Fatal type A botulism in South Africa, 2002

Although wildfowl and domestic livestock botulism has been recognized as a problem in southern Africa, very few human cases have ever been described in the region. In late February 2002, two siblings aged eight and 12 years developed acute flaccid paralysis and died. Mouse bioassays revealed the presence of type A botulinum toxin in the serum of both children, and in the retrieved remains of the implicated food. The implicated vehicle of the toxin was tinned fish in tomato sauce, commercially produced in South Africa. Type A Clostridium botulinum was cultured from the food. The most likely scenario was that corrosion damage had allowed entry of environmental organisms, including Clostridium botulinum, to the tinned food. This is the first outbreak of human type A botulism in southern Africa to be documented, and the first fatal outbreak described; previous human cases in this region have involved type B botulinum toxin, which tends to produce milder disease. A few other outbreaks elsewhere in Africa have been published, the most extensive being a type E epidemic in Egypt. Commercially tinned products were not involved in any of those outbreaks.