Outbreak Of Botulism Research Articles

Outbreak of Foodborne Botulism Associated with Improperly Earthenware Cheese (Koupé): A Case Report

Here we report the consumption of traditional cottage cheese (Koupé) in western Iran, as a new way of transmission of botulism. All the patients (a nine member family) had at least two specific symptoms of botulism. Given the clinical symptoms and contact history, antitoxins were injected in the early hours of hospital admission. On Jan 27, 2017, three patients clinically suspected of foodborne botulism were referred to the hospital in Sanandaj, western Iran from their local hospital in Baneh, western, Iran. Because of the worsening of clinical conditions, a 34-yr-old man with both gastrointestinal and neurological symptoms was admitted to the ICU, while other family members were treated in the infectious diseases ward of the hospital. The disease was diagnosed through isolating toxin A from the cheese and testing the serum sample of one of the patients. This case of botulism showed that traditional Koupé cheese could cause foodborne botulism. Hence, it is necessary to train and inform people about how to process and keep the cheese to prevent similar cases.

Manure contamination with Clostridium botulinum after avian botulism outbreaks: management and potential risk of dissemination

BackgroundPersistence of Clostridium botulinum in the environment is well known. Getting rid of it after animal botulism outbreaks is so tricky, especially as far as manure concerns. This study aimed...

Closing Clostridium botulinum Group I Genomes Using a Combination of Short- and Long-Reads.

Clostridium botulinum is a Gram-positive, spore-forming anaerobic bacterium that produces botulinum neurotoxin (BoNT). Closing their genomes provides information about their neurotoxin clusters’ arrangement(s) and their location (e.g., chromosome or plasmid) which cannot be assessed using draft genomes. Therefore, we tested the use of long-read sequencing (nanopore sequencing) in combination with short-read sequencing to close two toxin-producing strains. These genomes could be used by the Public Health Emergency Preparedness and Response staff during botulism outbreaks. The genomes of two toxin-producing C. botulinum strains, one from an environmental sample (83F_CFSAN034202) and the other from a clinical sample (CDC51232_CFSAN034200) were sequenced using MinION and MiSeq devices. The genomes, including the chromosomes and the plasmids, were closed by a combination of long-read and short-read sequencing. They belonged to different C. botulinum sequence types (STs), with 83F belonging to ST4 and CDC51232 to ST7. A whole genome single nucleotide polymorphism (SNP) analysis clustered these two strains with strains in lineage 2 (e.g., 6CDC297) and 4 (e.g., NCTC2916) from Group I, respectively. These two strains were also bivalent strains with the BoNTB and BoNTA4 clusters located in the larger plasmid for CDC51232, and the BoNTB and BoNTA1 clusters located both in the chromosome for 83F. Overall, this study showed the advantage of combining these two sequencing methods to obtain high quality closed C. botulinum genomes that could be used for SNP phylogenies (source tracking) as well as for fast identification of BoNT clusters and their gene arrangements.

Development of An Innovative and Quick Method for the Isolation of Clostridium botulinum Strains Involved in Avian Botulism Outbreaks.

Avian botulism is a serious neuroparalytic disease mainly caused by a type C/D botulinum neurotoxin produced by Clostridium botulinum group III, one of the entwined bacterial species from the Clostridium novyi sensu lato genospecies. Its isolation is very challenging due to the absence of selective media and the instability of the phage carrying the gene encoding for the neurotoxin. The present study describes the development of an original method for isolating C. botulinum group III strains. Briefly, this method consists of streaking the InstaGene matrix extraction pellet on Egg Yolk Agar plates and then collecting the colonies with lipase and lecithinase activities. Using this approach, it was possible to isolate 21 C. novyi sensu lato strains from 22 enrichment broths of avian livers, including 14 toxic strains. This method was successfully used to re-isolate type C, D, C/D, and D/C strains from liver samples spiked with five spores per gram. This method is cheap, user-friendly, and reliable. It can be used to quickly isolate toxic strains involved in avian botulism with a 64% success rate and C. novyi sensu lato with a 95% rate. This opens up new perspectives for C. botulinum genomic research, which will shed light on the epidemiology of avian botulism.

