Intestinal toxicoinfection by Clostridium botulinum type F in an adult. Case associated with Guillain-Barré syndrome.

A 27-year-old man with type F botulism (classification undetermined) had two episodes of botulinum toxaemia with identification of botulinum toxin and Clostridium botulinum organisms in faecal specimens during a three-month stay in hospital. Between these clinical episodes neither toxin nor Cl botulinum could be demonstrated. The illness was severe with quadriplegia, respiratory insufficiency, and bowel paralysis. In addition the patient had sensory abnormalities and a raised protein in the cerebrospinal fluid. The results demonstrate for the first time in detail an intestinal colonisation with and multiplication of C botulinum organisms and in-vivo production of toxin in an adult. The clinical findings at first pointed to Guillain-Barré syndrome, and it is suggested that patients with this syndrome should be examined for botulinum toxin in serum and for toxin and organisms in stool.

Continuous microbiological and pathological study of 70 sudden and unexpected infant deaths: toxigenic intestinal clostridium botulinum infection in 9 cases of sudden infant death syndrome.

As part of a programme to exclude infection as the cause of death in infants who died suddenly and unexpectedly necropsies were carried out on 70 such infants. In 11 cases (15%), a pathological diagnosis could be made at necropsy; in 9 of these, causative bacteria or viruses were found. The 59 cases in which the cause of death could not be found had histological features characteristic of sudden infant death syndrome (SIDS). Botulinum toxin was found in 9 SIDS cases (15%). 8 of these infants had botulinum toxin and organisms of different types (A, B, C, F, G) in the contents of the ileojejunum or colon. 4 of them also had toxin in the serum. No botulinum toxin or organisms were found in the 11 infants who died of identified causes or 18 other infants who died in hospital of known causes.