A summary of surveillance, morbidity and microbiology of laboratory-confirmed cases of infant botulism in Canada, 1979–2019

Abstract

Background: Infant botulism is a rare toxicoinfectious disease caused by colonization of the infant’s intestine with botulinum neurotoxin-producing clostridia (i.e. Clostridium botulinum or neurotoxigenic strains of C. butyricum or C. baratii). Our goal was to examine data from laboratory-confirmed cases of infant botulism reported in Canada to summarize incidence over time, over geographic distribution by province or territory, and by sex, and to compare these parameters with data from the Canadian Notifiable Disease Surveillance System (CNDSS). The average age of onset, serotype of botulinum neurotoxin (BoNT), case outcomes, length of hospitalization and suitability of clinical specimens for laboratory confirmation were also determined. Methods: We examined laboratory records from the Health Canada Botulism Reference Service and the British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory. The Discharge Abstract Database (DAD) and the Hospital Morbidity Database (HMDB) of the Canadian Institute of Health Information (CIHI) were queried for data on hospitalization of infant botulism cases. The CNDSS was queried for data on reported cases of infant botulism. Results: From 1979 to 2019, 63 laboratory-confirmed cases of infant botulism were confirmed by the Health Canada Botulism Reference Service and the BCCDC Public Health Laboratory for an annual rate of 4.30 cases per million live births. From 1983 to 2018, 57 cases of infant botulism were reported to the CNDSS. Of the 63 cases confirmed by the reference laboratories, the median age of onset was 16 weeks with a range of 2 to 52 weeks. The majority of cases were type A (76%) and B (21%), with single cases of type F and type AB. Of the 23 laboratory-confirmed cases with matched hospital records, 13 were transferred to special care and eight needed ventilator support; no deaths were reported. Conclusion: Spores of C. botulinum are present naturally in the environment, thus diagnosis of infant botulism does not require a history of exposure to high-risk foods such as honey. Stool samples are the most useful diagnostic specimen.

Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review

“…The largest incidence rate (6.5 cases per 100,000 live births) is reported by California, which notified 1345 laboratory-confirmed cases in 1976-2016 [62]. In Canada, from 1979 to 2019, 63 cases were laboratory-confirmed [63]. Among European countries, Italy reported the largest number of laboratory-confirmed cases and, from 1984 to October 2021, notified 55 cases.…”

Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

“…During the illness, the child's state of consciousness remains intact, and the central nervous system is not affected, while the possible appearance of fever is a consequence of concomitant infections. The typical sign of the clinical picture of infantile botulism is instead generalized paralysis involving the cranial nerves [30,36,38,39]. Adult intestinal toxemia is a very rare kind of botulism.…”

“…The differential diagnosis of botulism includes dehydration and electrolyte imbalance, sepsis, polyneuropathies such as Guillain-Barré syndrome, myasthenia gravis, spinal muscular atrophy, stroke, encephalitis, and others (Table 3) [43][44][45][46]. The criteria for laboratory conferment of botulism for all the clinical forms are based on the detection of BoNTs in serum, feces, and/or food samples and on the identifi-cation of Clostridi, which produces BoNTs in feces, wound sites, and in food samples (Figure 3) [38,45,47].…”

“…The electromyogram shows the typical results of exposure to botulism including normal nerve conduction velocity, normal sensory nerve function, a pattern of short small-amplitude motor potentials, and a clear incremental response (facilitation) to repetitive stimulation often seen only at 50 Hz [40]. The CT/CT-Angio imaging of the brain, spine, and chest are normal in botulism and the CSF is unchanged in botulism and autoantibodies are not present in botulism [38,41,45].…”

“…The criteria for laboratory conferment of botulism for all the clinical forms are based on the detection of BoNTs in serum, feces, and/or food samples and on the identification of Clostridi, which produces BoNTs in feces, wound sites, and in food samples (Figure 3) [38,45,47]. The electromyogram shows the typical results of exposure to botulism including normal nerve conduction velocity, normal sensory nerve function, a pattern of short small-amplitude motor potentials, and a clear incremental response (facilitation) to repetitive stimulation often seen only at 50 Hz [40].…”