First record of mass wild waterfowl mortality due to Clostridium botulinum in Brazilian semiarid.

In 2008, 270 wild birds from aquatic environments were found dead or debilitated on the banks of smaller lakes that had been formed due to the decrease in the level of the holding lake of the Sobradinho Dam located on the São Francisco River in the Caatinga of Bahia, Brazil. The outbreak occurred months after the dam's partial drainage, with the formation of puddles that accumulated decomposing organic material. Amongst the 270 individuals examined and/or found dead, the majority (50%) of the birds found belonged to the Anatidae family. The debilitated birds presented neurological clinical signs including lack of motor coordination, weakness, grave flaccid paralysis in the legs, wings, neck and eyelids, diarrhea, and dyspnea. Tissue samples of the birds were collected, as were water samples and samples of the substrate of the lakes. Zoonotic arboviroses or heavy metals were not detected. Analyses of liver and digestive tract content samples through bioassay and serum neutralization in mice revealed the presence of type C botulinic toxin in the viscerae samples, and type D in sediment samples. According to our knowledge, this is the first record of an outbreak of botulism in wild birds in natural conditions in Brazil.

A large-scale outbreak of botulism associated with a traditional celebratory Egyptian fish dish in five governorates - Lower Egypt, 2019: a teaching case-study

A large-scale outbreak of botulism associated with a traditional celebratory Egyptian fish dish in five governorates - Lower Egypt, 2019: a teaching case-study

Avian-botulism risk in waterbird breeding colonies and implications for environmental water management

Avian botulism poses a significant risk to waterbird health in Australian wetlands. This paralytic, often fatal, disease occurs when birds ingest a neurotoxin produced by the bacterium Clostridium botulinum. Our current understanding of avian botulism comes largely from studies in the northern hemisphere, with many of these studies linking outbreaks of avian botulism with poor water quality. The Murray–Darling Basin provides the most important breeding habitat for colonial waterbirds in Australia, but the frequency of large-scale breeding events has declined, and waterbird populations are near record-low numbers. Avian botulism has the capacity to have significant impacts on waterbird recruitment if not managed appropriately. We propose that environmental water-management strategies that aim to maintain water quality through flow delivery to waterbird colonies could mitigate the risk of botulism outbreaks and contribute to waterbird population recovery.

Outbreak of avian botulism and its effect on waterbirds in the Wilderness Lakes, South Africa

Outbreak of avian botulism and its effect on waterbirds in the Wilderness Lakes, South Africa

Botulism in Cattle Associated with Osteophagy in the State of Acre, Brazil

Background:Botulism is a non-febrile intoxication resulting from the ingestion of Clostridium botulinum neurotoxins manifested by partial or complete flaccid paralysis of the musculature of locomotion, swallowing and respiration. The objective of this study was to report the first case of botulinum intoxication associated with osteopathy in the state of Acre, as well as to alert breeders and veterinarians to the incidence of this disease in cattle farming.Case: The present report is an outbreak of botulism in the municipality of Acrelândia, in the state of Acre, which resulted in the death of 16 Nelore beef cattle in approximately 30 days. The affected animals were females in reproductive phase maintained under extensive breeding system. The main clinical signs presented were weakness in the pelvic limbs, prostration, recumbency and death in less than 48 hours. Only one animal, with similar symptomatology, was found alive and submitted to emergency therapeutic measures, but without success. During the necropsy of this bovine, no significant changes were found, only related to the decubitus and agony time, except for fragments of long bones visualized in the reticulum. Samples of bone particles, ruminal contents, reticulum, rumen and intestine fragments were collected for the detection of botulinum toxins by the mouse bioassay method, as well as brain and brain stem for differential diagnosis of rabies and bovine spongiform encephalopathy by direct immunofluorescence and immunohistochemistry, respectively. The samples were sent to the Laboratory of General Bacteriology of the Biological Institute, São Paulo, Brazil, and all the analyzes presented negative results.Discussion: One of the main risk factors for the occurrence of botulinum toxin is the presence of carcasses in the pastures, added to the deficiency of phosphorus and other minerals. The cattle develop the habit of gnawing bones and tissues from dead animals in the field. With this exercise, animals can ingest pre-formed toxins in corpses, as decomposing remains offer an anaerobic environment conducive to spore development and toxin production. Bovine females, in breeding, present greater nutritional need than adult males and younger animals. This is because the reproductive phase increases the demands of minerals, vitamins and organic compounds that participate in the female's reproductive physiological process. In this case, the inadequate supply of minerals may stimulate the osteopagic practice of cadaveric remains in the pastures, making the bovids susceptible to botulism. Diagnosis is established by means of clinical signs, epidemiological characteristics and absence of specific anatomopathological findings. Confirmation is given by the isolation of the toxin in the body of the diseased animal. However, the lack of detection of this does not rule out the possibility of occurrence of the disease, in view of the rapid passage of the neurotoxin through the hematogenous route and through the tissues before reaching the neuromuscular junctions. In suspect cases, it is important to perform a differential diagnosis for other diseases that demonstrate clinical symptoms of neurological or acute neuromuscular character. The description of this outbreak, besides exposing the first notification of botulism in the state of Acre, shows the epidemiological relationship between the main risk factors and the occurrence of the disease in the Brazilian herds.

