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Infant botulism due to C. butyricum type E toxin: a novel environmental association with pet terrapins

  • E. B. SHELLEY (a1), D. O'ROURKE (a2), K. GRANT (a3), E. McARDLE (a1), L. CAPRA (a4), A. CLARKE (a1), E. McNAMARA (a5), R. CUNNEY (a6) (a7), P. McKEOWN (a7), C. F. L. AMAR (a3), C. COSGROVE (a8), M. FITZGERALD (a1), P. HARRINGTON (a9), P. GARVEY (a7), F. GRAINGER (a9), J. GRIFFIN (a10), B. J. LYNCH (a2), G. McGRANE (a8), J. MURPHY (a11), N. NI SHUIBHNE (a2) and J. PROSSER (a8)...

Summary

We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet ‘yellow-bellied’ terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.

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Copyright

Corresponding author

* Author for correspondence: Professor E. B. Shelley, Department of Public Health, Health Service Executive, Dr Steevens Hospital, Dublin 8, Ireland. (Email: emer.shelley@hse.ie)

References

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1. Fox, CK, Keet, CA, Strober, JB. Recent advances in infant botulism. Pediatric Neurology 2005; 32: 149154.
2. Barash, JR, Arnon, SS. A novel strain of Clostridium botulinum that produces type B and type H botulinum toxins. Journal of Infectious Diseases 2014; 209: 183191.
3. Arnon, SS, et al. Human botulism immune globulin for the treatment of infant botulism. New England Journal of Medicine 2006; 354: 462471.
4. King, LA, et al. Infant botulism in France, 1991–2009. Archives of Pediatrics and Adolescent Medicine 2010; 17: 12881292.
5. Fenicia, L, Anniballi, F. Infant botulism. Annali dell'Istituto Superiore di Sanita 2009; 45: 134146.
6. Grant, KA, McLauchlin, J, Amar, C. Infant botulism: advice on avoiding feeding honey to babies and other possible risk factors. Community Practitioner 2013; 86: 4446.
7. Arnon, SS. Infant botulism. In: Feigen, RD, et al. , eds. Textbook of Pediatric Infectious Diseases, 5th edn. Philadelphia: Saunders, 2004, pp. 17581766.
8. Dezfulian, M, et al. Selective medium for isolation of Clostridium botulinum from human feces. Journal of Clinical Microbiology 1981; 13: 526531.
9. Grant, KA, et al. Report of two unlinked cases of infant botulism in the UK in October 2007. Journal of Medical Microbiology 2009; 58: 16011606.
10. Desai, M, et al. Genome sequence-based fluorescent amplified fragment length polymorphism of Campylobacter jejuni, its relationship to serotyping, and its implications for epidemiological analysis. Journal of Clinical Microbiology 2001; 39: 38233829.
11. Koepke, R, Sobel, J, Arnon, SS. Global occurrence of infant botulism 1976–2006. Pediatrics 2008; 122: e73e82.
12. Dykes, JK, et al. Laboratory investigation of the first case of Clostridium butyricum type E infant botulism in the United States. In Proceedings, 45th Interagency Botulism Research Coordinating Committee Meeting, Philadelphia, 2008; abstract P–45.
14. Abe, YT, et al. Infantile botulism caused by Clostridium butyricum type E toxin. Pediatric Neurology 2008; 38: 5557.
15. Barash, JR, Tang, TWH, Arnon, SS. First case of infant botulism caused by Clostridium baratii type F in California. Journal of Clinical Microbiology 2005; 43: 42804282.
16. Lúquez, C, et al. First report worldwide of an infant botulism case due to Clostridium botulinum type E. Journal of Clinical Microbiology 2010; 48: 326328.
17. Spika, JS, et al. Risk factors for infant botulism in the United States. American Journal of Diseases of Children 1989; 143: 828832. [Erratum in American Journal of Diseases of Children 1990; 144: 60.]
18. Novartis Vaccines and Diagnostics. (http://www.immunisation.ie/en/Downloads/pdffile_15706_en.pdf). Accessed 12 September 2014.
19. Horowitz, BZ. Type E botulism. Clinical Toxicology 2010; 48: 880895.
20. Derman, Y, et al. Infant botulism with prolonged faecal excretion of botulinum neurotoxin and Clostridium botulinum for 7 months. Epidemiology and Infection 2014; 142: 335339.
21. López, Laso E, et al. Infant botulism. Anales de Pediatría 2008; 68: 499502.
22. Nevas, M, et al. Infant botulism acquired from household dust presenting as sudden infant death syndrome. Journal of Clinical Microbiology 2005; 43: 511513.
23. Sheppard, YD, et al. Intestinal toxaemia botulism in 3 adults, Ontario, Canada, 2006–2008. Emerging Infectious Diseases 2012; 18: 16.
24. Tsukamoto, K, et al. Characterization of Clostridium butyricum neurotoxin associated with food-borne botulism. Microbial Pathogenesis 2002; 33: 177184.
25. Ghoddusi, HB, Sherburn, R. International Journal of Food Microbiology Preliminary study on the isolation of Clostridium butyricum strains from natural sources in the UK and screening the isolates for presence of the type E botulinal toxin gene. International Journal of Food Microbiology 2010; 142: 202206.
26. Chun, CL, et al. Association of toxin-producing Clostridium botulinum with the macroalga Cladophora in the Great Lakes. Environmental Science and Technology 2013; 47: 2587–94.
27. Giménez, JA, Sugiyama, H. Comparison of toxins of Clostridium butyricum and Clostridium botulinum Type E. Infection and Immunity 1988; 56: 926929.
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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