First record of mass wild waterfowl mortality due to Clostridium botulinum in Brazilian semiarid.

In 2008, 270 wild birds from aquatic environments were found dead or debilitated on the banks of smaller lakes that had been formed due to the decrease in the level of the holding lake of the Sobradinho Dam located on the São Francisco River in the Caatinga of Bahia, Brazil. The outbreak occurred months after the dam's partial drainage, with the formation of puddles that accumulated decomposing organic material. Amongst the 270 individuals examined and/or found dead, the majority (50%) of the birds found belonged to the Anatidae family. The debilitated birds presented neurological clinical signs including lack of motor coordination, weakness, grave flaccid paralysis in the legs, wings, neck and eyelids, diarrhea, and dyspnea. Tissue samples of the birds were collected, as were water samples and samples of the substrate of the lakes. Zoonotic arboviroses or heavy metals were not detected. Analyses of liver and digestive tract content samples through bioassay and serum neutralization in mice revealed the presence of type C botulinic toxin in the viscerae samples, and type D in sediment samples. According to our knowledge, this is the first record of an outbreak of botulism in wild birds in natural conditions in Brazil.

Estudo retrospectivo de surtos de botulismo no Brasil e no mundo

A distribuição do botulismo é mundial, com casos esporádicos ou surtos familiares, em geral, relacionados à produção e à conservação de alimentos de maneira inadequada. As intoxicações alimentares constituem um dos significantes problemas de saúde pública. O botulismo é uma doença grave, causada pelo Clotrisdium botulinum e deve ser considerado emergência médica e de saúde pública. De ocorrência súbita, caracteriza-se por manifestações neurológicas seletivas, de evolução dramática e elevada mortalidade, entre 30 e 65%. Devido a importância do botulismo como um problema de saúde pública, é indispensável relatar que o maior perigo de contaminação está nos alimentos preparados de forma artesanal, principalmente em conservas caseiras.

The distribution of botulism is worldwide, with sporadic cases or outbreaks family usually related to production and conservation of food improperly. The food poisoning is one of the significant public health problems. Botulism is a serious illness caused by Clostridium botulinum should be considered a medical emergency and public health. The sudden occurrence characterized by neurological manifestations selective evolution of dramatic and high mortality between 30 and 65%. Due to the importance of botulism as a public health problem, it is essential to report that the greatest danger of contamination in food is prepared by hand, especially in home canning.

Estudo retrospectivo de surtos de botulismo no Brasil e no mundo

A distribuição do botulismo é mundial, com casos esporádicos ou surtos familiares, em geral, relacionados à produção e à conservação de alimentos de maneira inadequada. As intoxicações alimentares constituem um dos significantes problemas de saúde pública. O botulismo é uma doença grave, causada pelo Clotrisdium botulinum e deve ser considerado emergência médica e de saúde pública. De ocorrência súbita, caracteriza-se por manifestações neurológicas seletivas, de evolução dramática e elevada mortalidade, entre 30 e 65%. Devido a importância do botulismo como um problema de saúde pública, é indispensável relatar que o maior perigo de contaminação está nos alimentos preparados de forma artesanal, principalmente em conservas caseiras.(AU)

The distribution of botulism is worldwide, with sporadic cases or outbreaks family usually related to production and conservation of food improperly. The food poisoning is one of the significant public health problems. Botulism is a serious illness caused by Clostridium botulinum should be considered a medical emergency and public health. The sudden occurrence characterized by neurological manifestations selective evolution of dramatic and high mortality between 30 and 65%. Due to the importance of botulism as a public health problem, it is essential to report that the greatest danger of contamination in food is prepared by hand, especially in home canning.(AU)

First report of an infant botulism case due to Clostridium botulinum type Af.

Most infant botulism cases worldwide are due to botulinum toxin types A and B. Rarely, Clostridium botulinum strains that produce two serotypes (Ab, Ba, and Bf) have also been isolated from infant botulism cases. This is the first reported case of infant botulism due to C. botulinum type Af worldwide.

