title: Intestinal toxemia botulism in two young people, caused by Clostridium butyricum type E.
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.
authors.affiliation: Food Microbiology Laboratory, National Reference Center for Botulism, Istituto Superiore della Sanità, 00161 Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Fenicia
authors.forename: G
authors.initials: G
authors.lastname: Franciosa
authors.forename: M
authors.initials: M
authors.lastname: Pourshaban
authors.forename: P
authors.initials: P
authors.lastname: Aureli
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000032:analysis; D002648:Child; D003013:Clostridium / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D008297:Male; D008826:Microbial Sensitivity Tests; D014115:Toxemia / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000900:Anti-Bacterial Agents; D001905:Botulinum Toxins; C096326:botulinum toxin type E