ABSTRACT
Botulism is a rare disease in Chile and of the known clinical presentation, infant botulism is the most common. We report the case of a previously healthy seven month oíd male infant with a two weeks history of rinorrea, cough, fatigue, constipation and progressive weakness after the consumption of honey. Stool cultures were positive for Clostridium botulinum group 1 type A and electromyography was compatible with the diagnosis. The patient evolved with arterial hypertension, interpreted as secondary to autonomic dysfunction, which responded to calcium channel blockers. Muscle tone improved progressively during the following four weeks. Infant botulism is a potentially fatal disease; diagnosis can be difficult given the broad clinical manifestations. Prevention should focus on education of parents of infants as well as medical personnell.
El botulismo es un trastorno poco frecuente en nuestro país. De las formas conocidas, el botulismo infantil da cuenta de la mayoría de los casos. Comunicamos el caso clínico de un paciente de siete meses, sexo masculino, sin antecedentes mórbidos. Historia de dos semanas de coriza, tos y decaimiento. Tras la ingesta de miel presentó exacerbación de la sinto-matología respiratoria, constipación y debilidad muscular progresiva. Se analizó muestra de heces resultando positiva para Clostridium botulinum grupo I tipo A. El estudio electromiográñco fue compatible con el diagnóstico. Presentó hipertensión arterial, atribuyéndose a disfunción autonómica, con buena respuesta a bloqueadores de los canales de calcio. Recuperó progresivamente el tono muscular. En un control ambulatorio se apreciaba importante regresión de la sinto-matología. El botulismo infantil es una enfermedad potencialmente letal de no tratarse oportunamente y de difícil diagnóstico, ya que su presentación es similar a otros cuadros clínicos. Es necesario educar a padres y personal médico sobre las medidas de prevención para los lactantes bajo doce meses de edad.
Subject(s)
Humans , Infant , Male , Botulism/diagnosis , Clostridium botulinum type A , Calcium Channel Blockers/therapeutic use , Honey/adverse effects , Botulism/drug therapy , Botulism/etiology , Clostridium botulinum type A/isolation & purification , Electromyography , Feces/microbiology , Honey/microbiology , Treatment OutcomeABSTRACT
O botulismo infantil tem afetado crianças abaixo de um ano de idade em várias regiões do mundo, e o mel tem sido identificado como uma das mais importantes fontes de intoxicação alimentar. Apesar disso, há dados escassos sobre o botulismo entre crianças no Brasil, especialmente no tipo de alimento comercial mais implicado nesta patologia. Este estudo pretendeu investigar a presença de esporos de Clostridium botulinum em mel comercializado no Brasil. Cem amostras de mel comercializado em seis diferentes Estados brasileiros (SP, MG, GO, CE, MT, SC) foram pesquisados para a presença de esporos de Clostridium botulinum, usando o choque térmico, seguido pela inoculação em caldo Cooked Meat Medium (Difco®) e incubado em condições anaeróbias. As culturas positivas foram analisadas através de esfregaços corados pelo Gram e semeadas em placas de Reinforced Clostrideo Agar (Difco®) e placas de Sulfito Polimixina Sulfadiazina -SPS (Difco®), as quais foram incubadas em condições anaeróbicas para obter colônias desta bactéria. As colônias positivas foram submetidas a teste de toxicidade através da inoculação em camundongos susceptíveis e caracterização bioquímica. Foram encontradas colônias de Clostridium botulinum que produzem toxinas ativas em 7 por cento das amostras de mel comercial, realçando a relevância deste microrganismo para a saúde pública devido ao alto risco potencial de o mel comercializado nestas regiões brasileiras causar o botulismo infantil, especialmente em crianças abaixo de um ano de idade.
