Molecular and Epidemiological Characterization of Infant Botulism in Beijing,China

Laboratory-based pathogen isolation, identification, and toxicity determination were performed on samples from a suspected case of infant botulism. Mice injected with cultures generated from the enema sample and ingested Powered infant formula (PIF) presented typical signs of botulism. Antitoxins to polyvalent botulinum neurotoxins (BoNTs) and monovalent BoNT type B antitoxin had protective effects. Clostridium botulinum isolated from the enema and residual PIF samples were positive for type B toxin. Pulsed-field gel electrophoresis (PFGE) revealed that the two strains of C. botulinum isolated from the two samples produced indistinguishable pulsotypes. These findings confirmed this case of type B infant botulism associated with the ingestion of PIF contaminated by type B C. botulinum spores.     

Botulism in New South Wales, 1980-1981

The isolation of Clostridium botulinum from the home environment of New South Wales patients with infant botulism is reported. Of the three cases of infant botulism type B, the bacteria were isolated from soil around the dwelling in one, and from tank rainwater in another. In one case with type A, the bacteria were present in the soil, vacuum-cleaner dust, and tank rainwater. The bacteria were not detected in the environment of two adult patients and a child with C. botulinum in their stools. The home location of the patients with infant botulism, and the frequency of isolation of the bacteria from rainwater, soil and vacuum-cleaner dust in Cobar, Nyngan, some Sydney suburbs, and at five pastoral homesteads suggest that infants in rural areas are more at risk than those in large metropolitan areas. The age of the infants with diagnosed botulism in New South Wales, compared with those reported in the United States data, strongly suggests that the disease is not being fully recognised in younger infants.     

Type A botulism from sauteed onions. Clinical and epidemiologic observations

Twenty-eight persons were hospitalized in Illinois with neurologic signs and symptoms compatible with botulism in October 1983. Twelve patients required ventilatory support, and 20 patients were treated with trivalent ABE antitoxin; one patient died while still in the hospital six months after onset of illness. Type A toxin and/or type A Clostridium botulinum were subsequently identified in specimens from 18 patients. Case-control studies implicated sauteed onions made from fresh raw onions and served on a patty-melt sandwich in a local restaurant as the vehicle of transmission. Although the original sauteed onions were not available for toxin testing, type A toxin was detected in washings from a wrapper in which a patty-melt sandwich was taken home by one of the ill persons. Also, type A C botulinum was cultured from five of 75 raw onions taken from the restaurant. This outbreak implicated an unusual vehicle for botulinal toxin that was initially not suspected and demonstrates the importance of considering all theoretically possible food items as potential vehicles for toxin until epidemiologic and laboratory data have been collected and analyzed.     

Coproexamination for botulinal toxin and clostridium botulinum. A new procedure for laboratory diagnosis of botulism.

Stool or serum specimens or both from 318 persons pertaining to 165 botulism investigations over a three-year period were examined. Botulinal toxin was detected in stools of 19 of 56 patients and in sera of 20 of 60 patients with clinical botulism; it was not detected in specimens from 246 persons with an illness other than botulism or well contacts of patients. Clostridium botulinum was identified in stools of 36 of 60 clinical botulism patients and in four of 27 asymptomatic contacts of patients with botulism victims, but not in stools of 65 persons not associated with confirmed botulism. When stool and serum samples were examined, confirmatory evidence was obtained for 72.9% of the botulism cases. Detection of botulinal toxin or C botulinum in the stool of a persons should be considered evidence supporting the clinical diagnosis of botulism.     

An overview of type E botulism in China

The geographical distribution of C. botulinum type E and its associated disease, type E botulism in China, is different from that in other areas of the world. Cases of type E botulism generally arise in costal regions. In China, however, type E botuhsm is found primarily in the Qinghai-Tibet plateau of northwest China far from the ocean, at an altitude of approximately 4-5 kin. The foods most commonly associated with the disease are fermented grain and beans as well as raw meat A suspected outbreak of type E botulism poisoning in the central costal region of China in the 1990s prompted the collection and analysis of samples of mud, sand, and fish from the region. The toxin produced by type E botulinum was found in these samples. Surprisingly, though, upon further analysis, the strain isolated from the samples was identified not as type E C. botulinum, but as the neurotoxigenic bacterium Clostridiurn butyricurn.     

