Early diagnosis and treatment in a child with foodborne botulism.

INTRODUCTION: Foodborne botulism is a neuroparalytic disease caused by ingestion of food contaminated with botulinum toxins. Despite rare the mortality rate is high if untreated. Diagnosis of botulism is still a challenge for clinician, due to the variability of clinical manifestations and disease course. We report on a child with type B botulin intoxication who was early diagnosed and treated underlining that clinical suspicion is crucial to start prompt treatment. CASE PRESENTATION: An 11-year-old boy presented with bilateral ptosis and mydriasis, dry mouth, difficulty in swallowing, dysphonia, urine retention and constipation. Clear sensorium and no fever were observed. Immediately the suspicion of botulism was risen and botulinum antitoxin was administered. 3 days later serum and rectal samples tested positive for Clostridium botulinum. The patient completely recovered when discharged from hospital. DISCUSSION: Foodborne botulism is still possible in developed countries. The confirmation test of botulism requires some days. To avoid long delays between intoxication and diagnosis prompt clinical suspicion is thus crucial. The outcome depends on rapid implementation of appropriate management with intensive respiratory care and antitoxin administration.

Dilated pupils, dry mouth and dizziness - a case study.

A man, 44 years of age, presented with a 4 hour history of dizziness, blurred vision, dry mouth and dilated pupils. He was previously well and on no medications and there was no history of recent drug use, head injury or focal neurological symptoms. On questioning, the patient said that he had eaten lupini beans for lunch but that he hadn't had enough time to soak them for long enough before eating them. On examination his Glasgow Coma Score (GCS) was 15/15, heart rate 98 bpm, blood pressure 144/98, temperature 37.8°C and respiratory rate 18 breaths/minute. His skin was warm and dry with dry mucous membranes. His pupils were dilated at 6 mm and were nonreactive. Cardiovascular, respiratory, abdominal and neurological examinations were normal. He was unable to pass urine. Electrocardiogram showed normal sinus rhythm with a rate of 98 bpm.

Fully integrated and slidable paper-embedded plastic microdevice for point-of-care testing of multiple foodborne pathogens.

This study presents a slidable paper-embedded plastic microdevice fully integrated with DNA extraction, loop-mediated isothermal amplification (LAMP), and colorimetric detection functionalities. The developed microdevice consists of three layers that allow a sliding movement to mix the sample and reagents for DNA purification, amplification, and detection in a sequential manner. An FTA card was employed in the main chamber for DNA extraction and purification from intact bacterial cells. Subsequently, LAMP reagents and fuchsin-stored chambers were pulled toward the main chambers for DNA amplifications at 65 °C. After 30 min, the detection reagents-stored chambers were then moved to main chambers for result analysis. For the detection of LAMP amplicons, a novel colorimetric fuchsin-based method was employed. The wide applicability of the integrated microdevice was demonstrated by successfully screening three major foodborne pathogens, namely Salmonella spp., Staphylococcus aureus, and Escherichia coli O157:H7 in food, enabling highly sensitive detection of 3.0 × 101 CFU/sample of Gram-negative bacteria (Salmonella spp. and Escherichia coli O157:H7) and 3.0 × 102 CFU/sample of Gram-positive bacteria (Staphylococcus aureus) within 75 min. The portable and integrated microdevice presented in this study holds significant promise for point-of-care applications to accurately and rapidly diagnose and control diseases.

Unintentional ingestion of Cordyceps fungus-infected cicada nymphs causing ibotenic acid poisoning in Southern Vietnam.

BACKGROUND: Cordyceps fungus found in infected cicada nymphs ("cicada flowers") is utilized in traditional Chinese medicine. Cordyceps fungus toxicity in humans has not been previously reported. We report 60 cases of apparent Cordyceps poisoning in Southern Vietnam. METHODS: We retrospectively collected demographic and clinical data from the medical records (21 cases) and by telephone interview (39 cases) of patients admitted to seven hospitals in Southern Vietnam following ingestion of cicada flowers between 2008 and 2015. We also determined the species of Cordyceps present in the cicada flowers and performed a partial chemical analysis of the fungus. RESULTS: Sixty cases of toxic effects following ingestion of cicada flowers were documented. Symptom onset occurred within 60 minutes following ingestion. Symptoms included dizziness, vomiting, salivation, mydriasis, jaw stiffness, urinary retention, seizures, agitated delirium, hallucinations, somnolence and coma. None of the patients suffered liver or kidney injury. There was one fatality. The Cordyceps fungus involved in these poisoning was identified as Ophiocordyceps heteropoda. The presence of ibotenic acid was confirmed, but musimol and muscarine were absent. CONCLUSIONS: Cicada infected with Ophiocordyceps heteropoda in Vietnam contain ibotenic acid and are associated with a clinical syndrome consistent with its effects.

Sample preparation and DNA extraction procedures for polymerase chain reaction identification of Listeria monocytogenes in seafoods.

