title: Infant botulism due to C. butyricum type E toxin: a novel environmental association with pet terrapins.
abstract: We describe two cases of infant botulism due to Clostridium butyricum producing botulinum type E neurotoxin (BoNT/E) and a previously unreported environmental source. The infants presented at age 11 days with poor feeding and lethargy, hypotonia, dilated pupils and absent reflexes. Faecal samples were positive for C. butyricum BoNT/E. The infants recovered after treatment including botulism immune globulin intravenous (BIG-IV). C. butyricum BoNT/E was isolated from water from tanks housing pet 'yellow-bellied' terrapins (Trachemys scripta scripta): in case A the terrapins were in the infant's home; in case B a relative fed the terrapin prior to holding and feeding the infant when both visited another relative. C. butyricum isolates from the infants and the respective terrapin tank waters were indistinguishable by molecular typing. Review of a case of C. butyricum BoNT/E botulism in the UK found that there was a pet terrapin where the infant was living. It is concluded that the C. butyricum-producing BoNT type E in these cases of infant botulism most likely originated from pet terrapins. These findings reinforce public health advice that reptiles, including terrapins, are not suitable pets for children aged <5 years, and highlight the importance of hand washing after handling these pets.
authors.affiliation: Public Health Department,Health Service Executive,Dublin,Ireland.
authors.forename: E B
authors.initials: EB
authors.lastname: Shelley
authors.affiliation: Department of Neurology,Children's University Hospital,Temple Street,Dublin,Ireland.
authors.forename: D
authors.initials: D
authors.lastname: O'Rourke
authors.affiliation: Gastrointestinal Bacteria Reference Laboratory,Public Health England,Colindale,London,UK.
authors.forename: K
authors.initials: K
authors.lastname: Grant
authors.affiliation: Public Health Department,Health Service Executive,Dublin,Ireland.
authors.forename: E
authors.initials: E
authors.lastname: McArdle
authors.affiliation: Department of General Paediatrics,Children's University Hospital,Temple Street,Dublin,Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Capra
authors.affiliation: Public Health Department,Health Service Executive,Dublin,Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Clarke
authors.affiliation: Public Health Laboratory, Cherry Orchard Hospital,Dublin,Ireland.
authors.forename: E
authors.initials: E
authors.lastname: McNamara
authors.affiliation: Department of Microbiology,Children's University Hospital,Temple Street,Dublin,Ireland.
authors.forename: R
authors.initials: R
authors.lastname: Cunney
authors.affiliation: Health Protection Surveillance Centre,Dublin,Ireland.
authors.forename: P
authors.initials: P
authors.lastname: McKeown
authors.affiliation: Gastrointestinal Bacteria Reference Laboratory,Public Health England,Colindale,London,UK.
authors.forename: C F L
authors.initials: CF
authors.lastname: Amar
authors.affiliation: Environmental Health, Health Service Executive,Dublin,Ireland.
authors.forename: C
authors.initials: C
authors.lastname: Cosgrove
authors.affiliation: Public Health Department,Health Service Executive,Dublin,Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Fitzgerald
authors.affiliation: Environmental Health, Health Service Executive,Wicklow,Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Harrington
authors.affiliation: Health Protection Surveillance Centre,Dublin,Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Garvey
authors.affiliation: Environmental Health, Health Service Executive,Wicklow,Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Grainger
authors.affiliation: Department of Agriculture,Food and the Marine,Dublin,Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Griffin
authors.affiliation: Department of Neurology,Children's University Hospital,Temple Street,Dublin,Ireland.
authors.forename: B J
authors.initials: BJ
authors.lastname: Lynch
authors.affiliation: Environmental Health, Health Service Executive,Dublin,Ireland.
authors.forename: G
authors.initials: G
authors.lastname: McGrane
authors.affiliation: South Dublin County Council,Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Murphy
authors.affiliation: Department of Neurology,Children's University Hospital,Temple Street,Dublin,Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Ni Shuibhne
authors.affiliation: Environmental Health, Health Service Executive,Dublin,Ireland.
authors.forename: J
authors.initials: J
authors.lastname: Prosser
mesh_terms: D000818:Animals; D001904:Botulinum Antitoxin / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000032:analysis*; D001906:Botulism / Q000175:diagnosis* / Q000473:pathology* / Q000628:therapy; D046972:Clostridium butyricum / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005243:Feces / Q000737:chemistry*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D058889:Molecular Typing; D057805:Pets; D012104:Reptiles; D016896:Treatment Outcome; D006113:United Kingdom; D014871:Water Microbiology
chemical_list: D001904:Botulinum Antitoxin; D001905:Botulinum Toxins; C096326:botulinum toxin type E
keywords: Botulism; Clostridium; public health; toxins; zoonoses