Skip to main content

Advertisement

SpringerLink
Log in

Intestinal toxemia botulism in Italy, 1984–2005

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Botulism in humans is caused by botulinum neurotoxins, produced in most cases by Clostridium botulinum, although other Clostridia species are implicated as well. Of the five forms of botulism in humans, three are referred to as “infective”: wound botulism, infant botulism, and adult intestinal botulism; the latter two forms are also referred to as “intestinal toxemia botulism” because the organism colonizes the lumen of the intestinal tract and produces botulinum neurotoxin in vivo. Twenty-three cases of infant botulism and three cases of adult intestinal botulism occurred in Italy between 1984 and 2005. Microbiological analyses of clinical, environmental, and food samples and analysis of clinical and epidemiological data revealed two main characteristics of intestinal toxemia botulism in Italy that are not common in cases in other countries: the isolation of a strain of C. butyricum that produced botulinum neurotoxin type E in 6 of 26 cases, including two cases of adult intestinal toxemia botulism, and the onset of botulism in these cases with concomitant severe gastrointestinal symptomatology. This report summarizes the microbiological, clinical, and epidemiological data of all cases of intestinal toxemia botulism that have occurred in Italy in the period 1984–2005.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cherington M (2004) Botulism: update and review. Semin Neurol 24:155–163

    Article  PubMed  Google Scholar 

  2. Pickett J, Berg B, Chaplin E, Brunstetter-Shafer MA (1976) Syndrome of botulism in infancy: clinical and electrophysiologic study. N Engl J Med 295:770–772

    Article  PubMed  CAS  Google Scholar 

  3. Midura TF, Arnon SS (1976) Infant botulism: identification of Clostridium botulinum and its toxins in faeces. Lancet 2:934–936

    Article  PubMed  CAS  Google Scholar 

  4. Chia JK, Clark JB, Ryan CA, Pollak M (1986) Botulism in an adult associated with food-borne intestinal infection with Clostridium botulinum. N Engl J Med 315:239–240

    Article  PubMed  CAS  Google Scholar 

  5. Arnon SS (1995) Botulism as an intestinal toxemia. In: Blaser MJ, Smith PD, Ravdin JI, Greenberg HB, Guerrant RL (eds) Infection of the gastrointestinal tract. Raven, New York, pp 257–271

    Google Scholar 

  6. Schechter R, Arnon SS (1999) Commentary: where Marco Polo meets Meckel: type E botulism from Clostridium butyricum. Clin Infect Dis 29:1388–1393

    Article  PubMed  CAS  Google Scholar 

  7. Trethon R, Budai J, Herendi A, Szabo V, Geczy M (1995) Botulism in infancy. Orv Hetil 136:1497–1499

    PubMed  CAS  Google Scholar 

  8. Harvey SM, Sturgeon J, Dassey DE (2002) Botulism due to Clostridium baratii type F toxin. J Clin Microbiol 40:2260–2262

    Article  PubMed  CAS  Google Scholar 

  9. Aureli P, Fenicia L, Pasolini B, Gianfranceschi MV, McCroskey LM, Hatheway CL (1986) Two cases of type E infant botulism caused by neurotoxigenic Clostridium butyricum in Italy. J Infect Dis 154:207–211

    PubMed  CAS  Google Scholar 

  10. Fenicia L, Franciosa G, Pourshaban M, Aureli P (1999) Intestinal toxemia botulism in two young people, caused by Clostridium butyricum type E. Clin Infect Dis 29:1381–1387

    Article  PubMed  CAS  Google Scholar 

  11. Anniballi F, Fenicia L, Franciosa G, Aureli P (2002) Influence of pH and temperature on the growth and toxin production by neurotoxigenic strains of Clostridium butyricum type E. J Food Prot 65:1267–1270

    PubMed  CAS  Google Scholar 

  12. Franciosa G, Anniballi F, Fenicia L, Aureli P (1998) New recovery of neurotoxigenic Clostridium butyricum type E from a case of infant botulism. In: Abstracts of the European Clostridia Conference, Germany

  13. Chie M, Yanagawa Y, Shibata M, Obata H, Yamada S, Itoh T (2006) Botulism-Yokio 1996–2005. In: Abstracts of the 43rd interagency botulism research coordinating committee meeting, Abstract no. 26

  14. Meng X, Karasawa T, Zou K, Kuang X, Wang X, Lu C, Wang C, Yamakawa K, Nakamura S (1997) Characterization of a neurotoxigenic Clostridium butyricum strain isolated from the food implicated in an outbreak of food-borne type E botulism. J Clin Microbiol 35:2160–2162

    PubMed  CAS  Google Scholar 

  15. Chaudhrj R, Dhawan B, Kumar D, Bhatia R, Gandhi JC, Patel RK, Purohit BC (1998) Outbreak of suspected Clostridium butyricum botulism in India. Emerg Infect Dis 4:506–507