A review of botulism in China

The epidemiological characteristics and etiology of botulism in China, as well as the distribution of different types of Clostridium botulinum in China, are described. Through 1989, 15 provinces and autonomous regions reported the occurrence of botulism. There were 2861 cases involved in 745 outbreaks. Among the cases 421 died, with a case fatality of 14.7%. The main epidemiological characteristics of botulism in China are: (i) the major foods causing botulism are homemade fermented bean products which accounted for 62.6% of the cases; (ii) the incubation period is longer (3 h-54 days) than that described in the western literature (mostly 2-7 days); (iii) the peak occurrence is from February to May; (iv) the progression of symptoms and signs is slower than that of western cases. All types of C. botulinum, with the exception of type G, have been found in China. The distribution of various types of C. botulinum is significantly different between southern and northern China; this is related to the latitude and is correlated with the prevalence of this disease. Most of the botulism outbreaks occurred above 30 degrees north latitude in northern China and outbreaks rarely occurred below 30 degrees north latitude. Nationwide surveys showed that the average detection rate of C. botulinum spores in soil and foods in the northern parts of China was 14.8%, while it was only 2.5% in the south. C. botulinum types A, B, E, and F, which are involved in human botulism, were frequently found in the North, while types C and D, which are involved only in animal intoxication, were found more frequently in the south.     

Type A and type B botulism in the North: first reported cases due to toxin other than type E in Alaskan Inuit.

Botulism outbreaks shown to be due to type A and type B toxin occurred in Alaska, a region previously known for only type E botulism. The outbreak due to type A toxin involved three people, two of whom died. The outbreak due to type B toxin involved nine people, none of whom died. Both outbreaks were in Inuit villages, and native foods were incriminated. The occurrence of these outbreaks strongly suggests that Clostridium botulinum, types A and B are indigenous to Alaska. The outbreaks underscore the need for initial treatment of patients with antitoxin that is trivalent (ABE), even in Arctic regions.     

Type B botulism outbreak caused by a commercial food product. West Virginia and Pennsylvania, 1973

In the week of May 7, 1973, seven persons contracted botulism after eating together. The most common symptoms were vomiting, constipation, dry mouth, dysphagia, and dysphonia. All were treated with trivalent botulinal antitoxin, and none died. Serum specimens obtained from all seven patients were negative for botulinal toxin, but stool specimens from three patients were positive for type B toxin. Electromyographic studies performed on five patients documented the neurophysiologic abnormalities of botulism. Commercially canned peppers in oil were implicated epidemiologically, and type B toxin was identified in leftover peppers. The processor voluntarily recalled the pepper product, and no further cases were reported.     

Infant botulism in Australia: availability of human botulinum antitoxin for treatment

We report the first Australian case of treatment of infant botulism with a human botulinum antitoxin developed in the United States by the California Department of Public Health. Our patient's clinical improvement was rapid, and although the product is expensive, cost-analysis supports the economical viability of its use. In future cases of suspected infant botulism, we recommend that Australian clinicians promptly obtain and administer this antitoxin to their patient.     

Ocular findings in botulism type B.

In April 1977, fifty-nine persons became ill with type B botulism in a large, common-source outbreak. A combination of signs and symptoms that should make the clinician strongly suspect botulism was derived from the histories and ocular findings of these persons. Certain signs of third cranial nerve dysfunction reliably predicted in which patients ventilatory insufficiency would develop.     

Human Botulism due to Commercial Products

Two cases of botulism occurred in Montreal following the ingestion of commercially canned liver paste. A toxigenic, proteolytic strain of Clostridium botulinum type B was isolated from the paste in which type B toxin was also demonstrated by animal protection tests. One patient died undiagnosed about 45 hours after eating several liver-paste sandwiches. The second developed diplopia, dysphagia, speech difficulty and weakness 18 hours after ingestion of three bites of a sandwich. All symptoms progressed until admission to hospital where he was treated with 160,000 units of divalent botulinum AB antitoxin over a 72-hour period. Recovery was complete. The need for readily available supplies of both diagnostic and therapeutic botulinum antitoxin to meet such an emergency is stressed.     

膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的临床研究

目的：观察膀胱不同部位注射A型肉毒素治疗女性难治性膀胱过度活动症的疗效。方法40例入选病例,随机分为逼尿肌注射组（A组）、逼尿肌联合三角区注射组（B组）,评估患者治疗前及治疗后4周的临床症状（平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数）及尿动力学指标（初始尿意膀胱容量、最大膀胱容量）和 OABSS 评分、QOL 评分情况。结果经过A型肉毒素注射治疗4周后,A组平均每日日间排尿次数、平均每次排尿量、夜尿次数、尿急次数以及OABSS评分, QOL评分、最大膀胱容量均较B组有明显改善（P＜0．05）。结论 A型肉毒素膀胱内注射治疗难治性膀胱过度活动症疗效好,无明显毒副作用,是治疗难治性膀胱过度活动的经济、有效的新方法;采用逼尿肌联合三角区部位的注射,症状缓解更为明显,值得进一步的研究及推广。     

单克隆抗体在ELISA法检测B型肉毒毒素中的应用

于ELISA—双夹心法系统中采用B型肉毒毒素单克隆抗体作为包被抗体,可检出B型肉毒类毒素4—31ng/ml,与A型交叉最低浓度为4—8μg/ml,特异性比值为250—1,000;可检出B型肉毒毒素16ng/ml(4LD_(50)/ml) A型大于32μg/ml(大于301LD_(50)/ml),特异性比值大于2,000;检出污染食物标本中的B型肉毒毒素最低浓度为0.67—7.8LD_(50)/ml,与A型间未见交叉现象。其敏感度接近RPHA,特异性明显优于RPHA。     

Candida meningitis in newborn infants: a review and report of combined amphotericin B--flucytosine therapy

Meningitis due to Candida albicans was successfully treated in a 1.1 kg premature infant using combined antifungal therapy of amphotericin B for three weeks and 5-fluorocytosine for four months. Hydrocephalus and profound psychomotor retardation were present one year later. Psychomotor retardation, aqueductal stenosis and hydrocephalus were found to be common in a review of 16 previously reported cases of central nervous system (CNS) candidiasis in newborn infants. The diagnosis and institution of therapy were frequently delayed, and the mortality rate was 29% in the 17 patients reviewed here. The subacute course, lack of clinical findings, variable cerebrospinal fluid (CSF) findings, negative CSF cultures due to low concentrations of organisms, slow in vitro growth of C. albicans and misinterpretation of positive cultures as contaminants are factors frequently leading to delayed diagnoses. Using combination therapy, it should be possible to use lower doses and shorter courses of amphotericin B therapy for C. albicans meningitis in the newborn infant.     

Outbreak of type A botulism caused by a commercial food product in Taiwan: clinical and epidemiological investigations

In late September 1986, we found 7 patients from a printing factory in Chang-Hwa city who developed an endemic disease manifested by general malaise, ptosis, double vision, dysarthria, dysphagia, and proximal limb weakness. After clinical, epidemiological, microbiological, and toxicological investigations, an outbreak of botulism was confirmed 2 weeks later, Commercially canned peanuts made by an unlicensed cannery were identified as the vehicle of botulinum toxin transmission. Antitoxin was given to 2 patients who needed ventilator support. One of the 7 victims died from medical complications and the remaining 6 patients recovered. Several administrative problems exposed in this outbreak were the poor governmental supervision of canned food, the inadequate quantities of "orphan drugs" stored in this country, the inefficient system for recalling the problem products, and the delayed broadcasting of warnings to the public. Since commercially processed food is increasingly popular with modernization, the possibility of future botulism outbreaks should not be overlooked.     

