Food-borne botulism outbreak during the Rugby World Cup linked to marinated sardines in Bordeaux, France, September 2023.

In September 2023, a botulism outbreak affecting 15 individuals occurred in Bordeaux, France, during the Rugby World Cup. We report on eight individuals from four different countries on two continents admitted to the intensive care unit at our hospital, where six required invasive mechanical ventilation. Cases reported consuming locally produced canned sardines at a restaurant. This report highlights the importance of rapid, worldwide alerts from health authorities to prevent severe consequences of such outbreaks, particularly during events attracting international visitors.

Botulismo alimentario durante la pandemia por el SARS-CoV-2. Descripción de un caso y de un posible brote familiar en Barcelona / Food borne-botulism during SARS-CoV-2 pandemic time. A case and a possible familial outbreak in Barcelona

Introducción. El botulismo es un síndrome neuroparalítico hoy en día infrecuente, potencialmente fatal, causado por neurotoxinas de Clostridium botulinum. El origen es alimentario en el 25% de los casos. Caso clínico. Describimos el caso confirmado de botulismo alimentario en una paciente atendida en nuestro hospital en septiembre de 2020 y la sospecha de un segundo caso en un familiar de la paciente, no confirmado éste por las pruebas de laboratorio. La instauración en pocos días de una afectación bilateral de pares craneales, incluyendo disfagia, disnea y disartria, junto con midriasis y tetraparesia graves, precedida de diarrea, constituyó la presentación clínica en el primer caso; mientras que en su familiar cursó con síntomas inespecíficos y transitorios. Constatamos disautonomía consistente en hipotensión arterial en ambos casos. Teniendo en cuenta la situación pandémica en aquel momento, se descartó repetidamente la infección por SARS-CoV-2 antes de plantear alternativas diagnósticas. La neurotoxina B de C. botulinum fue detectada en las heces de la paciente, confirmando el diagnóstico de botulismo, que relacionamos con la ingesta de una conserva casera de alubias. Se completó el diagnóstico diferencial del cuadro descartando otras posibles etiologías. Conclusión. La sospecha clínica temprana, confirmada con los hallazgos de laboratorio y neurofisiológicos y que llevaron al manejo específico de la paciente, fueron cruciales para la evolución favorable. No fue necesario aplicar medidas de salud pública, a excepción de la notificación a sus allegados de la contaminación detectada. Conocer la existencia de esta patología puede contribuir a su pronóstico.(AU)

Introduction. Botulism is a potentially fatal neuroparalytic syndrome caused by Clostridium botulinum neurotoxin. The 25% are food-borne botulism cases. Case report. We describe a confirmed case of botulism attended in our hospital in September 2020, together with a second case in a patient’s relative, suspected but not confirmed by laboratory tests. Clinical presentation consisted on general weakness, bilateral cranial palsy, mydriasis, and rapidly progressive tetraparesis in case 1, involving respiratory and swallowing function so she required hospitalization and support treatment. Non specific and transient symptoms occurred in case 2. SARS-CoV-2 infection was initially suspected in both cases due to pandemic situation in our country, ruled out by negative PCR. When B neurotoxin was detected in stool sample of patient 1 we confirmed the diagnosis of food-borne botulism probably linked to home-made conserved beans. Conclusion. Early clinical suspicion, together with laboratory and electromyography findings, and support treatment provided at hospital were crucial for favourable outcome. Being aware of this rare syndrom might contribute to its better management.(AU)

Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997-2019.

BACKGROUND: Botulism is a low incidence but potentially fatal infectious disease caused by neurotoxins produced mainly by Clostridium botulinum. There are different routes of acquisition, food-borne and infant/intestinal being the most frequent presentation, and antitoxin is the treatment of choice in all cases. In Spain, botulism is under surveillance, and case reporting is mandatory. METHODS: This retrospective study attempts to provide a more complete picture of the epidemiology of botulism in Spain from 1997 to 2019 and an assessment of the treatment, including the relationship between a delay in antitoxin administration and the length of hospitalization using the Cox proportional hazards test and Kruskal-Wallis test, and an approach to the frequency of adverse events, issues for which no previous national data have been published. RESULTS: Eight of the 44 outbreaks were associated with contaminated commercial foods involving ≤7 cases/outbreak; preserved vegetables were the main source of infection, followed by fish products; early antitoxin administration significantly reduces the hospital stay, and adverse reactions to the antitoxin affect around 3% of treated cases.

Human Botulism in France, 1875-2016.