Epidemiology, clinical signs, laboratorial and pathological findings in eight outbreaks of botulism in cattle in Rio Grande do Norte state, Northeastern Brazil / Epidemiologia, sinais clínicos, achados laboratoriais e patológicos em oito surtos de botulismo em bovinos no Rio Grande do Norte

Background: Botulism is caused by a neurotoxin produced by Clostridium botulinum, a gram-positive bacterium, sporeforming anaerobe. In Brazil, this disease has relevant importance causing economic disturbance in livestock production. The present study aimed to report the epidemiology, clinical-pathological and laboratorial findings of eight outbreaks of botulism in cattle from Rio Grande do Norte, Northeastern Brazil.Material, Methods & Results: Clinical and epidemiological data of eight outbreaks of botulism were obtained during visits to farms from Mossoró, Serra do Mel, Governador Dix-Sept Rosado and Olho Dágua dos Borges municipalities, located at the semiarid region of Rio Grande do Norte state, Northeastern Brazil. The outbreaks occurred in July 2009, August and September 2010, and April, May and October 2013. Blood and cerebrospinal fluid samples were collected from eleven and six animals, respectively, for laboratorial analysis. Ten cattle that recently died were necropsied, and fragments of several tissues (central nervous system, liver, kidney, heart and small intestine) were collected for histopathological examination. The observed clinical signs varied according to the clinical evolution of the disease, and included progressive paralysis of hindlimbs and sternal decubitus. The common clinical findings in all cattle was decreased muscular tonus of tongue...

Epidemiology, clinical signs, laboratorial and pathological findings in eight outbreaks of botulism in cattle in Rio Grande do Norte state, Northeastern Brazil / Epidemiologia, sinais clínicos, achados laboratoriais e patológicos em oito surtos de botulismo em bovinos no Rio Grande do Norte

Background: Botulism is caused by a neurotoxin produced by Clostridium botulinum, a gram-positive bacterium, sporeforming anaerobe. In Brazil, this disease has relevant importance causing economic disturbance in livestock production. The present study aimed to report the epidemiology, clinical-pathological and laboratorial findings of eight outbreaks of botulism in cattle from Rio Grande do Norte, Northeastern Brazil.Material, Methods & Results: Clinical and epidemiological data of eight outbreaks of botulism were obtained during visits to farms from Mossoró, Serra do Mel, Governador Dix-Sept Rosado and Olho Dágua dos Borges municipalities, located at the semiarid region of Rio Grande do Norte state, Northeastern Brazil. The outbreaks occurred in July 2009, August and September 2010, and April, May and October 2013. Blood and cerebrospinal fluid samples were collected from eleven and six animals, respectively, for laboratorial analysis. Ten cattle that recently died were necropsied, and fragments of several tissues (central nervous system, liver, kidney, heart and small intestine) were collected for histopathological examination. The observed clinical signs varied according to the clinical evolution of the disease, and included progressive paralysis of hindlimbs and sternal decubitus. The common clinical findings in all cattle was decreased muscular tonus of tongue...(AU)

Infant botulism in Costa Rica: first report from Central America.

INTRODUCTION: Clostridium botulinum is known to cause descending paralysis in infants throughout the world. METHODOLOGY: The subject of this study was a three-month-old Costa Rican boy who was hospitalized because of poor suction and feeding, hypotonia, and constipation. Clinical history and physical examination findings suggested infant botulism. Samples were sent to the Winnipeg Public Health Laboratory, where Clostridium botulinum toxin A was identified by PCR and culture from the stools, making this the first report of infant botulism in Central America. CONCLUSIONS: Although infant botulism is a known disease, the limitations in identifying it in Central America contributes to the misdiagnosis and under-reporting of this disease.

Analysis of a unique Clostridium botulinum strain from the Southern hemisphere producing a novel type E botulinum neurotoxin subtype.

BACKGROUND: Clostridium botulinum strains that produce botulinum neurotoxin type E (BoNT/E) are most commonly isolated from botulism cases, marine environments, and animals in regions of high latitude in the Northern hemisphere. A strain of C. botulinum type E (CDC66177) was isolated from soil in Chubut, Argentina. Previous studies showed that the amino acid sequences of BoNT/E produced by various strains differ by < 6% and that the type E neurotoxin gene cluster inserts into the rarA operon. RESULTS: Genetic and mass spectral analysis demonstrated that the BoNT/E produced by CDC66177 is a novel toxin subtype (E9). Toxin gene sequencing indicated that BoNT/E9 differed by nearly 11% at the amino acid level compared to BoNT/E1. Mass spectrometric analysis of BoNT/E9 revealed that its endopeptidase substrate cleavage site was identical to other BoNT/E subtypes. Further analysis of this strain demonstrated that its 16S rRNA sequence clustered with other Group II C. botulinum (producing BoNT types B, E, and F) strains. Genomic DNA isolated from strain CDC66177 hybridized with fewer probes using a Group II C. botulinum subtyping microarray compared to other type E strains examined. Whole genome shotgun sequencing of strain CDC66177 revealed that while the toxin gene cluster inserted into the rarA operon similar to other type E strains, its overall genome content shared greater similarity with a Group II C. botulinum type B strain (17B). CONCLUSIONS: These results expand our understanding of the global distribution of C. botulinum type E strains and suggest that the type E toxin gene cluster may be able to insert into C. botulinum strains with a more diverse genetic background than previously recognized.

