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Hoyt KM, Barr JR, Hopkins AO, Dykes JK, Lúquez C, Kalb SR. Validation of a clinical assay for botulinum neurotoxins through mass spectrometric detection. J Clin Microbiol 2024:e0162923. [PMID: 38687021 DOI: 10.1128/jcm.01629-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Botulism is a paralytic disease due to the inhibition of acetylcholine exocytosis at the neuromuscular junction, which can be lethal if left untreated. Botulinum neurotoxins (BoNTs) are produced by some spore-forming Clostridium bacteria. The current confirmatory assay to test for BoNTs in clinical specimens is the gold-standard mouse bioassay. However, an Endopep-MS assay method has been developed to detect BoNTs in clinical samples using benchtop mass spectrometric detection. This work demonstrates the validation of the Endopep-MS method for clinical specimens with the intent of method distribution in public health laboratories. The Endopep-MS assay was validated by assessing the sensitivity, robustness, selectivity, specificity, and reproducibility. The limit of detection was found to be equivalent to or more sensitive than the mouse bioassay. Specificity studies determined no cross-reactivity between the different serotypes and no false positives from an exclusivity panel of culture supernatants of enteric disease organisms and non-toxigenic strains of Clostridium. Inter-serotype specificity testing with 19 BoNT subtypes was 100% concordant with the expected results, accurately determining the presence of the correct serotype and the absence of incorrect serotypes. Additionally, a panel of potential interfering substances was used to test selectivity. Finally, clinical studies included clinical specimen stability and reproducibility, which was found to be 99.9% from a multicenter evaluation study. The multicenter validation study also included a clinical validation study, which yielded a 99.4% correct determination rate. Use of the Endopep-MS method will improve the capacity and response time for laboratory confirmation of botulism in public health laboratories.
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Affiliation(s)
- Kaitlin M Hoyt
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John R Barr
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - André O Hopkins
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janet K Dykes
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolina Lúquez
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne R Kalb
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lúquez C, Halpin JL, Dykes J. Unintended consequences: Renaming botulinum neurotoxin-producing species of clostridium and related species. Toxicon 2023; 224:107036. [PMID: 36693544 PMCID: PMC10866187 DOI: 10.1016/j.toxicon.2023.107036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/05/2023] [Accepted: 01/20/2023] [Indexed: 01/22/2023]
Abstract
Botulinum neurotoxin-producing species of Clostridium are highly diverse. Clostridium botulinum could represent at least four different species of Clostridium. In addition, strains that do not produce botulinum neurotoxin are closely related to toxigenic strains, probably representing the same species. Although reclassification of these organisms has been proposed in the past, their species names have remained unchanged, mainly because of the premise that changing names of medically relevant organisms might cause confusion in the healthcare and scientific community. In this review, we discuss the possible unintended consequences of reclassifying botulinum neurotoxin-producing species of Clostridium, which are of public health, medical, and biodefense interest.
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Affiliation(s)
- Carolina Lúquez
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Janet Dykes
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Halpin JL, Foltz V, Dykes JK, Chatham-Stephens K, Lúquez C. Clostridium botulinum Type B Isolated From a Wound Botulism Case Due to Injection Drug Use Resembles Other Local Strains Originating From Hawaii. Front Microbiol 2021; 12:678473. [PMID: 34367084 PMCID: PMC8339428 DOI: 10.3389/fmicb.2021.678473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/09/2021] [Indexed: 11/30/2022] Open
Abstract
Clostridium botulinum produces botulinum neurotoxin (BoNT), which can lead to death if untreated. In the United States, over 90% of wound botulism cases are associated with injection drug use of black tar heroin. We sought to determine the phylogenetic relatedness of C. botulinum isolated from an injection drug use wound botulism case and isolates from endogenous infant botulism cases in Hawaii. Nineteen C. botulinum type B isolates from Hawaii and one type B isolate from California were analyzed by whole-genome sequencing. The botulinum toxin gene (bont) subtype was determined using CLC Genomics Workbench, and the seven-gene multi-locus sequence type (MLST) was identified by querying PubMLST. Mashtree and pairwise average nucleotide identity were used to find nearest neighbors, and Lyve-SET approximated a phylogeny. Eighteen of the isolates harbored the bont/B5 gene: of those, 17 were classified as sequence type ST36 and one was classified as ST104. A single isolate from Hawaii harbored bont/B1 and was determined to belong to ST110, and the isolate from California harbored bont/B1 and belonged to ST30. A tree constructed with Lyve-SET showed a high degree of homology among all the Hawaiian C. botulinum isolates that harbor the bont/B5 gene. Our results indicate that the bont/B-expressing isolates recovered from Hawaii are closely related to each other, suggesting local contamination of the drug paraphernalia or the wound itself with spores rather than contamination of the drug at manufacture or during transport. These findings may assist in identifying interventions to decrease wound botulism among persons who inject drugs.