    Article  Google Scholar 

  16. Meng X, Yamakawa K, Zou K, Wang X, Kuang X, Lu C, Wang C, Karasawa T, Nakamura S (1999) Isolation and characterization of neurotoxigenic Clostridium butyricum from soil in China. J Med Microbiol 48:133–137

    Article  PubMed  CAS  Google Scholar 

  17. Turner HD, Brett EM, Gilbert RJ, Ghosh AC, Liebeschuetz HJ (1978) Infant botulism in England. Lancet 1:1277–1278

    Article  PubMed  CAS  Google Scholar 

  18. Neubauer M, Milacek V (1981) Infant botulism type B in central Europe. Zentalbl Bakteriol Mikrobiol Hyg [A] 250:540–547

    CAS  Google Scholar 

  19. Aureli P, Franciosa G, Fenicia L (2002) Infant botulism and honey in Europe: a commentary. Pediatr Infect Dis J 21:866–868

    Article  PubMed  Google Scholar 

  20. Nevas M, Lindstrom M, Virtanen A, Hielm S, Kuusi M, Arnon SS, Vuori E, Korkeala H (2005) Infant botulism acquired from household dust presenting as sudden infant death syndrome. J Clin Microbiol 43:511–513

    Article  PubMed  Google Scholar 

  21. Thomasse Y, Arends JP, van der Heide PA, Smit LM, Weerden TW, Fock JM (2005) Three infants with constipation and muscular weakness: infantile botulism. Ned Tijdschr Geneeskd 149:826–831

    PubMed  CAS  Google Scholar 

  22. Johnson EA, Tepp WH, Bradshaw M, Gilbert RJ, Cook PE, McIntosh EDG (2005) Characterization of Clostridium botulinum strains associated with an infant botulism case in the United Kingdom. J Clin Microbiol 43:2602–2607

    Article  PubMed  CAS  Google Scholar 

  23. Shapiro RL, Hatheway C, Swerdlow DL (1998) Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med 129:221–228

    PubMed  CAS  Google Scholar 

  24. Gupta A, Sumner CJ, Castor M, Maslanka S, Sobel J (2005) Adult botulism type F in the United States, 1981–2002. Neurology 65:1694–1700

    Article  PubMed  CAS  Google Scholar 

  25. Kobayashi H, Fujisawa K, Saito Y, Kamijo M, Oshima S, Kubo M, Eto Y, Monma C, Kitamura M (2003) A botulism case of a 12-year-old girl caused by intestinal colonization of Clostridium botulinum type Ab. Jpn J Infect Dis 56:73–74

    PubMed  Google Scholar 

  26. Centorbi HJ, Aliendro OE, Demo NO, Dutto R, Fernandez R, Centorbi ONP (1998) First case of infant botulism associated with honey feeding in Argentina. In: Abstracts of the Anaerobe Society of the Americas Congress on anaerobic bacteria and anaerobic infections. Abstract no. 15PP

  27. Aureli P, Ferrini AM (1988) Identification of C. botulinum spores in a case of sudden infant death in Italy. Description of a clinical case. Minerva Pediatr 40:125–126

    PubMed  CAS  Google Scholar 

  28. Fenicia L, Anniballi F, Pulitanò S, Genovese O, Polidori G, Aureli P (2004) A severe case of infant botulism caused by Clostridium botulinum type A with concomitant intestinal viral infections. Eur J Pediatr 163:501–502

    Article  PubMed  Google Scholar 

  29. Fenicia L, Da Dalt L, Anniballi F, Franciosa G, Zanconato S, Aureli P (2002) A case of infant botulism due to neurotoxigenic Clostridium butyricum type E associated with Clostridium difficile colitis. Eur J Clin Microbiol Infect Dis 21:736–738

    Article  PubMed  CAS  Google Scholar 

  30. Fenicia L, Ferrini AM, Aureli P, Pocecco M (1993) A case of infant botulism associated with honey feeding in Italy. Eur J Epidemiol 9:671–673

    Article  PubMed  CAS  Google Scholar 

  31. Aureli P, Fenicia L, Creti R, Bertini E, Vigevano F, Di Capua M, Pirozzi N (1989) Botulismo infantile in Italia. Aspetti clinici e microbiologici di 5 casi. Riv Ital Pediatr 15:442–447

    Google Scholar 

  32. Squarcione S, Prete A, Vellucci L (1999) Botulism surveillance in Italy: 1992–1996. Eur J Epidemiol 15:917–922

    Article  PubMed  CAS  Google Scholar 

  33. Centers for Disease Control and Prevention (1997) Case definitions for infectious conditions under public health surveillance. MMWR 46:1–55. http://www.cdc.gov/mmwr/PDF/RR/RR4610.pdf and http://bt.cdc.gov/Agent/Botulism/CaseDef.asp

