Duration of Fecal Excretion of Clostridium Botulinum and Botulinum Neurotoxin in Patients Recovering from Infant Botulism.

This study sought to determine duration of fecal excretion of Clostridium botulinum organisms and neurotoxin after onset of infant botulism in 66 affected infants. Median excretion was longer for type A than type B patients (organisms: 5.9 vs 3.5 weeks, toxin: 4.8 vs 1.6 weeks, respectively). Toxin excretion always ceased before organism excretion. Antibiotic therapy did not affect duration of excretion.

Descriptive Epidemiology of Infant Botulism in California: The First 40 Years.

OBJECTIVE: To ascertain the descriptive epidemiology of infant botulism, the flaccid paralysis that results when neurotoxigenic Clostridium species produce botulinum toxin (BoNT) in the infant colon, in its first 40 years following initial recognition in California in 1976. STUDY DESIGN: Cases were defined by laboratory identification of BoNT and/or neurotoxigenic Clostridium species in patients' feces. Parents were interviewed using a structured questionnaire. Descriptive epidemiologic characteristics were compared between 1976-1996 and 1997-2016. RESULTS: From 1976-2016, 1345 cases of infant botulism occurred in 45 of 58 California counties (6.5 cases/100 000 live-births/year) caused by BoNT types A, B, Ba, Bf, and F; 88% of cases were ≤6 months of age and 51% were female. Cases were white (84.2%), Asian (8.9%), other races (3.8%), and African American (2.8%); 29.4% of cases were Hispanic. More than 99% of cases were hospitalized. Case occurrence peaked in summer-fall. Of 8 designated geographic regions, the Central Coast counties had 3 times the statewide incidence in both 20-year time periods. Breast-fed patients (83%) were more than twice as old at onset as formula-fed patients (median, 4.4 vs 1.7 months, respectively; P < .001). BoNT/A cases were older at onset than BoNT/B cases (median, 3.8 vs 2.9 months, respectively; P < .001). CONCLUSIONS: Comprehensive continuous surveillance of infant botulism for 40 years in a large, diversely populated state identified fundamental epidemiologic characteristics of this uncommon illness. Unusual features included greater than 99% case hospitalization, absence of male preponderance, and a distinctive age distribution.

Seven-Year Case-Control Study in California of Risk Factors for Infant Botulism.

OBJECTIVE: To ascertain possible risk factors for infant botulism, the intestinal infectious form of human botulism, in the years immediately following its initial recognition in California in 1976. STUDY DESIGN: Parents of 159 California laboratory-confirmed cases of infant botulism from 1976 to 1983 and 318 healthy controls were interviewed using a comprehensive (>300 factors) questionnaire. "Neighborhood controls" (n = 184) were matched on date of birth, sex, race/ethnicity, and neighborhood of residence. "County controls" (n = 134) were matched only on date of birth, sex, and county of residence. Age-stratified bivariate and multivariate conditional logistic regression analyses were performed using SAS. RESULTS: All cases required hospitalization. Bivariate analyses identified several risk factors that in multivariate analyses were not significant. In multivariate analyses, risk factors differed with stratification by age. For the ≤2 month-old neighborhood controls comparison, birth order >1, cesarean delivery, ≤1 bowel movements (BMs) per day, and windy residence area were associated with illness hospitalization, and for the county controls comparison, only pacifier use was associated. For the <2 month-old neighborhood controls comparison, <1 bowel movements (BMs) per day, cesarean delivery, birth order >1, and windy residence area were associated with illness hospitalization, and for the county controls comparison, pets in the home was an additional risk factor. CONCLUSIONS: With the exception of the ≤2-month-old county controls group, slower intestinal transit time (≤1 BM/d) was associated with illness. Otherwise, our case-control investigation identified few physiologic, environmental, and maternal factors associated with infant botulism hospitalization in California.

Molecular epidemiology of infant botulism in California and elsewhere, 1976-2010.

BACKGROUND: Infant botulism (IB), first identified in California in 1976, results from Clostridium botulinum spores that germinate, multiply, and produce botulinum neurotoxin (BoNT) in the immature intestine. From 1976 to 2010 we created an archive of 1090 BoNT-producing isolates consisting of 1012 IB patient (10 outpatient, 985 hospitalized, 17 sudden death), 25 food, 18 dust/soils, and 35 other strains. METHODS: The mouse neutralization assay determined isolate toxin type (56% BoNT/A, 32% BoNT/B). Amplified fragment-length polymorphism (AFLP) analysis of the isolates was combined with epidemiologic information. RESULTS: The AFLP dendrogram, the largest to date, contained 154 clades; 52% of isolates clustered in just 2 clades, 1 BoNT/A (n=418) and 1 BoNT/B (n=145). These clades constituted an endemic C. botulinum population that produced the entire clinical spectrum of IB. Isolates from the patient's home environment (dust/soil, honey) usually located to the same AFLP clade as the patient's isolate, thereby identifying the likely source of infective spores. C. botulinum A(B) strains were identified in California for the first time. CONCLUSIONS: Combining molecular methods and epidemiological data created an effective tool that yielded novel insights into the genetic diversity of C. botulinum and the clinical spectrum, occurrence, and distribution of IB in California.

