Examination of feces and serum for diagnosis of infant botulism in 336 patients

Abstract

In the 12-year period 1975 to 1987, feces from 336 infants were examined for botulinal neurotoxin and Clostridium botulinum. All the infants had illnesses which prompted their physicians to consider infant botulism in the diagnosis. Stool specimens from 113 of the infants yielded organisms that produced botulinal neurotoxins assumed to be responsible for the illness. The types of botulinal toxin in the confirmed cases were distributed as follows: 38 A, 69 B, 2 atypical B, 1 E, 1 F, 1 A + B, and 1 B + F. The type A and B toxins in a single infant were produced by two different strains of organism, and the type B and F toxins in another infant were produced by a single strain. The physiological characteristics of all the isolated toxigenic organisms except two were consistent with those of group I (proteolytic) C. botulinum. The toxigenic isolate from the infant with type E botulism was identified as C. butyricum, and that from the infant with type F botulism was identified as C. barati. Toxin of the same type as produced by the isolated organisms was identified in feces of 98 of 111 culture-positive infants. Botulinal toxin was identified in the serum of 9 of 67 culture-positive infants (8 of 22 infants with type A organisms; 1 of 43 infants with type B organisms; neither of 2 infants with A + B or atypical type B organisms). Botulinal toxin was not detected in feces (206 infants) or in serum (114 infants) of the culture-negative infants. The culture-positive infants had clinical features and a course of illness consistent with those of infant botulism. Most of the culture-negative infants probably had illnesses other than botulism, but specimens might have been obtained late in some infants' illnesses, when the organism had disappeared.

Characterization of six type A strains ofClostridium botulinumthat contain type B toxin gene sequences

“…Although most botulinum strains express a single antigenically distinct toxin, a few isolates have been shown to produce more than one toxin type. To date, strains with three di¡erent combinations of toxin genes have been reported and designated Ab (4,5,16) [1^3], Af (6, 1) [4,5], Ba (7,9) [6,7] and Bf (10) [8], where the smaller case letter indicates the toxin with lesser activity.…”

Polymerase chain reaction for detection of Clostridium botulinum types A, B and E in food, soil and infant faeces

“…Commercial caviar (Hauschild and Hilsheimer 1979) and rockfish fillets (Ikawa and Genigeorgis 1987) were unable to support the growth of type E spores inoculated at levels greater than lo4 cells per 25 g sample. In cases of infant botulism there is concern that low numbers of the organism in the faeces may produce toxin levels which cannot be detected with the mouse bioassay (Hatheway and McCroskey 1987). As observed in this study, initial levels of 10 spores per 2.5 g infant faeces (types A and B) were not detected with the animal assay but produced positive PCR results, a test that does not rely on the detection of expressed protein but detection only of the neurotoxin gene.…”

Update: infant botulism

“…The detection of botulinum toxin in serum is useful in cases of food-borne and wound botulism. However, serum specimens from infant cases are rarely positive for circulating botulinum toxin (30,58). Stools from ill infants have contained high toxin levels and up to 10 8 organisms per g (42,58,76).…”

“…C. botulinum can be isolated from stool, food, and other specimens by using anaerobic procedures and special enrichment techniques that have been well described (12,20,21,28,29,30,44,48). All of the organisms capable of producing botulinum neurotoxins of types A through F possess the ability to produce lipase, which can be detected as an iridescent film surrounding the colony growth on egg yolk agar media (12,20,29).…”