title: Intestinal toxemia botulism in 3 adults, Ontario, Canada, 2006-2008.
abstract: Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41-61 days), indicative of intestinal toxemia botulism. Patients' clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient's feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.
authors.affiliation: Ministry of Health and Long-Term Care, Toronto, Ontario, Canada.
authors.forename: Yolanda D
authors.initials: YD
authors.lastname: Sheppard
authors.forename: Dean
authors.initials: D
authors.lastname: Middleton
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Whitfield
authors.forename: Felix
authors.initials: F
authors.lastname: Tyndel
authors.forename: Shariq
authors.initials: S
authors.lastname: Haider
authors.forename: Jamie
authors.initials: J
authors.lastname: Spiegelman
authors.forename: Richard H
authors.initials: RH
authors.lastname: Swartz
authors.forename: Mark P
authors.initials: MP
authors.lastname: Nelder
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Baker
authors.forename: Lisa
authors.initials: L
authors.lastname: Landry
authors.forename: Ross
authors.initials: R
authors.lastname: Maceachern
authors.forename: Sherri
authors.initials: S
authors.lastname: Deamond
authors.forename: Lorrie
authors.initials: L
authors.lastname: Ross
authors.forename: Garth
authors.initials: G
authors.lastname: Peters
authors.forename: Michelle
authors.initials: M
authors.lastname: Baird
authors.forename: David
authors.initials: D
authors.lastname: Rose
authors.forename: Greg
authors.initials: G
authors.lastname: Sanders
authors.forename: John W
authors.initials: JW
authors.lastname: Austin
mesh_terms: D001904:Botulinum Antitoxin / Q000627:therapeutic use; D001906:Botulism / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology*; D003014:Clostridium botulinum / Q000302:isolation & purification; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario
chemical_list: D001904:Botulinum Antitoxin