Related Experiment Videos
Intestinal toxemia botulism in two young people, caused by Clostridium butyricum type E
L Fenicia1, G Franciosa, M Pourshaban
1Food Microbiology Laboratory, National Reference Center for Botulism, Istituto Superiore della Sanità, 00161 Rome, Italy.
Insights
Two children developed type E botulism from Clostridium butyricum producing botulinum-like toxin. Meckel's diverticulum may predispose individuals to this rare intestinal toxemia.
Area of Science:
- Microbiology
- Toxicology
- Gastroenterology
Background:
- Botulism is a rare but serious paralytic illness caused by toxins produced by Clostridium botulinum.
- Type E botulism is typically associated with fish and seafood consumption.
- Unusual neurotoxigenic strains of Clostridium butyricum have been identified in Italy.
Observation:
- Two pediatric cases of type E botulism presented with abdominal pain and neurological impairment.
- Both patients underwent surgery for suspected appendicitis, revealing large Meckel's diverticula.
- Neurotoxigenic Clostridium butyricum strains, identical to Italian isolates, were found in patient feces.
Findings:
- The isolated Clostridium butyricum strains produced a botulinum-like toxin type E.
- No cytotoxic activity was observed, suggesting toxin production occurs in vivo.
- Persistent neurotoxigenic clostridia in feces indicated large intestine colonization.
Implications:
- This study highlights a rare cause of type E botulism linked to Clostridium butyricum.
- Meckel's diverticulum might be a predisposing factor for intestinal toxemia botulism.
- Further research is needed to understand the role of Meckel's diverticulum in botulism pathogenesis.
Abstract:
Two unconnected cases of type E botulism involving a 19-year-old woman and a 9-year-old child are described. The hospital courses of their illness were similar and included initial acute abdominal pain accompanied by progressive neurological impairment. Both patients were suspected of having appendicitis and underwent laparotomy, during which voluminous Meckel's diverticula were resected. Unusual neurotoxigenic Clostridium butyricum strains that produced botulinum-like toxin type E were isolated from the feces of the patients. These isolates were genotypically and phenotypically identical to other neurotoxigenic C. butyricum strains discovered in Italy in 1985-1986. No cytotoxic activity of the strains that might explain the associated gastrointestinal symptoms was demonstrated. The clinical picture of the illness and the persistence of neurotoxigenic clostridia in the feces of these patients suggested a colonization of the large intestine, with in vivo toxin production. The possibility that Meckel's diverticulum may predispose to intestinal toxemia botulism may warrant further investigation.