FATAL FISH: A RARE CASE OF BOTULISM AFTER INGESTION OF FERMENTED FISH

SESSION TITLE: Case Report Semifinalists 10 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Botulism is a rare, life-threatening neuromuscular syndrome caused be the ingestion of Clostridium botulinum neurotoxin. C botulinum is a spore-forming gram-positive rod that is known to inhabit surfaces of seafood. We discuss the cases of a mother and daughter who presented with variable symptoms of botulism two days after ingesting Fesikh; a traditional Egyptian dish consisting of raw uneviscerated mullet fish fermented in salt water. CASE PRESENTATION: A 30-year-old female and her mother presented to the emergency department with vomiting, diarrhea, and abdominal pain two days after eating Fesikh. The daughter’s symptoms appeared more severe on presentation as she also complained of blurry vision and difficulty speaking. On examination, the daughter was lethargic in appearance and demonstrated difficulty with horizontal eye movements past midline and bilateral Ptosis. Although the patient’s muscle strength in her tongue was intact, her speech was muffled and she complained of difficulty swallowing. Both patients presented hypotensive on admission, however the mother’s blood pressure improved after intravenous fluid resuscitation. The daughter remained hypotensive requiring vasopressor support and was subsequently admitted to the intensive care unit. Although the mother did not demonstrate any symptoms suggestive of cranial nerve involvement on admission, during her hospital stay she began to experience dysphagia and evidence of autonomic dysfunction with dizziness and orthostatic hypotension. Poison Control was contacted and initially suspected Ciguatera toxin poisoning. As our suspicion for botulism remained high given the patient’s cranial nerve abnormalities and recent ingestion of Fesikh, the Center of Disease Control (CDC) was contacted and the decision was made to treat both patients for presumed botulism with heptavalent botulinum antitoxin. After administration of antitoxin, both patients demonstrated significant clinical improvement in their symptoms. Botulism was later confirmed by the CDC after stool, blood and specimens of the fish ingested were analyzed and tested for C botulinum and its neurotoxin. DISCUSSION: Although uncommon, outbreaks of foodborne botulism have occurred after the consumption of fermented fish. Clinical manifestations of botulism vary however, descending flaccid paralysis affecting cranial nerves remains the classic presentation. Common presenting symptoms include blurry vision, diplopia, ptosis, and difficulty speaking and swallowing. When not recognized and treated promptly, botulism can be potentially fatal leading to respiratory collapse. The importance of a thorough history and physical exam are of utmost importance in early recognition of botulism. CONCLUSIONS: When there is a high clinical suspicion, the threshold for treating botulism should be low as delay in treatment can result in increased mortality and worsened overall outcomes. Reference #1: From the Centers for Disease Control. Outbreak of type E botulism associated with an uneviscerated, salt-cured fish product--New Jersey, 1992. (1992). JAMA: The Journal of the American Medical Association, 268(8). https://doi.org/10.1001/jama.268.8.963b DISCLOSURES: No relevant relationships by Pavan Ganapathiaju, source=Web Response No relevant relationships by Pavan Ganapathiaju, source=Web Response No relevant relationships by Daniel Gurrieri, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $5001 - $20000 Added 03/20/2019 by Frances Loftus, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boerhyinger ingelheim Please note: $1001 - $5000 Added 03/20/2019 by Frances Loftus, source=Web Response, value=Honoraria No relevant relationships by Natalie Millet, source=Web Response