实验性家兔肉毒中毒的观察

肉毒毒素是已知毒性最烈的一种毒物,它不但可以引起人的中毒,也可以引起许多种動物的中毒。为了解肉毒中毒的動物模型,我们使用了肉毒毒素耳静脉注射,观察家兔实验性肉毒中毒的过程。报告如下。材料和方法选用健康家兔20只,随机分为两组。A组每公斤体重耳静脉注射A型肉毒毒素0.5毫升。B组每公斤体重注射B型肉毒毒素0.5毫升。注射前观察動物的饮食、活動、呼吸     

Botulism as a cause of respiratory failure in injecting drug users

Background Wound botulism occurs as a consequence of inoculation of Clostridium botulinum spores into a wound. Aim To describe such a case of wound botulism. Results A 23-year-old drug-injecting user presented with bulbar symptoms and progressive signs over a three-day period. The diagnosis of botulism was suspected and was treated with large doses of penicillin and botulinum antitoxin. The diagnosis was confirmed by the presence of serum botulinum toxin A. Conclusion Physicians should be aware of the association of botulism in injecting drug users, particularly in Ireland.     

Botulinum toxin as a biological weapon: medical and public health management

OBJECTIVE: The Working Group on Civilian Biodefense has developed consensus-based recommendations for measures to be taken by medical and public health professionals if botulinum toxin is used as a biological weapon against a civilian population. PARTICIPANTS: The working group included 23 representatives from academic, government, and private institutions with expertise in public health, emergency management, and clinical medicine. EVIDENCE: The primary authors (S.S.A. and R.S.) searched OLDMEDLINE and MEDLINE (1960-March 1999) and their professional collections for literature concerning use of botulinum toxin as a bioweapon. The literature was reviewed, and opinions were sought from the working group and other experts on diagnosis and management of botulism. Additional MEDLINE searches were conducted through April 2000 during the review and revisions of the consensus statement. CONSENSUS PROCESS: The first draft of the working group's consensus statement was a synthesis of information obtained in the formal evidence-gathering process. The working group convened to review the first draft in May 1999. Working group members reviewed subsequent drafts and suggested additional revisions. The final statement incorporates all relevant evidence obtained in the literature search in conjunction with final consensus recommendations supported by all working group members. CONCLUSIONS: An aerosolized or foodborne botulinum toxin weapon would cause acute symmetric, descending flaccid paralysis with prominent bulbar palsies such as diplopia, dysarthria, dysphonia, and dysphagia that would typically present 12 to 72 hours after exposure. Effective response to a deliberate release of botulinum toxin will depend on timely clinical diagnosis, case reporting, and epidemiological investigation. Persons potentially exposed to botulinum toxin should be closely observed, and those with signs of botulism require prompt treatment with antitoxin and supportive care that may include assisted ventilation for weeks or months. Treatment with antitoxin should not be delayed for microbiological testing.     

Nosocomial hepatitis A. A multinursery outbreak in Wisconsin

Seven premature infants contracted asymptomatic hepatitis A while hospitalized in an intensive care nursery (nursery A) from May through August 1981. Fifteen secondary cases occurred between Aug 13 and Oct 14 and included six family members of nursery A infants, five nursery A nurses, and three nurses and a physician at two other nurseries--B and C. Nurseries B and C had each received an infected infant transferred from nursery A in July. An epidemiologic investigation was conducted to determine the mode of transmission of hepatitis A in infants. A common vehicle was not identified. Review of dates of onset of illness in adults suggested that hepatitis A was transmitted in at least two generations of illness in infants at nursery A. Evaluation of infant handling in nursery A, using a case-control study, suggested that hepatitis A was transmitted among infants by nurses. Asymptomatic infected premature infants can be a source of hepatitis A in nursery infants and personnel and in the community.     

小针高频电凝配合注射肉毒杆菌毒素A诱导家兔咬肌萎缩的实验研究

目的 探讨小针高频电凝配合肉毒毒素A治疗咬肌肥大的可行性.方法 健康家兔36只,随机分为4组,每组9只;A组在咬肌注射肉毒毒素A 2 U/kg;B组于咬肌插入数枚电凝针,20 W电凝3 s;C组为A组注射剂量为1 U/kg,联合高频电凝20 W,3 s;D组为空白对照组.A组、B组、C组治疗对侧注射等量生理盐水做自身对...