Persistent extraradicular infection in root-filled asymptomatic human tooth: scanning electron microscopic analysis and microbial investigation after apical microsurgery.

INTRODUCTION: Procedural accidents have a negative effect on healing and might contribute to the persistence of infections in inaccessible apical areas, requiring surgical intervention. This report describes a case of persistent apical periodontitis of a lower left first molar associated with the sinus tract and a periapical lesion that required nonsurgical endodontic retreatment and apical surgery for resolution. METHODS: The tooth had received endodontic treatment 3 years ago and had to be retreated using the crown-down technique with chemical auxiliary substance (2% chlorhexidine gel), foramen patency, and enlargement and was filled in a single appointment. The occlusal access cavity was immediately restored with composite resin. After 1 month, it could be observed that the sinus tract persisted and, radiographically, the lesion remained unaltered. Therefore, endodontic microsurgery was indicated. Apical microsurgery was performed under magnification with the use of a dental operating microscope including apicectomy, root end with ultrasound, and sealing with mineral trioxide aggregate. A microbiological sample was collected from the apical lesion. The resected distal root apex was observed by scanning electron microscopy. RESULTS: The following species were detected: Actinomyces naeslundii and Actinomyces meyeri, Propionibacterium propionicum, Clostridium botullinum, Parvimonas micra, and Bacteroides ureolyticus; scanning electron microscopic analysis revealed bacterial biofilm surrounding the apical foramen and external radicular surface. Gutta-percha overfilling at the apex because of a zip caused during initial endodontic treatment could be observed. A 6-month follow-up showed apparent radiographic periapical healing, which progressed after 24 months. CONCLUSION: Gram-positive anaerobic bacteria and extraradicular biofilm seem to participate in the maintenance of persistent periapical pathology, and endodontic retreatment followed by periapical microsurgery proved to be a successful alternative in the resolution of persistent extraradicular infections.

Botulism in Brazil, 2000-2008: epidemiology, clinical findings and laboratorial diagnosis / Botulismo no Brasil, 2000-2008: epidemiologia, achados clínicos e diagnóstico laboratorial

Botulism is a rare and potentially lethal illness caused by Clostridium botulinum neurotoxin. We describe the findings of a laboratorial investigation of 117 suspected cases of botulism reported to the surveillance system in Brazil from January 2000 to October 2008. Data on the number and type of samples analyzed, type of toxins identified, reporting of the number of botulism cases and transmission sources are discussed. A total of 193 clinical samples and 81 food samples were analyzed for detection and identification of the botulism neurotoxin. Among the clinical samples, 22 (11.4 percent) presented the toxin (nine type A, five type AB and eight with an unidentified type); in food samples, eight (9.9 percent) were positive for the toxin (five type A, one type AB and two with an unidentified type). Of the 38 cases of suspected botulism in Brazil, 27 were confirmed by a mouse bioassay. Laboratorial botulism diagnosis is an important procedure to elucidate cases, especially food-borne botulism, to confirm clinical diagnosis and to identify toxins in food, helping sanitary control measures.

Botulismo é uma doença rara e potencialmente letal, resultante da ação de uma neurotoxina produzida pelo Clostridium botulinum. No presente estudo, estão descritos os resultados da investigação laboratorial de 117 casos suspeitos de botulismo notificados ao sistema de vigilância, ocorridos no Brasil no período de janeiro de 2000 a outubro de 2008. Os dados obtidos sobre as fontes de transmissão, os tipos de toxina identificados e de amostras analisadas serão discutidos. Foram analisadas 193 amostras clínicas e 81 amostras de alimentos para detecção e identificação de neurotoxina botulínica. Entre as amostras clínicas, 22 (11,4 por cento) amostras apresentaram resultado positivo para toxina (nove do tipo A, cinco do tipo AB e em oito o tipo não foi identificado) e entre as amostras de alimentos, oito (9,9 por cento) foram positivas (cinco do tipo A, uma do tipo AB e em duas o tipo não foi identificado). Dos 38 casos considerados positivos para botulismo, 27 foram confirmados pelo bioensaio em camundongo. O diagnóstico laboratorial de botulismo é importante para elucidação dos casos, principalmente de botulismo alimentar, para confirmação dos diagnósticos clínicos e identificação das toxinas nos alimentos, provendo subsídios para as medidas de controle sanitário.