Maternal hospital experiences associated with breastfeeding at 6 months in a northern California county.

A retrospective cohort study of infant-feeding practices at 6 months of age was conducted for 382 breastfed infants in a semirural northern California county. The authors hypothesized that almost exclusive breastfeeding at 6 months would be related to maternal experiences in the hospital. Multiple logistic regression analysis, controlling for maternal age and education, found that almost exclusive breastfeeding at 6 months was positively associated with receiving a telephone number for breastfeeding help from the hospital (odds ratio, 6.45; 95% confidence interval, 1.23-33.9), use of a breast pump in the first 6 months (odds ratio, 2.19; 95% confidence interval, 1.01-4.76), and gestational age (odds ratio, 2.26; 95% confidence interval, 1.08-4.71 for a 4-week age difference), whereas formula supplementation at the hospital had a negative association (odds ratio, 0.27; 95% confidence interval, 0.13-0.56). Making postpartum breastfeeding support easily accessible and offering breast pumps at low or no cost may help to increase exclusive breastfeeding rates in this county.

Toxoplasma gondii seropositivity and co-infection with TORCH pathogens in high-risk patients from Qatar.

Testing of patients who are deemed to be at high risk for TORCH pathogens, e.g., pregnant women, their fetuses, neonates, and acquired immunodeficiency syndrome (AIDS) patients, is important so that specific treatment can be initiated. This study included 1,857 such patients between 2005 and 2008. Logistic regression was used to evaluate factors associated with Toxoplasma gondii seropositivity. Among 823 women of childbearing age, 35.1% and 5.2% tested positive for T. gondii IgG and IgM, respectively. Three infants < or = 6 months of age (0.8% of 353) were congenitally infected. Factors associated with T. gondii IgG seropositivity included older age, East Mediterranean or African nationality, positive cytomegalovirus (CMV) and herpes simplex virus (HSV)-1 serostatus, and negative rubella IgG results. The decreasing prevalence of IgM antibodies between 2005 and 2008 suggested that exposure to T. gondii from food or environmental sources declined over this period in Qatar. Population-based studies of newborns would be helpful to accurately estimate incidence of congenital toxoplasmosis.

Avaliação de um folheto educativo abordamento o conhecimento sobre toxoplasmose / Evaluation of an educational handout on knowledge about toxoplasmosis

Aims: The study sought to determine the factors associated with prior knowledge about toxoplasmosis, and to assess what participants learned after reading an educational handout. Methods: Participants were recruited at two sites in California: a public meeting about water quality in Morro Bay; and at the Women Infants and Children?s Nutrition Program office or La Leche League meetings in Yolo County. Demographic differences between sites were compared using Fisher?s exact test, and change in knowledge before and after reading the handout using Mantel-Haenszel methodology. Results: Non-Hispanic white participants were more likely than those of Hispanic ethnicity (62% vs. 20%, respectively) to have prior knowledge about toxoplasmosis. The most common source of information was newspapers (36%). Only 16% had obtained information from medical professionals. After reading the handout, 85% of participants identified Toxoplasma gondii as a parasite and 98% identified cats as the source of oocysts. Ninety-eight percent of participants who read the handout were aware they could acquire infection from cat faeces, 94% from meat, 78% from soil or in utero, and 69% from unwashed vegetables. Fewer (59%) recognized all sources. Conclusions: Knowledge about Toxoplasma gondii increased in all areas evaluated, but gaps remained, particularly with regard to environmental sources of Toxoplasma gondii infection and clinical manifestations of disease. In addition to care in handling cat faeces/litter and avoidance of undercooked meat, healthcare providers counseling pregnant women should emphasize the importance of wearing gloves when gardening, hand washing after handling soil or meat, and rinsing fresh vegetables thoroughly before consumption.

Evaluation of lactation support in the workplace or school environment on 6-month breastfeeding outcomes in Yolo County, California.

