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![Reported botulism cases in the U.S. from 2001–2018. (a) Graph depicts the number of cases of each type of botulism, demonstrating the prevalence of infant botulism compared to other clinical types. (b) Shows the causative toxin type of reported cases if specified. All data obtained from the CDC national botulism surveillance annual summaries [110].](publication/376112207/figure/fig2/AS:11431281257177417@1719592872148/Reported-botulism-cases-in-the-US-from-2001-2018-a-Graph-depicts-the-number-of-cases.jpg)
Reported botulism cases in the U.S. from 2001–2018. (a) Graph depicts the number of cases of each type of botulism, demonstrating the prevalence of infant botulism compared to other clinical types. (b) Shows the causative toxin type of reported cases if specified. All data obtained from the CDC national botulism surveillance annual summaries [110].
Source publication
Clostridium botulinum, a polyphyletic Gram-positive taxon of bacteria, is classified purely by their ability to produce botulinum neurotoxin (BoNT). BoNT is the primary virulence factor and the causative agent of botulism. A potentially fatal disease, botulism is classically characterized by a symmetrical descending flaccid paralysis, which is left...
Citations
... These symptoms can include dysphagia, muscle weakness, diplopia, ptosis, blurred vision, slurred speech, respiratory distress or failure, and ocular palsy. Despite the characteristic features of botulism, including symptoms that typically begin in the cranial nerves, consistent descending progression, symmetry, and absence of sensory nerve dysfunction, it is frequently misdiagnosed as Guillain-Barre syndrome, Miller-Fisher syndrome, myasthenia gravis, or other central nervous system diseases [1,2,7]. ...
Background
Botulism has not been previously reported in the Kingdom of Saudi Arabia. This rare and sometimes fatal foodborne illness is caused by neurotoxins and primarily results from consuming home-canned fruits, vegetables, dairy, and seafood products & it can lead to paralysis.
Objective
The purpose of this study was to evaluate the clinical features of patients who developed botulism in Riyadh in 2024 after consuming mayonnaise from a well-known local chain of restaurants in Riyadh, Saudi Arabia.
Methods
We conducted a retrospective analysis of medical records and interviewed patients or their attendants for all hospitalized cases of foodborne botulism at Riyadh First Health Cluster. For each patient, a standard case report form was completed, containing information on demographics, clinical aspects, botulinum test results, and type of exposure. Descriptive statistics were applied to assess the data. During the outbreak, nineteen patients with foodborne diseases were admitted to Riyadh First Health Cluster Hospitals. Following thorough physical examinations, botulism was suspected in each case.
Results
Eight of the 19 suspected foodborne illness patients fully satisfied the botulism case definition requirements set forth by the Saudi Arabian Public Health Authority (Weqaya). Among these eight patients, 2 (25%) were male and 6 (75%) were female, with a mean age of 23.25 ± 9.29 years (range: 12–38 years). The incubation period for our patients was 36.25 ± 26.26 h. Notable symptoms included dysphagia in all eight patients (100%), dysarthria, generalized weakness, nausea and vomiting in seven patients (88%), diplopia in four patients (50%), and stomach discomfort in three patients (38%). Of the eight cases, six required intubation, one mimicked brain death, and two were stable. The presence of Clostridium botulinum spores as the cause of the outbreak was confirmed by detecting botulinum spores in contaminated food.
Conclusion
Diplopia and dysarthria were the most common early sign of botulism. Early manifestations may include respiratory symptoms without any musculoskeletal symptoms. or nausea, vomiting and disorientation.
... O botulismo é uma doença causada pela bactéria anaeróbica grampositiva Clostridium botulinum, produtora de neurotoxina que impede a liberação pré-sináptica de acetilcolina da junção neuro-muscular, causando uma síndrome neuroparalítica, e potencialmente fatal, uma vez que pode levar à morte por paralisia da musculatura respiratória, devendo ser tratada como uma emergência médica (Rawson et al., 2023;Cereser et al., 2008). ...