Presence of soil-dwelling clostridia in commercial powdered infant formulas.

OBJECTIVE: Because Clostridium botulinum was isolated from powdered infant formula (PIF) fed to an infant in the United Kingdom who subsequently developed infant botulism and from unopened PIF from the same manufacturer, we tested PIF manufactured in the United States for the presence of clostridial spores. STUDY DESIGN: Thirty PIF ingested by 19 California infants with botulism within 4 weeks of onset of illness (48% of all patients fed PIF during study) in 2006-2007 were cultured anaerobically to isolate clostridia. All isolated clostridia were identified to the species level and enumerated with standard microbiologic and molecular methods. RESULTS: Five of 30 (17%) PIF samples ingested by patients contained clostridial spores. Spores were also found in 7 of 9 (78%) market-purchased PIF samples. Clostridium sporogenes was isolated most frequently, followed by Clostridium butyricum and at least 10 other soil-dwelling clostridial species. No neurotoxigenic clostridia were isolated. The most probable number of clostridial spores in PIF ranged between 1.1 to >23 per 100 g. CONCLUSIONS: With the notable exception of production of botulinum neurotoxin, C sporogenes is physiologically comparable with proteolytic strains of C botulinum, and both share the same natural reservoir (soils and dust worldwide). The isolation of C sporogenes and potentially pathogenic clostridia from U.S.-manufactured PIF suggests that neurotoxigenic clostridial spores have the potential to be present in these products.

Botulism in Brazil, 2000-2008: epidemiology, clinical findings and laboratorial diagnosis.

Botulism is a rare and potentially lethal illness caused by Clostridium botulinum neurotoxin. We describe the findings of a laboratorial investigation of 117 suspected cases of botulism reported to the surveillance system in Brazil from January 2000 to October 2008. Data on the number and type of samples analyzed, type of toxins identified, reporting of the number of botulism cases and transmission sources are discussed. A total of 193 clinical samples and 81 food samples were analyzed for detection and identification of the botulism neurotoxin. Among the clinical samples, 22 (11.4%) presented the toxin (nine type A, five type AB and eight with an unidentified type); in food samples, eight (9.9%) were positive for the toxin (five type A, one type AB and two with an unidentified type). Of the 38 cases of suspected botulism in Brazil, 27 were confirmed by a mouse bioassay. Laboratorial botulism diagnosis is an important procedure to elucidate cases, especially food-borne botulism, to confirm clinical diagnosis and to identify toxins in food, helping sanitary control measures.

Linden flower (Tilia spp.) as potential vehicle of Clostridium botulinum spores in the transmission of infant botulism / El té de tilo como vehículo potencial de esporas de Clostridium botulinum en la transmisión del botulismo infantil

Infant botulism is an intestinal toxemia caused principally by Clostridium botulinum. Since the infection occurs in the intestinal tract, numerous food products have been investigated for the presence of C. botulinum and its neurotoxins. In many countries, people use linden flower (Tilia spp) tea as a household remedy and give it to infants as a sedative. Therefore, to help provide a clear picture of this disease transmission, we investigated the presence of botulinum spores in linden flowers. In this study, we analyzed 100 samples of unwrapped linden flowers and 100 samples of linden flowers in tea bags to determine the prevalence and spore-load of C. botulinum. Results were analyzed by the Fisher test. We detected a prevalence of 3% of botulinum spores in the unwrapped linden flowers analyzed and a spore load of 30 spores per 100 grams. None of the industrialized linden flowers analyzed were contaminated with botulinum spores. C. botulinum type A was identified in two samples and type B in one sample. Linden flowers must be considered a potential vehicle of C. botulinum, and the ingestion of linden flower tea can represent a risk factor for infant botulism.