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Affiliation(s)
- Jessica L. Halpin
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Abstract
Foodborne botulism is an intoxication caused by ingestion of food containing botulinum neurotoxin. Cases of foodborne botulism are usually sporadic (single, unrelated) but outbreaks of two or more cases occur. In this mini-review we will examine the following for the period 2001–2017, in the United States: botulism surveillance data, outbreaks of botulism affecting 10 or more people, and the public health preparedness and response approach.
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Affiliation(s)
- Carolina Lúquez
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Leslie Edwards
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Chelsey Griffin
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jeremy Sobel
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Gladney L, Halpin JL, Lúquez C. Genomic Characterization of Strains From a Cluster of Infant Botulism Type A in a Small Town in Colorado, United States. Front Microbiol 2021; 12:688240. [PMID: 34326824 PMCID: PMC8313963 DOI: 10.3389/fmicb.2021.688240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Three cases of infant botulism were reported in a small Colorado town between 1981 and 1984. The first two cases occurred in 1981, 6 months apart, and the third case occurred in 1984. Clostridium botulinum type A was isolated from stool of all three case patients and from environmental samples of the patient's homes. An epidemiological investigation and follow-up study were conducted from 1981 to 1986 and concluded the cases were likely related. In this study, we sought to determine whether the C. botulinum type A clinical isolates were related to each other and to isolates obtained from environmental samples. We performed whole genome sequencing (WGS) for 17 isolates associated with this potential cluster of infant botulism. Fifteen isolates were confirmed to be C. botulinum type A(B) and contained botulinum toxin gene subtypes A1 and B5 by WGS; these strains formed a monophyletic cluster in a phylogeny and were considered closely related to each other (0-18 high-quality single-nucleotide polymorphisms), but distinct from other C. botulinum type A(B) in Colorado and elsewhere in the United States. Results of our study suggest that the three infant botulism cases could have represented a cluster due to a C. botulinum type A(B) strain present in the environment.
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Affiliation(s)
- Lori Gladney
- National Botulism Laboratory, Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Halpin JL, Dykes JK, Katz L, Centurioni DA, Perry MJ, Egan CT, Lúquez C. Molecular Characterization of Clostridium botulinum Harboring the bont/B7 Gene. Foodborne Pathog Dis 2019; 16:428-433. [PMID: 30932710 PMCID: PMC6585170 DOI: 10.1089/fpd.2018.2600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Clostridium botulinum produces botulinum neurotoxin (BoNT), which is the causative agent of botulism, a rare but serious disease that can result in death if not treated. Infant botulism occurs when C. botulinum colonizes the intestinal tract of infants and produces BoNT. It has been proposed that infants under the age of 1 year are uniquely susceptible to colonization by C. botulinum as their intestinal microbiota is not fully developed and provides little competition, allowing C. botulinum to thrive and produce BoNT in the gut. There are seven well-characterized serotypes (A–G) of BoNT identified by the ability of specific antitoxins to neutralize BoNTs. Molecular technology has allowed researchers to narrow these further into subtypes based on nucleic acid sequences of the botulinum toxin (bont) gene. One of the most recently recognized subtypes for bont/B is subtype bont/B7. We identified through whole genome sequencing five C. botulinum isolates harboring bont/B7 from CDC's strain collection, including patient isolates and an epidemiologically linked isolate from an opened infant formula container. In this study, we report the results of whole genome sequencing analysis of these C. botulinum subtype bont/B7 isolates. Average nucleotide identity and high quality single nucleotide polymorphism (hqSNP) analysis resulted in two major clades. The epidemiologically linked isolates differed from each other by 2–6 hqSNPs, and this clade separated from the other isolates by 95–119 hqSNPs, corroborating available epidemiological evidence.