    Google Scholar 

  34. Centers for Disease Control and Prevention (1998) Botulism in the United States, 1899–1996. Handbook for epidemiologists, clinicians, and laboratory workers. CDC, Atlanta, GA, pp 15–21

    Google Scholar 

  35. AOAC Official Methods of Analysis (2000) Clostridium botulinum and its toxins in foods. AOAC official method n. 977.26

  36. Woodruff BA, Griffin PM, McCroskey LM, Smart JF, Wainwright RB, Bryant RG, Hutwagner LC, Hatheway CL (1992) Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975–1988. J Infect Dis 166:1281–1286

    PubMed  CAS  Google Scholar 

  37. Hatheway CL, McCroskey LM (1987) Examination of feces and serum for diagnosis of infant botulism in 336 patients. J Clin Microbiol 25:2334–2338

    PubMed  CAS  Google Scholar 

  38. Arnon SS, Damus K, Thompson B, Midura TF, Chin J (1982) Protective role of human milk against sudden death from infant botulism. J Pediatr 100:568–573

    Article  PubMed  CAS  Google Scholar 

  39. Arnon SS (1984) Breast feeding and toxigenic intestinal infections: missing links in crib death? Rev Infect Dis 6(Suppl 1):193–201

    Google Scholar 

  40. Long SS, Gajewski JL, Brown LW, Gilligan PH (1985) Clinical, laboratory and environmental features of infant botulism in southeastern Pennsylvania. Pediatrics 75:935–941

    PubMed  CAS  Google Scholar 

  41. Arnon SS, Midura TF, Damus K, Thompson B, Wood RM, Chin J (1979) Honey and other environmental risk factors for infant botulism. J Pediatr 94:331–336

    Article  PubMed  CAS  Google Scholar 

  42. Arnon SS, Damus K, Chin J (1981) Infant botulism: epidemiology and relation to sudden infant death syndrome. Epidemiol Rev 3:45–66

    PubMed  CAS  Google Scholar 

  43. Moreau MC, Corther G, Hulle MC, Dubos F, Raibaud P (1986) Relationships between rotavirus diarrhea and intestinal microflora establishment in conventional and gnotobiotic mice. J Clin Microbiol 23:863–868

    PubMed  CAS  Google Scholar 

  44. Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL (2006) Human botulism immune globulin for the treatment of infant botulism. N Engl J Med 354:462–471

    Article  PubMed  CAS  Google Scholar 

  45. Howard FM, Bradley JM, Flynn DM, Noone P, Szawatkowski M (1977) Outbreak of necrotizing enterocolitis caused by Clostridium butyricum. Lancet 2:1099–1102

    Article  PubMed  CAS  Google Scholar 

  46. Laverdiére M, Robert A, Chicoine R, Salet D, Rosenfeld R (1978) Clostridia in necrotising enterocolitis. Lancet 2:377

    Article  PubMed  Google Scholar 

  47. Smith MF, Borriello SP, Clayden GS, Casewell MW (1980) Clinical and bacteriological findings in necrotizing enterocolitis: a controlled study. J Infect 2:23–31

    Article  PubMed  CAS  Google Scholar 

  48. Schecter R, Peterson B, McGee J, Idowu G, Bradley J (1999) Clostridium difficile colitis associated with infant botulism: near-fatal case analogous to Hirschsprung’s enterocolitis. Clin Infect Dis 29:143–146

    Google Scholar 

  49. Creti R, Fenicia L, Aureli P (1990) Occurrence of Clostridium botulinum in the soil in the vicinity of Rome. Curr Microbiol 20:317–321

    Article  Google Scholar 

  50. Swenson JM, Thornsberry L, McCroskey L, Hatheway CL, Dowell VR (1980) Susceptibility of C. botulinum to thirteen antimicrobial agents. Antimicrob Agents Chemother 18:13–19

    PubMed  CAS  Google Scholar 

  51. Fenicia L, Ferrini AM, Anniballi F, Mannoni V, Aureli P (2003) Considering the antimicrobial sensitivity of the intestinal botulism agent Clostridium butyricum when treating concomitant infections. Eur J Epidemiol 18:1153–1154

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

We thank Stephen S. Arnon, founder and chief of the Infant Botulism Treatment and Prevention Program, California Department of Health Services, for his kind assistance in the editorial review.

Author information

Authors and Affiliations

  1. National Reference Center for Botulism, National Center for Food Quality and Risk Assessment, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy

    L. Fenicia, F. Anniballi & P. Aureli

Authors
  1. L. Fenicia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Anniballi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Aureli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Fenicia.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fenicia, L., Anniballi, F. & Aureli, P. Intestinal toxemia botulism in Italy, 1984–2005. Eur J Clin Microbiol Infect Dis 26, 385–394 (2007). https://doi.org/10.1007/s10096-007-0301-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-007-0301-9

Keywords

Search

Navigation