese literature. More than 3,000 cases of infant botulism cases were reported in the world. Rare cases were reported in China and only 1 case was reported in 2000.

CONCLUSIONMost cases of infant botulism had no clear exposure history. The main clinical manifestations are hypotonia, cranial nerve paralysis, flaccid paralysis, but different patients may have different presentations. Detection of C. Botulinum and its toxin in stool can help to confirm the diagnosis. Infant botulism is relatively rare in China, which may be related to the insufficient understanding and inspection level of the disease. It might be underestimated in China.

Botulinum toxin type A (BTA) is widely used for both medical treatment and cosmetic purposes. A 46-year-old woman presented with progressive generalized weakness and dysphagia. The patient had injected BTA into her both of her calves by herself for cosmetic purposes. Repetitive nerve stimulation of the right facial nerve demonstrated reduced compound muscle action potential amplitudes of the orbicularis oculi and nasalis muscles, and a reduced response to low-frequency, repetitive stimulation. The possibility of iatrogenic botulism should be considered when using BTA.
Action Potentials ; Botulinum Toxins ; Botulinum Toxins, Type A ; Botulism ; Cosmetics ; Deglutition Disorders ; Facial Nerve ; Female ; Humans ; Injections, Intramuscular ; Middle Aged ; Muscles

The geographical distribution of C. botulinum type E and its associated disease, type E botulism in China, is different from that in other areas of the world. Cases of type E botulism generally arise in costal regions. In China, however, type E botulism is found primarily in the Qinghai-Tibet plateau of northwest China far from the ocean, at an altitude of approximately 4-5 km. The foods most commonly associated with the disease are fermented grain and beans as well as raw meat. A suspected outbreak of type E botulism poisoning in the central costal region of China in the 1990s prompted the collection and analysis of samples of mud, sand, and fish from the region. The toxin produced by type E botulinum was found in these samples. Surprisingly, though, upon further analysis, the strain isolated from the samples was identified not as type E C. botulinum, but as the neurotoxigenic bacterium Clostridium butyricum.
Botulism ; epidemiology ; China ; epidemiology ; Humans

A completely synthetic gene encoding the He domain of Clostridium botulinum neurotoxin serotype A (AHc, 1287 bp, 429 aa, -50 kD) was constructed with oligonucleotides. After expressed in Escherichia coli, soluble product AHc was gained and verified by SDS-PAGE and Western blot analysis. The expressive level of recombinant AHc in E. coli was very high (36%-53% of soluble total proteins) and the purified yield was more than 30 mg/L by one-step purification. Then, the purified AHc was used to vaccinate Balb/c mice, which developed a strong and specific immune response as expected following administration of AHe protein via the subcutaneous route. Results from BoNT/A neutralization assay showed that the serum from mice vaccinated with AHc contained high titer protective antibody. These results showed that the soluble, stable and high-levelly expressive AHc not only could be produced by the prokaryotic expression system built in our lab, but also owned strong immunogenicity to prepare antitoxin for treatment and as sub-unit candidate vaccine for prophylaxis against botulinum toxin serotype A.
Animals ; Antibodies, Bacterial ; blood ; Bacterial Vaccines ; genetics ; immunology ; Botulinum Toxins, Type A ; biosynthesis ; genetics ; immunology ; Botulism ; immunology ; prevention & control ; Clostridium botulinum type A ; genetics ; immunology ; Escherichia coli ; genetics ; metabolism ; Female ; Lymphocyte Activation ; Mice ; Mice, Inbred BALB C ; Recombinant Proteins ; biosynthesis ; genetics ; immunology ; T-Lymphocytes ; immunology ; Vaccines, DNA ; genetics ; immunology

Korea has experienced sporadic cases or outbreaks of emerging and reemerging infectious diseases since the 1980s. Confirmed outbreaks have included leptospirosis and legionellosis in 1984, HIV infection in 1985, enterohemorrhagic E-coli infection in 1998, staphylococcus aureus infection with decreased vancomycin susceptibility in 1999, brucellosis in 2002, and botulism in 2003. Korea has also suffered from reemerging diseases such as vivax malaria along the Demilitarized Zone (DMZ) since 1993. Owing to globalization, imported cases of diarrheal diseases, malaria, and dengue have been increasing. In addition, the overall incidence of acute infectious diseases such as shigellosis, scrub typhus, and mumps, which had been decreasing since 1970 until the late 1990s, began to increase again after the late 1990s. The range of emerging and reemerging diseases poses serious public health threats to the public. The Korean government has been striving to build capacity to detect and respond to these infectious disease threats in a timely manner since the late 1990s. For this, the government revised the Communicable Disease Prevention Law, reorganized the government structure for communicable disease control, and developed human resources through field epidemiology and various other training programs. SARS and highly pathogenic avian influenza provided momentum to accelerate these endeavors. Korea has thus far achieved significant improvements in the field of infectious disease surveillance. There are, however, gaps that need to be addressed including insufficient capacity for disease surveillance and response for emerging infectious disease at the local government level, inadequate operation of various surveillance systems, insufficient integration among surveillance systems, and low participation rate for notification among physicians. Therefore, the Korean government plans to improve infectious disease surveillance by implementing the following procedures: establishment of a web-based reporting system, integration of EDI and laboratory surveillance systems, extension of the electronic reporting system to the private sector, continuous development of human resources to build capacity, and enhancement of collaboration with the private sector.
Animals ; Botulism ; Brucellosis ; Communicable Disease Control ; Communicable Diseases* ; Communicable Diseases, Emerging ; Cooperative Behavior ; Dengue ; Disease Outbreaks ; Dysentery, Bacillary ; Education ; Epidemiology ; HIV Infections ; Humans ; Incidence ; Influenza in Birds ; Internationality ; Jurisprudence ; Korea* ; Legionellosis ; Leptospirosis ; Local Government ; Malaria ; Malaria, Vivax ; Mumps ; Private Sector ; Public Health ; Scrub Typhus ; Staphylococcus aureus ; Vancomycin

Botulism ; therapy ; Child ; Female ; Humans ; Respiration, Artificial

We experienced 3 cases of food-borne botulism within a family. They presented with progressive ptosis, dysphonia, dysarthria and limb weakness, which had started about 12 hours after ingestion of vacuum-packed sausage. Two cases progressed to respiratory failure. Botulinum toxin A was detected from the stool sample of one case. Conservative treatment with mechanical ventilation was done and they recovered from respiratory failure over a 30-70 days period. This is the first case report of food-borne botulism in Korea.
Botulinum Toxins ; Botulism* ; Dysarthria ; Dysphonia ; Eating ; Extremities ; Humans ; Korea ; Respiration, Artificial ; Respiratory Insufficiency