Six-month breastfeeding outcomes (almost exclusive breastfeeding, partial breastfeeding, and not breastfeeding) were analyzed for 201 infants born to Yolo County, California, mothers who returned to work or school. Twenty-two percent of workplaces and 17% of schools did not provide a lactation room. Although part- or full-time status, knowledge of breastfeeding rules, and support from colleagues were independently associated with the outcome, they were not significant in the multivariate analysis. In the selected model, maternal age (odds ratio [OR] = 2.3; 1.3-3.9 for a 10-year difference), college or above versus

Risk factors for infection with pathogenic and antimicrobial-resistant fecal bacteria in northern elephant seals in California.

OBJECTIVES: The goal of this study was to identify potential environmental and demographic factors associated with Campylobacter jejuni (C. jejuni), Salmonella enterica (Salmonella spp.), and antimicrobial-resistant Escherichia coli (E. coli) infection in northern elephant seals stranded along the California coastline. METHODS: E. coli, Salmonella spp., and C. jejuni were isolated from rectal swabs from 196 juvenile northern elephant seals, which were found stranded and alive along the California coast and brought to The Marine Mammal Center in Sausalito, California, for rehabilitation. Gender, weight, county where the animal stranded, month stranded, coastal human population density, exposure to sewage outfall or freshwater outflow (river or stream), and cumulative precipitation in the previous 24 hours, seven days, 30 days, 90 days, and 180 days were analyzed as potential risk factors for infection. RESULTS: The odds of C. jejuni and antimicrobial-resistant E. coli were higher in feces of seals stranded at sites with higher levels of freshwater outflow compared with lower levels of freshwater outflow. The odds of Salmonella spp. in feces were 5.4 times greater in seals stranded in locations with lower levels of 30-day cumulative precipitation, along with substantially lower odds of Salmonella shedding for seals stranded in Monterey or Santa Cruz county compared with seals stranded in regions further north or south of this central California location. CONCLUSIONS: Juvenile northern elephant seals that have entered the water are being colonized by antimicrobial-resistant and pathogenic fecal bacteria that may be acquired from terrestrial sources transmitted via river and surface waters.

Evaluation of Cruzia americana, Turgida turgida, and Didelphostrongylus hayesi infection in the Virginia opossum (Didelphis virginiana) and risk factors along the California coast.

Three nematodes, Turgida turgida, Cruzia americana, and Didelphostrongylus hayesi, have been documented to cause morbidity and mortality in the Virginia opossum (Didelphis virginiana). The present study was designed to determine the frequency of infection of these nematodes in opossums at 2 study sites in California and to determine if there are risk factors associated with shedding of eggs or larvae in the feces. Turgida turgida and C. americana adults were found in 84.4% (stomach; n = 45) and 62.5% (intestinal wash and feces; n = 16) of sampled opossums. Eggs were present in opossum feces (n = 105) less frequently (40% T. turgida and 35.2% C. americana). Didelphostrongylus hayesi larvae were found in 79.0% of opossum feces examined (n = 105). Adult age and wet season (December through April) were significant predictive factors for the presence of T. turgida eggs, whereas the dry season (May through November) was significantly associated with the presence of C. americana eggs in feces. Adult opossums were more likely to have eggs and larvae from all 3 nematodes in the feces.

Risk factors for Toxoplasma gondii infection in wild rodents from central coastal California and a review of T. gondii prevalence in rodents.

Sera from 523 wild rodents were tested for Toxoplasma gondii antibodies using either an indirect fluorescent antibody test (IFAT) (rats and mice, with titer >or=80 considered positive) or a latex agglutination test (LAT) (voles, squirrels, and pocket mice, with titer >or=32 considered positive). Seventeen percent (88/523) of the rodents, including 26% (85/328) of the Peromyscus sp. and 8% (3/37) of Spermophilus beecheyi, were seropositive. Fourteen percent (23/161) of rodents captured in trap sites next to Morro Bay (California) and 15% (16/109) of rodents from sites adjacent to riparian habitats had antibodies to T. gondii, compared to 19% (49/253) of rodents captured in habitats not associated with water; this difference was not statistically significant (P = 0.32). Significantly fewer rodents were captured <200 m from residential housing compared to locations further away (11% vs. 30%, respectively). Factors associated with an increased risk for T. gondii seropositivity in rodents were capture location >or=200 m from residential housing and adult age.

Detection of Toxoplasma gondii-like oocysts in cat feces and estimates of the environmental oocyst burden.

