Adult botulism type F in the United States, 1981-2002.
BACKGROUND
Clostridium botulinum neurotoxin types A, B, and E cause most cases of the paralytic disease botulism. Little is known about the epidemiology, clinical features, or microbiology of botulism type F.


METHODS
Cases of adult type F botulism were identified by review of data collected by CDC's National Botulism Surveillance System between 1981 and 2002. A case was either an individual whose serum or stool demonstrated type F toxin or whose stool culture yielded an organism producing toxin type F. A detailed review of cases' medical charts and laboratory data from CDC and local health departments was performed.


RESULTS
Between 1981 and 2002, 1,269 cases of botulism among adults and infants were reported to CDC; 13 (1%) were adult type F. The median age of type F cases was 54 years; 7 (54%) were female. None were part of outbreaks. A toxigenic Clostridium baratii was identified in 9 (69%) of 13 cases. Among 11 cases for which clinical data were available, all required mechanical ventilation for a median duration of 17 days (range, 10 to 84); 8 (73%) were intubated within 24 hours of symptom onset. All patients had nearly complete or complete quadriplegia at the nadir of neurologic dysfunction, which occurred on average on day 5. On average by day 8, improvement in neuromuscular function was noted. The median duration of acute hospitalization was 31 days (range, 20 to 60). No deaths were reported. In only one case was a possible foodborne etiology identified.


CONCLUSIONS
Toxigenic C baratii are the sole documented causes of type F botulism in the United States since 1981. These cases are characterized by a fulminant course with rapid progression to respiratory failure and paralysis, making early recognition and intervention critical to appropriate management.
Gupta
A
A
Division of Applied Public Health Training, Epidemiology Program Office, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA. agupta25@jhmi.edu
Sumner
C J
CJ
Castor
M
M
Maslanka
S
S
Sobel
J
J
D000328:Adult; D001426:Bacterial Proteins; D001905:Botulinum Toxins; D001906:Botulism / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology*; D003013:Clostridium / Q000502:physiology; D018450:Disease Progression; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011782:Quadriplegia / Q000453:epidemiology / Q000382:microbiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000382:microbiology; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D001426:Bacterial Proteins; C081095:Clostridium barati F toxin; D001905:Botulinum Toxins; C096321:botulinum toxin type F