Botulism Cases in Romania—An Overview of 14-Year National Surveillance Data

Abstract

Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007–2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25–44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs.

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“…Initially considered to be a fungus, it was only between 1895 and 1897 that it was demonstrated that botulism was caused by the toxin of an anaerobic bacillus, known as Bacillus botulinus. During this same period, using a cell culture filtrate, free of bacilli and spores, signs of paralysis were reproduced in laboratory animals, confirming the existence of a toxin [12][13][14] Currently called Clostridium botulinum, this anaerobic bacillus is classified into seven types (A, B, C, D, E, F and G), based on the antigenic specificity of the neurotoxin (BoNT) produced by each strain. Encoded by the BoNT gene, these toxins are produced as 150 kDa polypeptide chains, which are cleaved into two smaller chains, prior to release by the microorganism.…”

“…The origin of the BoNT gene varies between types of C. botulinum: types A, B, E and F, which cause human botulism, are of chromosomal origin; types C and D, responsible for the vast majority of cases of the disease in animals, originate from bacteriophages; For type G, the origin is plasmid. .Interventionary studies involving animals or humans, and other studies that require ethical approval, must list the authority that provided approval and the corresponding ethical approval code [1,5,8,[12][13][14].…”

“…As a result, there is a reduction in the release of acetylcholine at neuromuscular junctions, which leads to the inability to contract muscles or flaccid paralysis of skeletal muscles. Each serotype cleaves specific peptide bonds from one or more SNARE proteins [1,5,8,[12][13][14].…”

“…Clinically, botulism in birds is characterized by an ascending symmetrical paralysis, affecting legs, wings, neck and eyelids, concomitantly with loss of feathers and unchanged psyche. Death occurs due to cardiorespiratory arrest [1,5,8,[12][13][14].…”