Abstract
Intoxication with botulinum neurotoxin can occur through various routes. Foodborne botulism results after consumption of food in which botulinum neurotoxin-producing clostridia (i.e., Clostridium botulinum or strains of Clostridium butyricum type E or Clostridium baratii type F) have replicated and produced botulinum neurotoxin. Infection of a wound with C. botulinum and in situ production of botulinum neurotoxin leads to wound botulism. Colonization of the intestine by neurotoxigenic clostridia, with consequent production of botulinum toxin in the intestine, leads to intestinal toxemia botulism. When this occurs in an infant, it is referred to as infant botulism, whereas in adults or children over 1 year of age, it is intestinal colonization botulism. Predisposing factors for intestinal colonization in children or adults include previous bowel or gastric surgery, anatomical bowel abnormalities, Crohn’s disease, inflammatory bowel disease, antimicrobial therapy, or foodborne botulism. Intestinal colonization botulism is confirmed by detection of botulinum toxin in serum and/or stool, or isolation of neurotoxigenic clostridia from the stool, without finding a toxic food. Shedding of neurotoxigenic clostridia in the stool may occur for a period of several weeks. Adult intestinal botulism occurs as isolated cases, and may go undiagnosed, contributing to the low reported incidence of this rare disease.
Highlights
Botulism is a rare but severe neuroparalytic disease caused by exposure to botulinum neurotoxins (BoNTs)
The disease may be naturally caused by ingestion of pre-formed toxin in food, infection of a wound with Clostridium botulinum resulting in toxin production in situ, colonization of the infant intestinal tract, and colonization of the intestinal tract of adults or children over 1 year of age
This review describes adult intestinal toxemia botulism, highlighting its peculiarities with respect to the other forms of botulism, as well as highlighting the difficulties in recognition of cases which, in turn, may result in underestimation of the incidence of the disease
Summary
Botulism is a rare but severe neuroparalytic disease caused by exposure to botulinum neurotoxins (BoNTs). The disease may be naturally caused by ingestion of pre-formed toxin in food (foodborne botulism), infection of a wound with Clostridium botulinum resulting in toxin production in situ (wound botulism), colonization of the infant intestinal tract (infant botulism), and colonization of the intestinal tract of adults or children over 1 year of age (intestinal toxemia botulism). In addition to these naturally occurring forms of botulism, iatrogenic and inhalation botulism have been recognized. This review describes adult intestinal toxemia botulism, highlighting its peculiarities with respect to the other forms of botulism, as well as highlighting the difficulties in recognition of cases which, in turn, may result in underestimation of the incidence of the disease
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