Botulism is a rare but severe disease which is characterized by paralysis and inhibition of secretions. Only a few cases had been reported at the end of the 19th century in France. The disease was frequent during the second world war, and then the incidence decreased progressively. However, human botulism is still present in France with 10-25 cases every year. Food-borne botulism was the main form of botulism in France, whereas infant botulism (17 cases between 2004 and 2016) was rare, and wound and inhalational botulism were exceptional. Type B was the prevalent botulism type and was mainly due to consumption of home-made or small-scale preparations of cured ham and to a lesser extent other pork meat products. In the recent period (2000-2016), a wider diversity of botulism types from various food origin including industrial foods was reported. Severe cases of type A and F botulism as well as type E botulism were more frequent. Albeit rare, the severity of botulism justifies its continued surveillance and recommendations to food industry and consumers regarding food hygiene and preservation practices.

Food-borne botulism in Apulia region, Italy: an expert witness testimony.

We report the epidemiology of food-borne botulism in Puglia, Italy, between 1977-2017, using surveillance data and Experts' personal observations. As the disease is rare, the diagnosis is often missed or delayed, and cases are initially misdiagnosed. This was the case of a family outbreak of botulism in the 1970s.

Complete paralytic botulism mimicking a deep coma in a child.

Botulism is a rare cause of neuroparalysis. Delay in diagnosis and treatment exerts adverse impact on mortality and morbidity. We report a child with complete flaccid paralysis followed by progression to coma-like consciousness. The patient required mechanical ventilation. As serological tests could not be performed, detailed history and physical examinations led to the suspicion of botulism, and repetitive nerve stimulation tests supported the diagnosis. Botulinum antitoxin was administered. The patient`s neuromuscular function improved rapidly.

Hemagglutinin gene shuffling among Clostridium botulinum serotypes C and D yields distinct sugar recognition of the botulinum toxin complex.

Clostridium botulinum strains produce a large-sized toxin complex (TC) that is composed of botulinum neurotoxin (BoNT), non-toxic non-hemagglutinin and three different hemagglutinins (HA-70, HA-33 and HA-17). HA components enhance toxin delivery across the intestinal cell wall in a sugar chain-dependent manner. Here we characterized the sugar recognition of serotype D strain 1873 (D-1873) botulinum L-TC. Most L-TCs produced by serotype C and D strains bind to cells via interactions between HA-33 and cell surface sialo-oligosaccharides. However, like the previously reported L-TC produced by serotype C strain Yoichi (C-Yoichi), D-1873 L-TC binds only to cells that have been treated with neuraminidase, indicating that they recognize asialo-oligosaccharides. The D-1873 HA-33 amino acid sequence is similar to that of C-Yoichi, but had lower similarity to the majority of serotype C and D HA-33s. A comparison of TC component primary structures for 12 serotype C and D strains suggested that at least three types of HA-33 genes exist, and these are shuffled among the serotype C and D strains independently of BoNT serotype. This shuffling produces the distinct sugar recognition of serotype C and D botulinum TCs.

Botulism with Unusual Rapid Progression to Complete Paralysis in a Child.

Botulism is a severe neuroparalytic illness which is difficult to diagnose accurately, especially in children. We report a child with type A botulism intoxication, with very rapid progression to coma-like consciousness and respiratory failure. Careful physical examinations led to the suspicion of botulism, and electrophysiologic examinations, including electroencephalogram and repetitive nerve stimulation tests, further supported the diagnosis. Hospitalization due to botulism had a great emotional impact on the patient and psychological support was crucial.

Food-borne botulism in Japan in March 2012.

In March 2012, two patients were transported urgently to the hospital in Tottori Prefecture, Japan, because of symptoms suggestive of botulism. Botulinum neurotoxin type A was detected in the clinical specimens and the food consumed by the two patients (vacuum packed adzuki-batto, a sweet adzuki bean soup containing noodles). We were able to make a prompt diagnosis of food botulism associated with the consumption of adzuki-batto, from which the causative pathogen Clostridium botulinum Ab was cultured.

Honey pacifier use among an indigent pediatric population.

BACKGROUND: Use of honey pacifiers by infants presenting to a pediatric clinic at a county hospital in Houston, Texas, was observed by several of our staff members. Although we could not find any published studies linking the use of honey pacifiers to infant botulism, we also could not find any studies assessing the prevalence of honey pacifier use in general. METHODS: We conducted a cross-sectional, descriptive study using a novel survey that had 19 items. The survey was administered to the parents of children up to age 12 months presenting to a county hospital pediatric clinic for well-child care in Houston, Texas, from February 2010 to April 2011. RESULTS: There were 397 respondents. Approximately 11% of the respondents reported using honey pacifiers with their infant children. Reasons for use included tradition, infant preference, and perceived health benefits (eg, helps with constipation or colic). Approximately 20% of the honey pacifier users and 23% of the entire group reported knowledge of honey potentially causing an illness in children <12 months of age. Nearly 40% of all respondents also reported using herbal or folk remedies. CONCLUSIONS: Honey pacifier use was relatively common among this population, seen in ∼1 out of 10 respondents. A majority of the mothers surveyed (∼80%) were unaware of the potential dangers of giving honey to infants under age 12 months. Herbal medicine use was also common.