... O botulismo de origem alimentar ocorre através da ingestão de toxinas em alimentos produzidos ou conservados de maneira inadequada, sendo esta a mais frequente; o botulismo causado por contaminação da pele, apesar de raro, pode acontecer em casos de ferimentos profundos, produzidos por esmagamento de membros ou agulhas compartilhadas por usuários de drogas injetáveis e até como consequência de lesões nasais destrutivas em usuários de drogas inalatórias; na forma intestinal do adulto, a produção e absorção de toxinas liberadas de esporos contidos em alimentos contaminados se multiplicam no intestino, muitas vezes devido a uma alteração da microbiota intestinal, causada pelo uso prolongado de antibióticos ou no caso de doenças inflamatórias intestinais, como a Doença de Crohn. O botulismo infantil é do tipo intestinal e tem como principal causa a ingestão de mel de abelha nas primeiras semanas de vida (Rawson et al., 2023;Cereser et al., 2008). ...
... O botulismo é caracterizado por um conjunto de sinais e sintomas neurológicos, de início inespecífico, que progride para paralisia de nervos cranianos, com evolução para enfraquecimento descendente simétrico do tronco, extremidades e músculo liso, desencadeando uma paralisia flácida e simétrica. O botulismo é uma doença grave considerada uma emergência médica e de saúde pública, devido a sua súbita ocorrência de manifestações neurológicas, o que eleva de maneira dramática a mortalidade, em sua maioria devido a insuficiência respiratória (Brasil, 2019;Rawson et al., 2023;Cereser et al., 2008). O presente estudo teve como objetivo identificar características clínicoepidemiológicas do botulismo associadas à população pediátrica quando comparada com a população adulta com o mesmo diagnóstico. ...
O botulismo é uma doença causada pela bactéria Clostridium botulinum, que produz uma neurotoxina levando a sintomas neurológicos graves. Foram documentadas quatro formas de botulismo, sendo a alimentar a mais comum. A confirmação do diagnóstico é feita por testes laboratoriais. O estudo buscou identificar as características do botulismo na população pediátrica em comparação com adultos. O estudo utilizou dados do SINAN-DATASUS referentes a casos de botulismo no Brasil de 2007 a 2022, extraídos por meio de script em linguagem R. Variáveis como sintomas, exposição alimentar e desfechos foram analisadas. As análises estatísticas incluíram o teste qui-quadrado de Pearson para associações e regressão logística para ajustar fatores associados. O desfecho considerou grupos etários (pediátrico e adulto). Foram observados 99 casos de botulismo no Brasil, sendo a maioria em adultos. As manifestações clínicas comuns em adultos incluem tontura (70,37%), visão turva (66,67%) e disfagia (65,38%), enquanto em crianças são fraqueza dos membros superiores e inferiores (82,35%), ptose palpebral (70,59%) e fraqueza simétrica (68,75%). No aspecto neurológico, adultos apresentam diplopia (63,29%) e parestesia (28,00%), enquanto crianças têm mais fraqueza dos membros (82,35%) e ptose palpebral (70,59%). A hospitalização foi prevalente em adultos (93,83%) e crianças (100%), com taxas de cura em crianças mais altas (93,33%). A suspeita de transmissão alimentar foi comum em adultos (96,05%) e crianças (94,12%), sendo a exposição caseira mais comum em crianças e a forma industrial em adultos. O estudo revelou diferenças nas manifestações clínicas e desfechos do botulismo entre a população pediátrica e adulta. Os sintomas mais comuns foram tontura, visão turva e disfagia em adultos, e fraqueza de membros em crianças. A principal origem da doença foi a causa alimentar por ingestão de produtos industrializados.