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Affiliation(s)
- Jessica L Halpin
- 1 Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, National Botulism and Enteric Toxins Team, Atlanta, Georgia
| | - Janet K Dykes
- 1 Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, National Botulism and Enteric Toxins Team, Atlanta, Georgia
| | - Lee Katz
- 1 Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, National Botulism and Enteric Toxins Team, Atlanta, Georgia.,2 Center for Food Safety, College of Agricultural and Environmental Sciences, University of Georgia, Griffin, Georgia
| | - Dominick A Centurioni
- 3 New York State Department of Health, Wadsworth Center, David Axelrod Institute, Albany, New York
| | - Michael J Perry
- 3 New York State Department of Health, Wadsworth Center, David Axelrod Institute, Albany, New York
| | - Christina T Egan
- 3 New York State Department of Health, Wadsworth Center, David Axelrod Institute, Albany, New York
| | - Carolina Lúquez
- 1 Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, National Botulism and Enteric Toxins Team, Atlanta, Georgia
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Bergeron G, Latash J, Da Costa-Carter CA, Egan C, Stavinsky F, Kileci JA, Winstead A, Zhao B, Perry MJ, Chatham-Stephens K, Sarpel D, Hughes S, Conlon MA, Edmunds S, Mohanraj M, Rakeman JL, Centurioni DA, Lúquez C, Chiefari AK, Harper S. Notes from the Field: Botulism Outbreak Associated with Home-Canned Peas - New York City, 2018. MMWR Morb Mortal Wkly Rep 2019; 68:251-252. [PMID: 30870408 PMCID: PMC6421961 DOI: 10.15585/mmwr.mm6810a5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Halpin JL, Joseph L, Dykes JK, McCroskey L, Smith E, Toney D, Stroika S, Hise K, Maslanka S, Lúquez C. Pulsotype Diversity of Clostridium botulinum Strains Containing Serotypes A and/or B Genes. Foodborne Pathog Dis 2017; 14:494-501. [PMID: 28692343 DOI: 10.1089/fpd.2017.2280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Clostridium botulinum strains are prevalent in the environment and produce a potent neurotoxin that causes botulism, a rare but serious paralytic disease. In 2010, a national PulseNet database was established to curate C. botulinum pulsotypes and facilitate epidemiological investigations, particularly for serotypes A and B strains frequently associated with botulism cases in the United States. Between 2010 and 2014 we performed pulsed-field gel electrophoresis (PFGE) using a PulseNet protocol, uploaded the resulting PFGE patterns into a national database, and analyzed data according to PulseNet criteria (UPGMA clustering, Dice coefficient, 1.5% position tolerance, and 1.5% optimization). A retrospective data analysis was undertaken on 349 entries comprised of type A and B strains isolated from foodborne and infant cases to determine epidemiological relevance, resolution of the method, and the diversity of the database. Most studies to date on the pulsotype diversity of C. botulinum have encompassed very small sets of isolates; this study, with over 300 isolates, is more comprehensive than any published to date. Epidemiologically linked isolates had indistinguishable patterns, except in four instances and there were no obvious geographic trends noted. Simpson's Index of Diversity (D) has historically been used to demonstrate species diversity and abundance within a group, and is considered a standard descriptor for PFGE databases. Simpson's Index was calculated for each restriction endonuclease (SmaI, XhoI), the pattern combination SmaI-XhoI, as well as for each toxin serotype. The D values indicate that both enzymes provided better resolution for serotype B isolates than serotype A. XhoI as the secondary enzyme provided little additional discrimination for C. botulinum. SmaI patterns can be used to exclude unrelated isolates during a foodborne outbreak, but pulsotypes should always be considered concurrently with available epidemiological data.