El botulismo del lactante es una toxiinfección causada, principalmente, por Clostridium botulinum. Debido a que esta infección ocurre en el tracto intestinal, la presencia de esta bacteria y sus neurotoxinas ha sido investigada en numerosos alimentos. En muchos países se utiliza el té de tilo (Tilia spp.) como sedante natural, el que se administra incluso a los lactantes. A fin de contribuir al esclarecimiento de la transmisión de esta enfermedad, se investigó la prevalencia y la carga de esporas botulínicas en esta hierba. Se analizaron 100 muestras de tilo comercializado a granel y 100 muestras de tilo industralizado en “saquitos”. Los resultados de prevalencia fueron analizados por el test de Fisher y la carga de esporas por la técnica del número más probable. Se halló una prevalencia de esporas de C. botulinum del 3% en el tilo comercializado a granel, con una carga de 30 esporas/100 g de hierba. En tanto, ninguna de las muestras en saquitos acusó la presencia del patógeno. Se identificaron tres cepas de C. botulinum, dos tipo A y una tipo B. En virtud de estos resultados, el tilo podría considerarse un potencial vehículo de esporas de C. botulinum y la administración de sus infusiones a menores y lactantes, un riesgo para la transmisión de la enfermedad.

Phenotypic characterization of Clostridium botulinum strains isolated from infant botulism cases in Argentina.

Infant botulism is the most common form of human botulism; however, its transmission has not been completely explained yet. Some of the most recognized potential sources of Clostridium botulinum spores are the soil, dust, honey and medicinal herbs. In Argentina, 456 cases of infant botulism were reported between 1982 and 2007. C. botulinum type A was identified in 455 of these cases whereas type B was identified in just one case. However, in Argentina, types A, B, E, F, G, and Af have been isolated from environmental sources. It is not clearly known if strains isolated from infant botulism cases have different characteristics from strains isolated from other sources. During this study, 46 C. botulinum strains isolated from infant botulism cases and from environmental sources were typified according to phenotypic characteristics. Biochemical tests, antimicrobial activity, and haemagglutinin-negative botulinum neurotoxin production showed uniformity among all these strains. Despite the variability observed in the botulinum neurotoxin's binding to cellular receptors, no correlation was found between these patterns and the source of the botulinum neurotoxin. However, an apparent geographical clustering was observed, since strains isolated from Argentina had similar characteristics to those isolated from Italy and Japan, but different to those isolated from the United States.

Food-borne botulism in Argentina.

Botulism is a severe neuroparalytic disease caused by Clostridium botulinum toxins. Although the disease is uncommon it is a cause of great concern due to its high rate of mortality. Food-borne outbreaks of botulism occur worldwide and require immediate public health attention and acute care resources. Analysis of outbreaks showed that the food products most often involved were fermented fish products in Alaska; home-canned food, oil preservation and restaurant sauce in the rest of the United States (US) and in London and; and home-canned vegetables, airtight packed food with inappropriate refrigeration, and aerosols in Argentina. The diagnosis is based only on clinical findings matching the disease and previous exposure to suspicious food. Botulism must be immediately identified as even one case suggests the start of an epidemic and should be treated as a public health emergency. Therefore, the purpose of the following review is to recognize the risks associated with the consumption of potentially dangerous foods, and to encourage prevention by seeking to make all public health professionals aware of the dangers of this potentially lethal disease.

Phenotypic characterization of Clostridium botulinum strains isolated from infant botulism cases in Argentina / Caracterización fenotípica de cepas de Clostridium botulinum aisladas de casos de botulismo del lactante en Argentina

Infant botulism is the most common form of human botulism; however, its transmission has not been completely explained yet. Some of the most recognized potential sources of Clostridium botulinum spores are the soil, dust, honey and medicinal herbs. In Argentina, 456 cases of infant botulism were reported between 1982 and 2007. C. botulinum type A was identified in 455 of these cases whereas type B was identified in just one case. However, in Argentina, types A, B, E, F, G, and Af have been isolated from environmental sources. It is not clearly known if strains isolated from infant botulism cases have different characteristics from strains isolated from other sources. During this study, 46 C. botulinum strains isolated from infant botulism cases and from environmental sources were typified according to phenotypic characteristics. Biochemical tests, antimicrobial activity, and haemagglutinin-negative botulinum neurotoxin production showed uniformity among all these strains. Despite the variability observed in the botulinum neurotoxin's binding to cellular receptors, no correlation was found between these patterns and the source of the botulinum neurotoxin. However, an apparent geographical clustering was observed, since strains isolated from Argentina had similar characteristics to those isolated from Italy and Japan, but different to those isolated from the United States.

