Abstract
Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41–61 days), indicative of intestinal toxemia botulism. Patients’ clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient’s feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.
Highlights
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Evaluate the prognosis of adult intestinal toxemia botulism
Diagnosis of intestinal toxemia botulism was determined through repeated detection of botulinum neurotoxins, viable C. botulinum, or both in clinical samples over extended periods
Summary
Case-Patient 1 A 63-year-old woman was admitted to a hospital on November 22, 2006, after a 2-day history of abdominal pain, blurred vision, diarrhea, dysarthria, dysphagia, horizontal binocular diplopia, imbalance, and weakness in the arms and hands. An opened jar of peanut butter from the patient’s residence yielded positive test results for C. botulinum type A spores, containing ≈14 C. botulinum spores/kg. Both heated and nonheated samples from the enema fluid were positive for C. botulinum type A, indicating the presence of spores. The patient’s medical history included a diagnosis of Crohn disease in 1979 and 4 previous bowel resections with ileocolonic anastomosis, complicated by enterocutaneous fistulas (in 1986, 1995, 2001, and 2002) She had no wounds, and no chest or abdominal pains were reported before the onset of symptoms. An opened jar of peanut butter from the home yielded positive test results for C. botulinum type A. The patient had a history of eating primarily commercial canned food, no specific types were reported, and none of the patient’s contacts were reported to be ill
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