... The main concern regarding honey is that it can contain Clostridium botulinum spores. Those spores are capable of causing infant botulinum (botulism case) in babies under 12 months old [21], whose gut flora are not yet fully developed and, thus, allow the spores to proliferate and produce botulinum toxin. However, the digestive system of a healthy adult does not support the germination of spores, and it is adept at handling these spores they are passed through our body and are excreted [22]. ...
Breast milk serves as the primary source of nourishment for newborns. In cases of low milk production, one approach to address this challenge involves the consumption of lactagogues. Chicken–herb essence, a beverage rich in protein, amino acids, and minerals, presents itself as a viable option to supplement a lactating mother’s diet, particularly in terms of protein intake. This study aimed to evaluate the effects of chicken–herb essence on prolactin and lactoferrin in lactating rats. Furthermore, the study also assessed the lactagogue effect on IgA in offspring. The experimental research method used a completely randomized design. The animal models in this study were female Sprague Dawley rats. The result showed that there was an increase in milk production, as seen from the results of the lactagogue effect. The highest increase in prolactin and lactoferrin was obtained in treatment group II (TG II). The increases in prolactin and lactoferrin of TG II were 214.18 ± 71.99 and 904.02 ± 435.35 pg/mL, respectively. The lactagogue test showed that TG II haspotency as a milk-booster. Testing the blood serum of offspring showed that the highest concentration of IgA was also found in TG II at 398.34 ± 214.85 pg/mL.
... The spores do not germinate in older children because of gastric acidity. Infants younger than 12 months have an immature immune system, a relative lack of gastric acidity, and diminished bacterial flora, which increases the risk of botulism [18]. The source of the spores is usually unknown, but some cases have been attributed to the ingestion of honey that may contain the spores of this germ. ...
Cough is a common presenting symptom for patients in a primary care setting and significantly impacts a patient’s quality of life. Cough involves a complex reflex arc beginning with the stimulation of sensory nerves that function as cough receptors that stimulate the cough center in the brain. This “cough center” functions to receive these impulses and produce a cough by activating efferent nervous pathways to the diaphragm and laryngeal, thoracic, and abdominal musculature. Drugs that suppress the neural activity of cough are non-specific as those treatments are not directed toward pathogenic causes such as inflammation and oxidative stress. Moreover, they block a reflex called the watchdog of the lung and have a defense mechanism. Acute respiratory infections of the upper and lower airways most commonly cause acute cough. In contrast, the most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease, all associated with an inflammatory reaction at the level of the cough receptors. The use of natural compounds or herbal drugs such as carob syrup, dry blackcurrant extract, dry extract of caraway fruit, dry extract of ginger rhizome, dry extract of marshmallow root, and dry extract of ivy leaves, to name a few, not only have anti-inflammatory and antioxidant activity, but also act as antimicrobials, bronchial muscle relaxants, and increase gastric motility and empty. For these reasons, these natural substances are widely used to control cough at its deep roots (i.e., contrasting its causes and not inhibiting the arch reflex). With this approach, the lung watchdog is not put to sleep, as with peripheral or central inhibition of the cough reflex, and by contrasting the causes, we may control cough that viruses use at self-advantage to increase transmission.
... The C. botulinum spores, which are metabolically latent, are widespread in the environment and are highly resistant to various environmental conditions, allowing their persistence in unfavorable conditions. Under anaerobiosis conditions, the spores can germinate and subsequently release the neurotoxin (BoNT) [2,3]. Regarding their antigenicity, there are seven known types of BoNT (designated from A to G) and several subtypes. ...
... The action of the toxin takes place at the presynaptic level, blocking the release of acetylcholine at the neuromuscular junction level [1,2]. Thus, the clinical picture of the disease includes symmetrical descending flaccid paralysis with a risk of respiratory failure, while in some particularly severe cases it can result in the death of the patient [3,5]. Six clinical forms of the disease have been described, with the most important being foodborne botulism. ...