El botulismo del lactante es la forma más común del botulismo humano; sin embargo, su forma de transmisión no ha sido totalmente explicada. El suelo, el polvo ambiental, la miel y algunas hierbas medicinales son potenciales fuentes de esporas de Clostridium botulinum. Entre 1982 y 2007 se informaron en Argentina 456 casos de botulismo del lactante, 455 casos debidos al serotipo A y uno al serotipo B. Sin embargo, los serotipos A, B, E, F, G y Af han sido aislados de suelos y otras fuentes en Argentina. No se conoce si las cepas aisladas de casos de botulismo del lactante poseen características diferentes de las cepas aisladas de otras fuentes. Durante este estudio se caracterizaron 46 cepas de C. botulinum. Las pruebas bioquímicas y de sensibilidad a los antimicrobianos y la producción de neurotoxina botulínica hemaglutinina-negativa mostraron uniformidad entre estas cepas. A pesar de la variabilidad observada respecto de la unión de la neurotoxina a receptores celulares, no se observó una correlación entre estos patrones de unión y la fuente de aislamiento. Sin embargo, se observó una aparente agrupación geográfica, ya que las cepas aisladas en Argentina tuvieron características similares a las observadas en las cepas aisladas en Italia y Japón, pero diferentes de las que se registraron en las cepas aisladas en los Estados Unidos.

Linden flower (Tilia spp.) as potential vehicle of Clostridium botulinum spores in the transmission of infant botulism.

Infant botulism is an intestinal toxemia caused principally by Clostridium botulinum. Since the infection occurs in the intestinal tract, numerous food products have been investigated for the presence of C. botulinum and its neurotoxins. In many countries, people use linden flower (Tilia spp) tea as a household remedy and give it to infants as a sedative. Therefore, to help provide a clear picture of this disease transmission, we investigated the presence of botulinum spores in linden flowers. In this study, we analyzed 100 samples of unwrapped linden flowers and 100 samples of linden flowers in tea bags to determine the prevalence and spore-load of C. botulinum. Results were analyzed by the Fisher test. We detected a prevalence of 3% of botulinum spores in the unwrapped linden flowers analyzed and a spore load of 30 spores per 100 grams. None of the industrialized linden flowers analyzed were contaminated with botulinum spores. C. botulinum type A was identified in two samples and type B in one sample. Linden flowers must be considered a potential vehicle of C. botulinum, and the ingestion of linden flower tea can represent a risk factor for infant botulism.

Botulismo infantil: comunicación de un caso y revisión del tema / Infant botulism: case-report and literature review

Background: Infant botulism is a rare and potentially lethal neurological disease produced by the ingestion of a neurotoxin secreted by Clostridium botulinum, causing diffuse paralysis. Objective: Describe the first case in Chile since the establishment of an obligatory report and describe the diagnosis, clinical presentation and outcome. Case-report: A 2 months-old male with 48 hours of poor feeding and swallowing, weak cry, listlessness and constipation. He was admitted for hospitalization with probable sepsis and required tracheotomy due to apnea with failed endotracheal intubation, requiring mechanical ventilation for 150 days and hospitalization during 180 days. The diagnosis was confirmed by isolating Clostridium botulinum toxin from stool. Conclusion: The diagnosis of infant botulism requires a high suspicion index and the treatment includes intensive care monitorization with general support.

El botulismo infantil es una enfermedad infrecuente que ha sido confirmada sólo en menores de un año, se produce por ingestión de esporas de clostridium botulinum que producen una neurotoxina in vivo, la cual se absorbe y es responsable de la parálisis flácida descendente aguda característica de esta enfermedad. Objetivo: Presentación del primer caso descrito desde que la notificación es obligatoria en Chile y revisión del tema. Caso clínico: Lactante de 2 meses. Dos días previo al ingreso presenta succión débil, hiporeactividad y llanto disfónico, consultando en Servicio de Urgencia y decidiéndose su hospitalización. Estudio: hemograma, PCR, neuroimagenes, EEG LCR, EMG normales y toxicológico negativo. Se confirma Clostridium botulinum productor de la toxina botulínica tipo A. Requirió ventilación mecánica a través de traqueotomía por 150 días y es dado de alta a los 180 días. Conclusión: El diagnóstico requiere de un alto índice de sospecha, el tratamiento es de soporte evitando las complicaciones.