National surveillance of food-borne botulism in Iran during 2011–2015

Food-borne botulism, a potentially lethal neuroparalytic disease, is also a health challenge with a variable prevalence rate in Iran. This work presents the results of a 5-year surveillance of botulism in Iran, with the distribution of the cases by regions and by vehicle of transmission. This descriptive-retrospective study was done on food-borne botulism poisoning cases reported to the Iran's Ministry of Health during 2011–2015. Data was collected by interview, examination and questionnaires. All the relevant and confirmed botulism outbreaks that occurred in the period under consideration are described. During these 5 years, 1743 cases of suspected botulism were reported from different clinical sources. A total of 99 (5.6%) cases confirmed as food-borne botulism of which the most occurred in West Azarbaijan, Guilan and Golestan provinces, respectively. The main causes of the food-borne botulism were consumption of nonpasteurized dairy products, spawn (a kind of caviar) and smoked fish. Twenty-six (26.2%) laboratory-confirmed incidents were caused by toxin type A, 21 (21.2%) by toxin type B and 15 (15.1%) by toxin type E. Among all confirmed patients, a total of 32 (32.3%) deaths were reported and the case-fatality rate ranged from 4% (in 2014) to 12% (in 2011). Though a relatively rare disease, botulism can be a serious problem of public health, particularly when connected with the consumption of traditional food products; moreover, in the last years, the shortage of specific antitoxin has caused some concern in the Public Health Authorities.

OUTBREAK OF BOTULISM IN CATTLE IN AN AREA OF THE NORTHEAST REGION OF BRAZIL

Botulism is an intoxication caused by the ingestion of a neurotoxin produced by Clostridium botulinum, an anaerobic, Gram-positive bacteria which can sporulate in adverse conditions. This work intends to report a surge of botulism in the city of União dos Palmares, Alagoas, Brazil, which occurred in an area of milk cows with 45 animals, 14 of which had died, showing signs of weakness of the hind limbs, and in 4 cases evolved over a period of 30 days, some with profuse, brownish-green, foul-smelling diarrhea, aside from progressive weight loss. An autopsy was performed on one of the sick animals, of which no significant lesions were observed. Samples of intestinal contents were collected and centrifuged to remove supernatant and later the biological test, inoculation of mice, was performed. This test confirmed the outbreak of the disease on the property studied. Clostridium botulinum was present on the property studied, causing the outbreak of botulism. The main factor initiating the appearance of the surge was the inadequate handling of carcasses and the presence of contaminated water reservoirs. The laboratory diagnosis was of great importance in verifying a clinical suspicion.

Foodborne Botulism Outbreak Associated With Commercial Nacho Cheese Sauce From a Gas Station Market.

Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, 4 California residents from 2 adjacent counties were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California. We interviewed suspected botulism patients and their families, inspected the suspect establishment, and collected suspect food. We tested patient sera, stool, and gastric aspirates using mouse bioassay for BoNT and/or culture for Clostridium botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives using direct mouse bioassay and culture. We performed whole-genome sequencing on food and clinical isolates. From April 2017 through May 2017, 10 patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; 7 required mechanical ventilation, and 1 died. Of 9 patients with information, all had visited Gas Station X before illness onset, where 8 reported consuming a commercial cheese sauce. BoNT/A and/or BoNT/A-producing C. botulinum were detected from each patient and from leftover cheese sauce. Clostridium botulinum isolates from 4 patients were closely related to cheese sauce isolates by whole-genome high-quality single-nucleotide polymorphism analysis. No other botulism cases associated with this cheese sauce were reported elsewhere in the United States. This large foodborne botulism outbreak in California was caused by consumption of commercial cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the outbreak source. The cheese sauce was likely locally contaminated, although the mechanism is unclear.

