title: Fatal outbreak of botulism in Greenland.
abstract: Botulism commonly occurs when the anaerobic, gram-positive bacterium Clostridium botulinum, under suitable conditions, produces botulinum neurotoxins. Named A-F, these toxins are the immediate causative agent of the clinical symptoms of symmetrical, descending neurological deficits, including respiratory muscle paralysis. We present five cases of foodborne botulism occurring in Greenland, two with fatal outcome, caused by ingestion of tradionally preserved eider fowl. In the cases of the survivors, antitoxin and supportive care, including mechanical ventilation, were administered. In these cases recovery was complete. Microbiological assays, including toxin neutralization bioassay, demonstrated the presence of neurotoxin E in two survivors. The third survivor was shown by PCR to have the BoNT type E gene in faeces. This is the first report of cases of fatal botulism in Greenland. It underscores the importance of prompt coordinated case management effort in a geographically isolated area such as Greenland.
authors.affiliation: From the 1 Department of Internal Medicine.
authors.forename: Tóra Hedinsdottir
authors.initials: TH
authors.lastname: Hammer
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.forename: Jakob
authors.initials: J
authors.lastname: Kanstrup
authors.forename: Vibe Cecilie
authors.initials: VC
authors.lastname: Ballegaard
authors.forename: Anne
authors.initials: A
authors.lastname: Kjerulf
authors.forename: Allan
authors.initials: A
authors.lastname: Gelvan
mesh_terms: D000328:Adult; D000818:Animals; D001717:Birds / Q000382:microbiology; D001904:Botulinum Antitoxin / Q000627:therapeutic use; D001905:Botulinum Toxins / Q000235:genetics / Q000302:isolation & purification / Q000633:toxicity*; D001906:Botulism / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D002675:Child, Preschool; D003014:Clostridium botulinum / Q000302:isolation & purification*; D004196:Disease Outbreaks; D017809:Fatal Outcome; D005243:Feces / Q000382:microbiology; D005260:Female; D005516:Food Microbiology; D006116:Greenland; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012121:Respiration, Artificial
chemical_list: D001904:Botulinum Antitoxin; D001905:Botulinum Toxins; C096326:botulinum toxin type E
keywords: Botulism; Clostridium botulinum; antitoxin; botulinum; neurotoxin