OBJECTIVE: To estimate the analytic sensitivity of microscopic detection of Toxoplasma gondii oocysts and the environmental loading of T gondii oocysts on the basis of prevalence of shedding by owned and unowned cats. DESIGN: Cross-sectional survey. SAMPLE POPULATION: 326 fecal samples from cats. PROCEDURES: Fecal samples were collected from cat shelters, veterinary clinics, cat-owning households, and outdoor locations and tested via ZnSO(4) fecal flotation. RESULTS: Only 3 (0.9%) samples of feces from 326 cats in the Morro Bay area of California contained T gondii-like oocysts. On the basis of the estimated tonnage of cat feces deposited outdoors in this area, the annual burden in the environment was estimated to be 94 to 4,671 oocysts/m(2) (9 to 434 oocysts/ft(2)). CONCLUSIONS AND CLINICAL RELEVANCE: Despite the low prevalence and short duration of T gondii oocyst shedding by cats detected in the present and former surveys, the sheer numbers of oocysts shed by cats during initial infection could lead to substantial environmental contamination. Veterinarians may wish to make cat owners aware of the potential threats to human and wildlife health posed by cats permitted to defecate outdoors.

Evaluation of two Toxoplasma gondii serologic tests used in a serosurvey of domestic cats in California.

We evaluated the sensitivity (Se) and specificity (Sp) of an IgG enzyme-linked immunosorbent assay (ELISA) and IgG indirect fluorescent antibody test (IFAT) for detection of Toxoplasma gondii-specific antibodies in sera from 2 cat populations using a Bayesian approach. Accounting for test covariance, the Se and Sp of the IgG ELISA were estimated to be 92.6% and 96.5%, and those of the IgG IFAT were 81.0% and 93.8%, respectively. Both tests performed poorly in cats experimentally coinfected with feline immunodeficiency virus and T. gondii. Excluding this group, Se and Sp of the ELISA were virtually unchanged (92.3% and 96.4%, respectively), whereas the IFAT Se improved to 94.2% and Sp remained stable at 93.7%. These tests and an IgM ELISA were applied to 123 cat sera from the Morro Bay area, California, where high morbidity and mortality attributable to toxoplasmosis have been detected in southern sea otters. Age-adjusted IgG seroprevalence in this population was estimated to be 29.6%, and it did not differ between owned and unowned cats. Accounting for Se, Sp, and test covariances, age-adjusted seroprevalence was 45.0%. The odds for T. gondii seropositivity were 12.3-fold higher for cats aged >12 mo compared with cats aged <6 mo.

Experimental infection of Peromyscus californicus with Toxoplasma gondii.

Eight female Peromyscus californicus were infected with 10(2) or 10(4) Toxoplasma gondii culture-derived tachyzoites (Type II or X) isolated from southern sea otters. All but 2 mice survived infection and developed antibodies to T. gondii. The 2 fatally infected mice were inoculated with 10(4) tachyzoites of the Type X strain. Parasite detection by immunohistochemistry (IHC) and DNA amplification with 2 polymerase chain reaction (PCR) methods was compared for brain, heart, lung, liver, spleen, biceps muscle, and tongue, at a mean of 41 days postinfection. Parasites were detected most commonly by IHC in spleen (8/8) and brain (6/8). DNA amplification by PCR was most successful from brain, heart, and spleen.

Outdoor fecal deposition by free-roaming cats and attitudes of cat owners and nonowners toward stray pets, wildlife, and water pollution.

OBJECTIVE: To estimate cat population size, management, and outside fecal deposition and evaluate attitudes of cat owners and nonowners to stray animal control, water pollution, and wildlife protection. DESIGN: Cross-sectional survey. SAMPLE POPULATION: 294 adult residents of Cayucos, Los Osos, and Morro Bay, Calif. PROCEDURES: Telephone survey. RESULTS: The region's cat population was estimated at 7,284 owned and 2,046 feral cats, and 38% of surveyed households owned a mean of 1.9 cats/household. Forty-four percent of cats defecated outside >75% of the time. Annual fecal deposition (wet weight) by owned cats in the 3 communities was estimated to be 77.6 tonnes (76.4 tons). Cat owners were more likely to oppose cat licensing and impounding stray cats and support trap-neuter-return for stray cats and less likely to be concerned about water pollution, than were noncat owners. CONCLUSIONS AND CLINICAL RELEVANCE: Feral cats represented a sizeable proportion (22%) of the free roaming cats in this area and could be contributing 30.0 tonnes (29.5 tons) of feces to the environment per year. However, feral cats are not the principal source of fecal loading because owned cats defecating outdoors contribute an estimated 77.6 tonnes (76.4 tons) or 72% of the annual outdoor fecal deposition.