Intestinal Toxemia Botulism in Two Young People, Caused by Clostridium butyricum Type E
From the Food Microbiology Laboratory, National Reference Center for Botulism, Istituto Superiore della Sanità, Rome, Italy
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.
Received 7 May 1998; revised 3 August 1999.
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See commentary by Schechter and Arnon on pages 1388–93.
Presented in part: Interagency Botulism Research Coordinating Committee Meeting, Centers for Disease Control and Prevention, Atlanta, GA, 13–15 November 1995.