Contaminación microbiológica y actividad antimicrobiana del azúcar de caña cristalizado sobre algunos agentes de interés médico en Costa Rica

Microbiological contamination and antimicrobial activity of cristalised cane sugar on some medically important microorganisms in Costa Rica. Unrefined cristalised cane sugar, obtained after the filtration and evaporation of sugar cane juice, is a nutritional product of traditional consumption in Costa Rica and other Neotropical countries. It has been used in the topic treatment of infected wounds, with satisfactory results even with some antibiotic-ressistant bacteria. We studied the microbiological quality of 50 commercial samples. The analyses included total aerobic and anaerobic bacteria plate count; aerobic and anaerobic spore count; mold and yeast count; total and fecal coliforms; and presence of Clostridium botulinum. The antimicrobial effect was tested for Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC 25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) and Aspergillus niger (Asni 06). Most of the samples (76 %) presented counts lower than 100 CFU/g especially for sporulated forms (90 % lower than 20 CFU/g), the mold and yeast count was higher (38 % higher than 102 CFU/g), demonstrating the importance of these microorganisms in the spoilage of the product; 76 % of the samples presented fecal contamination; C. botulinum was not isolated with the methodology employed. No inhibitory effect was observed for A. niger, but all samples han an inhibitory effect over the other species, especially for P. aeruginosa and S. aureus. Rev. Biol. Trop. 56 (2): 431-437. Epub 2008 June 30.

La tapa de dulce o panela es un producto alimenticio de consumo tradicional, típico de países neotropicales, obtenido de la filtración y evaporación del jugo de la caña de azúcar. Además de su uso clásico como endulzante, en Costa Rica y otras partes del mundo se ha utilizado para el tratamiento tópico y empírico de heridas infectadas, con resultados satisfactorios, aún en infecciones por bacterias resistentes a diversos antibióticos. A fin de valorar el riesgo o beneficio de esta práctica, se evaluó la calidad microbiológica de 50 muestras de tapa de dulce de producción nacional obtenidas en trapiches, mercados y supermercados. Se realizaron recuentos bacterianos aerobios y anaerobios, de bacterias esporuladas y no esporuladas y de hongos y levaduras, se determinó el número de coliformes totales y fecales, la presencia de Clostridium botulinum y se evaluó el efecto antimicrobiano de este producto sobre algunos patógenos: Staphylococcus aureus (ATCC 25923), S. epidermidis (UCR 2902), Pseudomonas aeruginosa (ATCC 9027), Escherichia coli (ATCC25922), Salmonella enteritidis (ATCC 13076), Listeria monocytogenes (ATCC 19116) y Aspergillus niger (Asni 06). La mayoría de las muestras (76%) presentaron recuentos bacterianos menores de 100 UFC/g, especialmente de esporulados (90% menos de 20 UFC/g), y recuentos de hongos y levaduras elevados (20% mayores a 100 UFC/g). Un alto porcentaje de las muestras presentó contaminación fecal (76%, NMP/g desde 3 hasta 460). No se logró aislar C. botulinum en ninguna de las muestras. Todas las muestras del producto concentrado desarrollaron halo de inhibición sobre los cultivos, principalmente sobre P. aeruginosa y S. aureus; pero no se observó ningún tipo de inhibición sobre A. niger.

Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism.

Nowadays, infant botulism is the most important form of human botulism in some countries. This illness affects infants younger than 52 weeks of age. The infection occurs in the intestinal tract; therefore, ingestion of Clostridium botulinum spores with food is proposed. In some countries, people use chamomile tea as a household remedy for intestinal colics and given this tea to infants. Chamomile can be contaminated with C. botulinum and could be a vehicle of its spores. Our aim was to study the prevalence and spore-load of C. botulinum in chamomile. We analysed 200 samples; the 7.5% of them were contaminated with botulinum spores. However, prevalence of these spores was significantly higher in chamomile sold by weight in herbal stores (unwrapped chamomile) than prevalence in chamomile sold in tea bags (p=0.0055). The spore-load detected in all positive samples was 0.3-0.4 spores per gram of chamomile. We identified C. botulinum types A, B, and F in the 53.3%, 6.7%, and 13.3%, respectively. Chamomile (principally, unwrapped chamomile) is a potencial vehicle of C. botulinum spores, and ingestion of chamomile tea could represent a risk for infant botulism.