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Epidemiol Infect. 2015 Feb;143(3):461-9. doi: 10.1017/S0950268814002672. Epub 2014 Oct 13.

Infant botulism due to C. butyricum type E toxin: a novel environmental association with pet terrapins.

Author information

1
Public Health Department,Health Service Executive,Dublin,Ireland.
2
Department of Neurology,Children's University Hospital,Temple Street,Dublin,Ireland.
3
Gastrointestinal Bacteria Reference Laboratory,Public Health England,Colindale,London,UK.
4
Department of General Paediatrics,Children's University Hospital,Temple Street,Dublin,Ireland.
5
Public Health Laboratory, Cherry Orchard Hospital,Dublin,Ireland.
6
Department of Microbiology,Children's University Hospital,Temple Street,Dublin,Ireland.
7
Health Protection Surveillance Centre,Dublin,Ireland.
8
Environmental Health, Health Service Executive,Dublin,Ireland.
9
Environmental Health, Health Service Executive,Wicklow,Ireland.
10
Department of Agriculture,Food and the Marine,Dublin,Ireland.
11
South Dublin County Council,Ireland.

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.

KEYWORDS:

Botulism; Clostridium; public health; toxins; zoonoses

PMID:
25306863
DOI:
10.1017/S0950268814002672
[Indexed for MEDLINE]

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