Botulism is a priority disease worldwide because it has a very severe course of evolution that can lead to death. This paper aims to describe the main epidemiological characteristics of botulism cases confirmed in Romania over 14 years (2007–2020). We performed a retrospective study using the publicly available national surveillance data and reported to the National Institute of Public Health. A total of 325 cases of foodborne botulism were reported in Romania, with no infant or wound botulism. Most of the cases (125, 38.5%) were reported among young adults (25–44 years old), over half (205, 63%) of them living in rural areas. The incriminated food item was identified in 161 cases; in most cases (145, 90%) the food item was prepared in the household. The main food category was represented by meat and meat-based products (94, 68.6%). In almost all cases the identified type was BoNT/B (230/231, 99.5%). Fifteen deaths were recorded, and the case fatality rate was 4.6%. Botulism cases were reported annually in Romania. Surveillance data are essential for implementing control measures and adapting educational campaigns according to existing needs.
... Often, these preserves are made from selfproduced raw materials and traditional recipes, frequently reducing the quantity of natural preservatives commonly used in homemade preserves (sugar, salt, vinegar, and lemon juice). 4 Therefore, the prevention and control of foodborne botulism rely on meticulous adherence to food safety rules both at the industrial and domestic levels. ...
... Clostridium botulinum is a Gram-positive, anaerobic bacterium that forms endospores and is responsible for botulism, a severe neuroparalytic disease affecting humans and vertebrate animals. 3,4 The etiology of botulism lies in the neurotoxin produced by Clostridium. [5][6][7] It is a metalloprotease capable of cleaving the proteins of the receptor for the N-ethylmaleimide-sensitive factor (SNARE) attachment protein in nerve terminals, preventing neurotransmitter release and blocking neural transmission to effector muscles. ...
... [19][20][21][22] Human botulism is characterized by bilateral descending muscle weakness, with symptoms generally starting in the cranial nerves, presenting as blurred or double vision, dry mouth, and difficulty speaking. 4 The classic early physical presentation of botulism can be remembered using the "four Ds": dysarthria, diplopia, dysphonia, and dysphagia. As the neurotoxin spreads, muscle weakness occurs, which if left untreated, can reach the respiratory muscles, causing respiratory failure and death. ...
Clostridium botulinum has become one of the most well-known microorganisms in medical history, thanks to both fatal botulism epidemics and the recent medical use of botulinum neurotoxin. It is a Gram-positive, anaerobic, spore-forming bacterium that causes classic foodborne botulism, infant botulism, wound botulism, and intestinal colonization botulism, a serious neuroparalytic disease. The most common type of botulism is foodborne botulism, which is caused by eating botulinum toxin-contaminated foods. Just a few micrograms of toxin are enough to cause symptoms and, if untreated, death. Rapid diagnosis of the condition is critical to avoiding fatal outcomes. This article describes a clinical case of a patient who presented to us in June with typical symptoms of botulism. Early clinical diagnosis is based on a thorough medical history, including a meticulous reconstruction of the patient's food history in the days preceding symptom onset, as well as a careful physical examination, which can be highly suggestive of botulinum intoxication. Botulism treatment consists of symptom control, mechanical respiratory support, and Botulinum Antitoxin (BAT) administered intravenously. Epidemiological investigation is critical for quickly identifying the food vehicle causing the intoxication.
... Clostridium botulinum is a species of bacteria from the Clostridiaceae family, which comprises more than 150 species, of which fewer than 20 are pathogenic [7]. These bacteria can be classified according to the mode and site of action of their toxins into several groups, among which the following stand out: histotoxic clostridia, enteropathogenic clostridia and producers of enterotoxaemia, as well as neurotoxic clostridia [8]. This Gram-positive bacillus is characterised by being large in size and having mobility thanks to its peritrichous flagella ( Figure 2) [9]. ...
... Clostridium botulinum is a species of bacteria from the Clostridiaceae family, which comprises more than 150 species, of which fewer than 20 are pathogenic [7]. These bacteria can be classified according to the mode and site of action of their toxins into several groups, among which the following stand out: histotoxic clostridia, enteropathogenic clostridia and producers of enterotoxaemia, as well as neurotoxic clostridia [8]. This Grampositive bacillus is characterised by being large in size and having mobility thanks to its peritrichous flagella ( Figure 2) [9]. ...