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Affiliation(s)
- Jessica L Halpin
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Lavin Joseph
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Janet K Dykes
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Loretta McCroskey
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Elise Smith
- 2 PFGE Molecular Subtyping Laboratory, Virginia Division of Consolidated Laboratory Services , Richmond, Virginia
| | - Denise Toney
- 2 PFGE Molecular Subtyping Laboratory, Virginia Division of Consolidated Laboratory Services , Richmond, Virginia
| | - Steven Stroika
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Kelley Hise
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Susan Maslanka
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Carolina Lúquez
- 1 National Botulism and Enteric Toxins Team, Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention , Atlanta, Georgia
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Peck MW, Smith TJ, Anniballi F, Austin JW, Bano L, Bradshaw M, Cuervo P, Cheng LW, Derman Y, Dorner BG, Fisher A, Hill KK, Kalb SR, Korkeala H, Lindström M, Lista F, Lúquez C, Mazuet C, Pirazzini M, Popoff MR, Rossetto O, Rummel A, Sesardic D, Singh BR, Stringer SC. Historical Perspectives and Guidelines for Botulinum Neurotoxin Subtype Nomenclature. Toxins (Basel) 2017; 9:toxins9010038. [PMID: 28106761 PMCID: PMC5308270 DOI: 10.3390/toxins9010038] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/04/2017] [Accepted: 01/07/2017] [Indexed: 11/26/2022] Open
Abstract
Botulinum neurotoxins are diverse proteins. They are currently represented by at least seven serotypes and more than 40 subtypes. New clostridial strains that produce novel neurotoxin variants are being identified with increasing frequency, which presents challenges when organizing the nomenclature surrounding these neurotoxins. Worldwide, researchers are faced with the possibility that toxins having identical sequences may be given different designations or novel toxins having unique sequences may be given the same designations on publication. In order to minimize these problems, an ad hoc committee consisting of over 20 researchers in the field of botulinum neurotoxin research was convened to discuss the clarification of the issues involved in botulinum neurotoxin nomenclature. This publication presents a historical overview of the issues and provides guidelines for botulinum neurotoxin subtype nomenclature in the future.
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Affiliation(s)
| | - Theresa J Smith
- Molecular and Translational Sciences Division, United States Army Medical Institute of Infectious Diseases, Fort Detrick, MD 21702, USA.
| | - Fabrizio Anniballi
- National Reference Centre for Botulism, Istituto Superiore di Sanita, Rome 299-00161, Italy.
| | - John W Austin
- Bureau of Microbial Hazards, Health Canada, Ottawa, ON K1A 0K9, Canada.
| | - Luca Bano
- Istituto Zooprofilattico Sperimentale delle Venezie, Treviso 31020, Italy.
| | - Marite Bradshaw
- Department of Bacteriology, University of Wisconsin, Madison, WI 53706, USA.
| | - Paula Cuervo
- Área de Microbiología, Departamento de Patología, Universidad Nacional de Cuyo, Mendoza 450001, Argentina.
| | - Luisa W Cheng
- Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, U.S. Department of Agriculture, Albany, CA 94710, USA.
| | - Yagmur Derman
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki 00014, Finland.
| | | | - Audrey Fisher
- Applied Physics Laboratory, Johns Hopkins University, Baltimore, MD 21218, USA.
| | - Karen K Hill
- Los Alamos National Laboratories, Los Alamos, NM 87545, USA.
| | - Suzanne R Kalb
- National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
| | - Hannu Korkeala
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki 00014, Finland.
| | - Miia Lindström
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki 00014, Finland.
| | - Florigio Lista
- Army Medical and Veterinary Research Center, Rome 00184, Italy.
| | - Carolina Lúquez
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - Christelle Mazuet
- Institut Pasteur, Bactéries anaérobies et Toxines, Paris 75015, France.
| | - Marco Pirazzini
- Biomedical Sciences Department, University of Padova, Padova 35131, Italy.
| | - Michel R Popoff
- Institut Pasteur, Bactéries anaérobies et Toxines, Paris 75015, France.
| | - Ornella Rossetto
- Biomedical Sciences Department, University of Padova, Padova 35131, Italy.
| | - Andreas Rummel
- Institut für Toxikologie, Medizinische Hochschule Hannover, Hannover 30623, Germany.
| | - Dorothea Sesardic
- National Institute for Biological Standards and Control, a Centre of Medicines and Healthcare Products Regulatory Agency, Hertfordshire EN6 3QG, UK.
| | - Bal Ram Singh
- Botulinum Research Center, Institute of Advanced Sciences, Dartmouth, MA 02747, USA.