Lead exposure in common shelduck (Tadorna tadorna): Tracking the success of the Pb shot ban for hunting in Spanish wetlands

Levels of lead (Pb) were analyzed in tissues of 25 Common shelduck (Tadorna tadorna) from La Albufera Natural Park (NP) in Valencia (Eastern Spain), which were found dead due to a botulism outbreak. The objective was to assess Pb exposure in waterfowl, fourteen years after the implementation of the Real Decreto 581/2001, which banned the use of Pb ammunition for hunting activities in internationally relevant wetlands. For this purpose, this study measured the actual ingestion of lead pellets in Common shelduck from La Albufera de Valencia and provide data on Pb residue concentrations in different tissues of this species breeding in this NP. The Pb distribution pattern in tissues was bone > kidney > liver > brain > muscle, with Pb concentrations of 778.96 ± 998.64, 122.40 ± 89.18, 92.08 ± 57.65, 18.90 ± 16.30 and 15.13 ± 11.85 ng/g (wet weight), respectively. This work presents, as far as we are aware, the first published data on Pb concentrations in Common shelduck. The Pb levels detected were lower than those reported in other studies on Anatid species from Spanish wetlands, which may be explained by this ban. Moreover, lead concentrations found were below those levels for which any observable effect has been described for acute or chronic lead exposure.

Notes from the Field: Botulism Outbreak Associated with Home-Canned Peas - New York City, 2018.

In June 2018, the New York City Department of Health and Mental Hygiene investigated an outbreak of botulism among three related, adult women, which was traced to ingestion of home-canned peas. Botulinum antitoxin was administered and all three patients survived but required prolonged intensive care and rehabilitation.

Outbreak of Foodborne Botulism Associated With Prepackaged Pouches of Liquid Herbal Tea.

BackgroundIn 2017, local public health authorities in California received reports of 2 elderly patients with suspected botulism who knew each other socially. A multijurisdictional investigation was conducted to determine the source.MethodsInvestigators reviewed medical records, interviewed family to establish food and drink histories, and inspected a facility that produced liquid herbal tea. Clinical specimens and product were tested for botulinum neurotoxin (BoNT).ResultsA total of 2 confirmed botulism cases were identified with BoNT type A; both were hospitalized, 1 died. Botulism was not suspected until several days after hospital admission. Case-patients ingested single-serving prepackaged liquid herbal tea. Inspection of the tea production facility identified conditions conducive to product contamination with C botulinum and toxin production. Samples of tea tested negative for botulinum toxin. Local and state public health authorities issued alerts and the facility recalled the liquid herbal tea.ConclusionsLiquid herbal tea prepackaged in sealed pouches was the likely source of this type A botulism outbreak because the 2 cases were linked socially and shared no other foods. This type of product has not previously been described in the foodborne botulism literature. In the absence of known risk factors for botulism at the time of presentation, suspicion based on clinically compatible findings is critical so that and treatment with botulinum antitoxin is not delayed. A coordinated response by public health authorities is necessary in identifying a potential food source, inspecting facilities producing the product, alerting medical providers and the public, and preventing further illness.

Epidemiological, clinicopathological, and economic aspects of an outbreak of botulism in beef cattle in the State of Tocantins, Brazil

The objective of this work was to quantify the economic losses caused by a botulism outbreak among beef cattle in a semi-containment regime. The animals were fed corn silage and commercial feed and had access to a pasture of Guinea grass ( Panicum maximum ). Of the 150 steers in the herd, 22 (14.6% morbidity rate) presented clinical signs compatible with botulism and died (100% lethality rate). The 22 steers were clinically evaluated and eight were necropsied. The carcasses were evaluated macroscopically, and samples of the main organs were collected for laboratory testing. Ruminal and intestinal contents, and samples of the silage and animal feed provided were also collected. Botulinum toxin type C was identified in the ruminal contents of one steer and in the corn silage. Herein, the epidemiology, clinical signs, and laboratory findings regarding botulinum intoxication are emphasized for this outbreak. Our findings show the importance of keeping the silage well preserved because this represented a means of neurotoxin transmission that generated economic damage to the producer.

