Wound botulism, its neurological manifestations, treatment and outcomes: A case series from the Glasgow outbreak, 2015.

Background and aims We examined the neurological manifestations, treatment and outcomes of a subset of 25 patients within the largest ever outbreak of wound botulism in Europe. Methods and results All 25 cases were intravenous drug users. The most common presenting symptom was dysarthria in 19/25 (76%), followed by dysphagia in 12/25 (48%), blurred vision in 10/25 (40%) and double vision in 8/25 (32%). Microbiological analysis confirmed the diagnosis in nine cases (36%). Duration of admission positively correlated with time to antitoxin, time to wound debridement and female sex. Conclusion As the outbreak continued, hospital stays shortened, reflecting growing awareness of the outbreak and quicker treatment initiation.

Survival of radio-marked mallards in relation to management of avian botulism.

Avian botulism outbreaks are frequently perpetuated by type C toxin produced by Clostridium botulinum proliferating in decomposing bird carcasses and consumption of toxic maggots from these carcasses by healthy birds. Therefore, removing bird carcasses has been advocated for disease management because availability of toxic maggots should be reduced, increasing duck survival. However, this management is expensive, and its effect on waterfowl mortality under field conditions is unknown. We radio-marked 419 molting mallards on 11 lakes in western Canada during July-August 1999-2001 and monitored them for 30 days, testing whether survival was higher on lakes with carcass removal. Botulism occurred on 10 lakes. On five carcass removal lakes, greater-than-normal effort was made to conduct early, thorough surveillance and immediately remove carcasses; on six nonremoval lakes, no carcasses were removed. In 1999, estimated 30-day survival probabilities ranged from 0.149 (95% CI=0.065-0.304) on one large lake with carcass removal to 0.466 (95% CI=0.270-0.674) and 0.618 (95% CI=0.443-0.767) on two nonremoval lakes. As a result, we conducted work on smaller wetlands thereafter, reasoning that any management benefit would be easier to detect. In 2000, estimated 30-day survival probabilities were 0.313 (95% CI=0.143-0.556) and 0.794 (95% CI=0.609-0.905) on two carcass removal lakes versus 0.525 (95% CI=0.362-0.682) and 0.743 (95% CI=0.564-0.866) on two nonremoval lakes. In 2001, botulism was detected on two nonremoval lakes where survival probabilities were 0.845 (95% CI=0.630-0.946) and 0.942 (95% CI=0.778-0.987), and on one removal lake where survival probability was 1.0 (95% CI=0.99-1.0), but not detected on the other removal lake where no marked birds died from botulism (1.0, 95% CI=0.99-1.0). Survival tended to be higher on lakes with lower carcass density, but when data were organized by carcass removal versus nonremoval, mallard survival was not consistently greater on lakes where carcasses were removed.

Pré-compostagem de cadáveres de bovinos acometidos pelo botulismo / The effect of composting cattle carcasses on botulinum spores and toxin content

Foram pré-compostados, em células individuais e isoladas, cinco cadáveres de bovinos acometidos pelo botulismo com a finalidade de monitorar a presença de esporos de Clostridium botulinum e de toxina botulínica antes e após o processo de decomposição em leira estática com fonte de carbono. O diagnóstico da intoxicação nos animais foi baseado nas características clínico-patológicas, epidemiológicas ou laboratoriais. Dos cinco bovinos com evolução clínica crônica de botulismo, cujos cadáveres foram pré-compostados, três foram acometidos pela toxina tipo D, um pelo complexo CD e um dos animais foi negativo na tentativa de detecção da toxina e de esporos da bactéria nas vísceras pelo bioensaio e neutralização em camundongo. O processo de pré-compostagem foi realizado em leira estática, com o uso de material carbonáceo umidificado como substrato e esquartejamento do animal, vedado individualmente com lona plástica e sem aeração por um período de 50 dias. A temperatura das leiras foi monitorada durante o período e oscilou de 40,5-52,4ºC. Após a abertura das leiras, pôde-se constatar a completa decomposição de todo material mole, com redução significativa do seu peso (de 26,5-44,5 por cento), restando apenas os ossos. Não foi detectado esporo ou toxina botulínica no interior dos ossos (n=5 para cada cadáver). Nas 200 amostras examinadas do homogeneizado restante (n=40 para cada cadáver), em apenas duas amostras de uma leira foram detectados esporos de C. botulinum tipo C, enquanto que todas foram negativas para a tentativa de detecção da toxina botulínica pelo bioensaio em camundongo. Da forma como foi avaliado o processo de pré-compostagem de bovinos mortos pela intoxicação botulínica não contribuiu para a proliferação de C. botulinum.

Five carcasses of cattle that died from botulism were composted in individual isolated beds with the purpose of monitoring the effect on spores of Clostridium botulinum and of botulinum toxin. The diagnosis of botulinum poisoning was based on clinical and pathological, epidemic and/or laboratorial characteristics. Of the five bovines with clinical signs of chronic botulism, three were affected by the type D toxin, one by the CD complex, and one was negative for toxin and spores of C. botulinum in the viscera using a mouse bioassay. The composting process was carried out in beds with carcasses cut up and mixed with sawdust as a carbon source. They were kept anaerobic under a plastic sheet for 50 days. The temperature of the beds was monitored during the period and oscillated from 40.5 to 52.4ºC. After this time, soft tissue had complete decomposed with a significant loss of weight (26.5-44.5 percent). The remaining bones no longer contained spores or botulinum toxin in the 5 samples taken from each carcass. Only 2 of the 200 samples of homogenized remaining (40 for each carcass) contained spores of C. botulinum type C. All samples were negative for botulinum toxin using the mouse bioassay. Composting carcasses of cattle that died from botulism eliminated botulinum spores and toxin from the remains.