Avian botulism caused by Clostridium botulinum emerged in 1910, affecting birds across North America, leading to severe outbreaks exacerbated by climate change, decreasing water levels, and inadequate wastewater management. While deadly for birds, its epidemiological impact on humans and other animals remains limited. Despite its significance, understanding and controlling the disease remain challenging. This review delves into the pathogen’s epidemiology in wild bird populations, exploring the transmission, pathogenicity, clinical symptoms, diagnosis and treatment. The disease’s growing concern in wild birds relates to the bacterium’s adaptability and expansive spread, evident through genetic similarities among strains across countries. Outbreaks are influenced by environmental factors such as temperature and soil characteristics. Wild birds inadvertently transmit the bacterium, perpetuating the cycle through carcasses and flies. Some species suffer severely, while others, like scavengers, show resistance. Understanding disease mechanisms, involving potential toxin ingestion or internal production, remains ongoing. Clinical signs vary, affecting diverse bird orders. Diagnostic methods evolve, with treatment success varying among affected populations. Prevention and surveillance take precedence due to treatment challenges, emphasising population-based strategies and preventive measures to manage the widespread presence of C. botulinum.
... There are three main kinds of botulism [1,2,10]. Foodborne botulism is the best-known type when foods containing low-acid preservation of vegetables, canned tuna, fermented, salted and smoked fish, as well as meat products like ham and sausage, have all been linked to botulinum toxin in different parts of the world [10]. ...
... About 20% of botulism cases involve honey or corn syrup [12]. Other sources of spores have originated from contaminated powdered baby formula and household dust [1]. Wound botulism a rare infection occurs when the bacterium enters an open wound and releases the neurotoxin. ...
... The condition can advance to cause weakness in the neck and arms before affecting the respiratory muscles and lower body muscles [10]. Substance misuse has also been linked to this condition, especially when injecting black tar heroin [1,10]. ...
... Comparative and pan-genome analyses of C. tetani isolates have been conducted (13,14). However, limited data are available regarding C. tetani isolate genomic diversity within specific countries or global regions (11,12,15,16). To date, C. tetani isolates have been categorized into two clades, clades 1 and 2 (14), with clade 1 strains being more prevalent globally. ...
Clostridium tetani is the etiological agent of the disease tetanus, resulting in various symptoms, including neck tension, tongue-twisting, a decline in walking ability, and death in severe cases. To date, publicly available genome sequences of C. tetani are limited. C. tetani was isolated from soil in Kumamoto Prefecture, Japan, between 2020 and 2022. Subsequently, bacteriological, biochemical, genetic, and immunological tests were conducted. Among the 46 soil sampling sites, 151 C . tetani strains were isolated from 33 sites, with a 71.7% positivity rate. Comparative genomic analysis subdivided clade 1 into clades 1-1, 1-2, and 1-3. The enzyme-linked immunosorbent assay revealed that partial clade 1-3 strains produced over sevenfold more tetanus neurotoxin (TeNT) than the reference strain (first isolate of C. tetani KHSU-154301-001). RNA-Seq analysis supported this elevated tetanus toxin tetX gene expression. Additionally, tetX -negative strains were isolated from the clade, indicating that TeNT may not be essential for ensuring the survival of their offspring without its representative toxin-causing tetanus. Five strains acquired the tetracycline resistance gene tet (M) in the tetX plasmid, resulting in significantly reduced susceptibility to tetracycline. In conclusion, although we investigated C. tetani isolates from a specific region of the Kumamoto Prefecture, we demonstrated that these isolates exhibit variable genomic features, toxin productivity, and substantial acquired antimicrobial resistance. These findings indicate that multiple C. tetani lineages have successfully adapted to the soil in Japan, as evidenced by the additional genome information and toxin productivity assays in this study.