Five grams of seafood products were inoculated with one to 500 viable or 10(9) heat-killed cells of Listeria monocytogenes. The presence of the pathogen was detected by the polymerase chain reaction (PCR) with primers specific for fragments of the listeriolysin O (hly) gene (two sets) and for the invasion-associated protein (iap) gene (one set). For DNA preparation, boiling, either alone or in combination with lysozyme and proteinase K treatment, was not always sufficient to lyse L. monocytogenes, while treatment with Triton X-100 produced consistently good DNA suitable for amplification. To avoid false-negative and false-positive results, 48 h incubations were necessary and a subculturing step after an initial 24 h incubation greatly improved the results. The primers that amplified regions of the listeriolysin O gene gave clearer and stronger products than primers for the invasion-associated protein gene. Using this method we were able to detect one to five L. monocytogenes cells in 5 g of product in a total of 55 h.

[Forensic medical identification of death due to poisoning of tetrodotoxin in puffer fish].

One case died of poisoning of tetrodotoxin in dry fugu fillet was reported. Through the detailed forensic examination for this lethal case, many questions about forensic medical identification of death due to poisoning of tetrodotoxin was discussed and its medico-legal significance was also discussed. In particular, emphasis was placed on the details of a case, extraction of TTX in specimen, quantitative detection of TTX, purplish mouth and nails, dilatation of stomach and intestines, excluding other causes and combining animal experiment in order to get definite forensic medical identification.

Foodborne botulism in southwest Romania during the post-communism period 1990-2007.

OBJECTIVES: This study was a retrospective investigation of botulism cases over a period of 18 years following major political and economic changes, addressing the question of whether this disease is still an important health concern in southwest Romania. METHODS: The medical records of botulism cases were used as the source of data. Patients from five southwest Romanian counties were hospitalized at Victor Babes Hospital of Infectious Diseases in Timisoara during the period 1990-2007. RESULTS: The median annual incidence of botulism cases in southwest Romania decreased from 0.1 per 100 000 persons during 1990-1998, to 0.05 per 100 000 persons during 1999-2007. Most of the cases (18.6%) were diagnosed in 1990, immediately following the communism period. The median age of the patients was 38 years (range 16-73 years); 24 (55.8%) were male; the case fatality rate was 2.3%. A significantly higher incidence rate of 2.7 cases per 100 000 persons occurred in rural areas, even though most of the cases (53.5%) were inhabitants of urban areas. The clinical pattern included: difficulty swallowing (79.1%), double and/or blurred vision (69.8%), dry mouth (60.5%), drooping eyelids (51.2%), vomiting (39.5%), mydriasis (37.2%), constipation (27.9%), abdominal pain (23.3%), and slurred speech (18.6%). All cases were attributed to contaminated food sources, mainly home-prepared traditional pork products. CONCLUSIONS: Although the botulism cases decreased over the study period in southwest Romania, this life-threatening disease continues to be an important concern. A strategy addressing individual behaviors in the home is needed to improve food safety.

[Ciguatera: clinical relevance of a marine neurotoxin]. / Ciguatera: Klinische Bedeutung eines marinen Neurotoxins.

HISTORY AND CLINICAL FINDINGS: A 45-year-old woman complained of gastrointestinal symptoms followed by paraesthesiae of the mouth, face, hands, feet, and trunk after she had eaten fish while she was on a journey to the red sea. Additionally, she suffered from headaches and muscle aches, weakness of the arms and legs, instability of gait as well as troubles of vision, taste, speech, and swallowing. Neurological examination revealed a cerebellar syndromE with mild dysarthria, multifocal dysaesthesiae, paresis of the arms and legs, generalized hyporeflexia, bilaterally reduced vision, and ataxic gait. INVESTIGATIONS: Laboratory work-up provided no diagnostic clues. Cranial and spinal magnetic resonance imaging were normal. The cerebrospinal fluid showed a normal cell count and a moderately impaired barrier function. Electrophysiological evaluation suggested a sensory and motor axonal neuropathy. DIAGNOSIS, TREATMENT AND COURSE: Based on the history and the characteristic clinical findings we made a diagnosis of ciguatera, a marine food poisoning caused by the ingestion of fish contaminated with ciguatoxin. Symptomatic treatment with mannitol, amitriptyline, carbamazepine, and corticosteroids started 3 weeks after the onset of symptoms proved inefficient, however, during the 21 months of follow-up there was a marked spontaneous clinical and electrophysiological reversal of symptoms. CONCLUSIONS: In the age of growing foreign tourism marine food intoxications have to be considered in the differential diagnosis of the frequently occurring travellers-diarrhea. The diagnosis of ciguatera is based on the typical history of a fishmeal followed by characteristic clinical findings with predominant neurological symptoms, often including dysaesthesiae, besides gastrointestinal disturbances. In the early phase of the disease intravenous therapy with mannitol has emerged as an efficient treatment.