Infant botulism has been affecting children under one year of age in several regions of the world and honey has been identified as one of the most important source of this food borne disease. Despite this, there are scarce data about botulism among children in Brazil, specially the type commercial food most implicated in this pathology. This study aimed at investigating the presence of spores of Clostridium botulinum in honey commercialized in Brazil. One hundred of honey samples commercialized in six different Brazilin states (SP, MG, GO, CE, MT, SC) were searched for the presence of spores of Clostridium botulinum, using thermal shock followed by the inoculation in Cooked Meat Medium (Difco®) and incubation in anaerobic conditions. The positives cultures were analyzed by Gram stain and seeded in Reinforced Clostrideo Agar (Difco®) and Sulfito Polimixina Sulfadiazina -SPS (Difco®) plates, which were incubated in anaerobic conditions in order to pick up the colonies of this bacteria. The positive colonies were submitted to toxicity test by inoculation in susceptible mice and to biochemical characterization. Clostridium botulinum colonies producing actively toxins were detected in 7 percent of the commercial honey samples, highlighting the relevance of this microorganism for public health due to the high potential risk of honey commercialized in these Brazilian regions to cause Infant Botulism, specially in children under one-year old.
ABSTRACT
Foodborne botulism is caused by ingestión of a preformed toxin produced in food by C. botulinum. The most frequent source is home-canned foods, in which spores that survive an inadequate cooking and canning process germinate, reproduce, and produce this toxin in the anaerobic environment of the canned food. From 1992 to 2003, 34 cases of food-borne cases and 275 cases of infant botulism were reported in Argentina. The severity of symptoms depends on the amount of toxin ingested. Mild cases may not seek medical attention at all. A patient presenting only nausea and mild neurological symptoms may not raise the physician's attention and therefore the case will not be reported. It is important to make physicians aware of this potentially fatal disease. In Argentina, most botulism cases are related to home-canned food. Therefore, botulism can be prevented through the education of consumers in order to discourage the consumption of that kind of food.
La causa más frecuente de botulismo de los alimentos es la elaboración y consumo de conservas caseras, que son procesadas de manera inapropiada, creando un ambiente anaeróbico que favorece la supervivencia de las esporas, su germinación, reproducción y síntesis de toxina. Entre 1992 y 2003, se han notificado en Argentina 34 casos de botulismo transmitido por alimentos y 275 casos de botulismo infantil. La gravedad de los síntomas depende de la ingesta de esporas viables por el paciente. Formas leves de botulismo pueden no requerir asistencia médica en absoluto, por lo que si un paciente presenta sólo náuseas y ligeros síntomas neurológicos, existe la posibilidad de que un caso de botulismo pueda no ser diagnosticado. En Argentina, la mayoría de los casos de botulismo se relacionan con alimentos de preparación casera. Es importante para la prevención, educar a los consumidores, desincentivando la ingesta de este tipo de alimentos.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Botulism/etiology , Food Handling , Food Microbiology , Food Preservation , Argentina/epidemiology , Botulism/diagnosis , Botulism/epidemiology , Risk Factors , Severity of Illness IndexABSTRACT
O botulismo alimentar ocorre pela ingestão de toxinas pré-formadas pelo Clostridium botulinum, consideradas as mais potentes dentre as toxinas conhecidas. Caracteriza-se como uma doença de extrema gravidade, de evolução aguda, provoca distúrbios digestivos e neurológicos, em conseqüência à ingestão de diversos tipos de alimentos. As conservas caseiras estão entre os alimentos que oferecem maior risco à população consumidora. Os produtos de origem animal são frequentemente associados aos surtos da doença, destacando-se os embutidos, tais como salsichas, salames, presuntos e patês. Derivados do leite e enlatados, bem como produtos fermentados, são passíveis de provocar a intoxicação. As outras formas naturais da doença são botulismo por feridas e botulismo infantil, normalmente associado ao consumo de mel contendo esporos do Clostridium botulinum.
Foodbourne botulism occurs after ingestion of preformed toxins produced by the Clostridium botulinum, which has been considered one of the most potent known one. The disease, acquired after ingestion of various kinds of foods, has acute character, and provokes gastrointestinal and neurologic symptoms. Homemade canned foods are those that represent higher risk to human health. Processed meat products are frequently associated with botulism outbreaks, mainly sausages, ham and pates. Dairy and canned food, as well as fermented foods, also may be related with this disease. Still, botulism may be caused by toxin production in deep wound, named wound botulism; and after ingestion of honey contaminated with spores by infants, named infant botulism.