IMPORTANCE
C. tetani is a spore-forming, anaerobic bacterium that produces a toxin causing muscle stiffness and paralysis. Tetanus is preventable with the toxoid vaccine, but it remains a significant public health threat in regions with low vaccine coverage. However, there are relatively few isolates and limited genomic information available worldwide. In Japan, about 100 cases are reported each year, but there have been no nationwide surveys of isolates, and no genomic information from Japanese isolates has been published. In our study, we analyzed the genomes of 151 strains from a limited survey of soil in Kumamoto, Japan. Our findings revealed a high degree of genetic diversity, and we also identified a subset of strains that produced significantly more toxin, which provides new insights into the pathogenesis of tetanus. Our findings lay the foundation for future studies to investigate the distribution and evolution of C. tetani in Japan and neighboring countries.
... After the disease develops, its treatment is problematic and mortality is high. Treatment includes trivalent or heptavalent equine botulinum antitoxin plus intensive care support, but even available between 5% and 10% of patients with food-borne botulism die (1,3,12,13). ...
... They may come from contami nated soil and dust from nearby construction sites, via the consumption of powdered milk, natural sweeteners, corn syrup, or medicinal herbs. The real impact of infant botulism is likely underestimated worldwide given diagnostic difficulties and the condition's non-specific presentation (12,13). At the time of the present study, iatrogenic botulism caused by the therapeutic use of BoNT (for the treatment of spasticity, focal dystonia, hemifacial spasm, hyperhydrosis, strabismus, chronic migraine, and cosmetic) was unreported. ...
To determine whether the neurotoxin BoNT/B2 causing botulism in Spain is clonal, the genetic diversity and phylogenetic relationships of Clostridium botulinum from food-borne episodes and infant cases of the condition were explored. The botulinum toxin gene ( bont ) subtype, the variable region of the flagellin gene ( fla VR), and a seven-gene multi-locus sequence type were examined by sequencing 37 BoNT-positive cultures obtained over the period 2010 to 2022. Out of 37 botulism events, 16 food-borne episodes and 16 infant cases were associated with bont/b 2. Eight bont/b 2 alleles were detected [nucleotide distance range 0.0259–0.415%, Hunter and Gaston discrimination index (HGDI) 0.71]. The most common bont/b 2 allele corresponded to that of strain Prevot 25 NCASE and its single and double locus variations (87.5%). Four known fla VR types were identified (HGDI 0.79), along with one previously unknown ( fla VR-15). Sixteen sequence types (STs) (HGDI 0.89) were recorded including seven new STs (ST164–ST170; 10 new alleles) and five new STs (ST171–ST175; with new allele combinations) were also noted. Correlations among some STs and fla VR types were seen. Overall, the present results show that the combined analysis of bont/b 2- fla VR-ST at the nucleotide level could be used to track botulism events in Spain. The neurotoxin BoNT/B2 has largely been responsible for human botulism in Spain. The polymorphism analysis of bont/b2 , fla VR typing, and sequence type determinations, revealed a wide variety of clones to be responsible for human botulism, ruling out a common source of acquisition.
IMPORTANCE
Botulism, a potentially fatal disease, is classically characterized by a symmetrical descending flaccid paralysis, which if left untreated can lead to respiratory failure and death. Botulinum neurotoxin (BoNT), produced by certain species of Clostridium, is the most potent biological toxin known, and the direct cause of botulism. This study characterizes the acquisition in Spain of two forms of botulism, i.e., food-borne and infant botulism, which are largely caused by the main neurotoxin BoNT/B2. Polymorphism analysis of the bont/b2 gene, typing of the flagellin variable region sequence (flaVR), and multilocus sequence typing, were used to explore the genetic background of Clostridium botulinum group I. To our knowledge, this is the first phylogenetic and typing study of botulism undertaken in Spain.