Clinical presentation of an outbreak of foodborne botulism in southern Denmark

Clinical presentation of an outbreak of foodborne botulism in southern Denmark

1721. An Outbreak of Botulism Associated With Nacho Cheese Sauce From a Gas Station in California

BackgroundFoodborne botulism is rare with 0–6 cases reported annually in California. During April 24–28, 2017, 4 hospitalized patients with suspect foodborne botulism were reported to the California Department of Public Health (CDPH) from 2 adjacent California counties. In collaboration with local public and environmental health, CDPH conducted an investigation to determine the magnitude of the outbreak, identify potential sources, and implement control measures.MethodsA case was defined as clinical botulism in a visitor to or resident of Sacramento County with illness onset during April 20 to May 5, 2017. Case-patients or their proxies were interviewed. Patient specimens and suspect food items were tested for the presence of botulinum toxin and toxin-producing Clostridium botulinum; C. botulinum isolates underwent whole genome sequencing (WGS) at the CDPH laboratory.ResultsIn April–May 2017, a total of 10 patients were hospitalized with laboratory-confirmed botulism. Median age was 34 years (range 16–57); 7 were male, and 8 were Latino. All patients required intensive care, 7 required ventilator support, and 1 died. Nine patients confirmed visiting Gas Station A in the week before illness onset; 8 reported consuming nacho cheese sauce served from a dispenser there. Inspection of Gas Station A on May 5 indicated that the cheese in the dispenser had a best by date of April 11; the dispenser was removed that day, before all patients were identified. The remaining pouch of nacho cheese sauce was laboratory confirmed to have botulinum toxin type A and toxin-producing C. botulinum. C. botulinum isolates from 3 patients clustered with the cheese isolate by WGS.ConclusionContaminated nacho cheese sauce served at a local gas station was the source of the largest outbreak of foodborne botulism reported to date in California. No other botulism cases associated with this commercial cheese sauce were identified elsewhere in the United States; although the mechanism of contamination is unclear, the cheese was likely contaminated locally. Intensive public health investigation and intervention, before all cases were identified and C. botulinum toxin was detected in the product, likely prevented additional cases and possible deathsDisclosures All authors: No reported disclosures.

PCR-based molecular diagnosis of botulism (types C and D) outbreaks in aquatic birds

Clostridium botulinum is a strictly anaerobic spore forming bacterium found in soil and sediments, producing botulinum neurotoxins. Group III strains of this organism are only able to produce neurotoxin types C, mosaic C/D, D/C, and D, which are associated with bird botulism. The threats and outbreak cycle of bird botulism are enhanced in the aquatic environment via a food web-environment-avian interface in response to global climatic changes. The aim of this review was to describe and discuss the development of PCR-based markers, diagnostic assays, and applications with special emphasis to botulism detection in aquatic birds. We employed a text-mining approach for collection of current diagnostic information to bird botulism in aquatic environments. Using the PubMed search engine, we have comprehensively collected relevant information from 124 articles and then summated for the purpose of this review. Genes coding for botulinum neurotoxin (bont/C, bont/C/D, bont/D/C, and bont/D), nontoxic components (ha70, ha17, ha33, and ntnh), and flagellin (fliC) were the molecular markers most commonly found for the genotyping of group III strains from environmental samples. “GeneDisc” real-time PCR system was a robust and reliable diagnostic technique for discrimination of neurotoxin types in the large sampled areas. PCR-based assays were the most perceptive and widely established for detection of bird botulism, even if several biochemical and molecular diagnostic techniques have been available. Thus, timely and accurate identification of its mortality is needed to provide a biosecurity, disease control management, and conservation of aquatic birds. PCR-based diagnosis is a promising alternative to the mouse bioassay. Hence, the present paper makes an attempt to review the PCR-based detection assays including primers, specificity, sensitivity, and detection limit and explore their potential applications in wildlife microbiology.