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Rinsky JL, Berl E, Greene V, Morrow J, Didomenico A, MacFarquhar J, Gómez G, Lúquez C, Williams C. Notes from the Field: Clostridium perfringensGastroenteritis Outbreak Associated with a Catered Lunch — North Carolina, November 2015. MMWR Morb Mortal Wkly Rep 2016; 65:1300-1301. [DOI: 10.15585/mmwr.mm6546a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Shirey TB, Dykes JK, Lúquez C, Maslanka SE, Raphael BH. Characterizing the fecal microbiota of infants with botulism. Microbiome 2015; 3:54. [PMID: 26593441 PMCID: PMC4655454 DOI: 10.1186/s40168-015-0119-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/28/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Infant botulism is the most prevalent form of botulism in the USA, representing 68.5 % of cases reported from 2001-2012. Infant botulism results when botulinum toxin-producing clostridia (BTPC) colonize the infant gut with concomitant in vivo production of the highly potent botulinum neurotoxin (BoNT). The gut microbiota of infants with botulism is largely uncharacterized; therefore, it remains unclear whether the microbiota profile of these patients are distinct in composition, abundance, or diversity. To address this uncertainty, we employed 16S rRNA gene profiling to characterize the fecal microbiota in 14 stool samples among laboratory-confirmed and non-confirmed infant botulism cases. RESULTS Seven bacterial phyla were identified among all 14 infant stool samples examined. Compared to samples from non-confirmed cases, the fecal microbiota of infant botulism patients displayed significantly higher Proteobacteria abundance. Of the 20 bacterial families identified, Enterobacteriaceae was significantly more abundant in samples from infants with botulism. Firmicutes abundance and the abundance ratio of Firmicutes/Proteobacteria was significantly lower in samples from infants with botulism. Lactobacillus spp. abundance was notably reduced in 12 of the 14 samples. Clostridium botulinum and Clostridium baratii were identified in low relative abundances in confirmed and non-confirmed samples based on their 16S rRNA gene profiles, although their toxigenicity remained undetermined. No significant differences were observed in the number of operational taxonomic units (OTUs) observed or in fecal microbiota diversity between laboratory-confirmed and non-confirmed samples. Correlations between individual phylum abundances and infant age were variable, and no significant differences were shown in number of OTUs observed or in fecal microbiota diversity between samples delineated by overall mean age. CONCLUSIONS Significant differences in Proteobacteria, Firmicutes, and Enterobacteriaceae abundances were identified in the fecal microbiota of infants with botulism when compared to samples from non-confirmed cases. Fecal microbiota diversity was not significantly altered in infants with botulism, and a limited presence of BTPC was shown. It could not be determined whether the fecal microbiota profiles shown here were comparable prior to patient illness, or whether they were the direct result of infant botulism. The results of this study do, however, provide a detailed and descriptive observation into the infant gut microbiota after intestinal colonization by BTPC.
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Affiliation(s)
- T Brian Shirey
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Janet K Dykes
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Carolina Lúquez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Susan E Maslanka
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
| | - Brian H Raphael
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.
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Dykes JK, Lúquez C, Raphael BH, McCroskey L, Maslanka SE. Laboratory Investigation of the First Case of Botulism Caused by Clostridium butyricum Type E Toxin in the United States. J Clin Microbiol 2015; 53:3363-5. [PMID: 26246485 PMCID: PMC4572528 DOI: 10.1128/jcm.01351-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 07/24/2015] [Indexed: 11/20/2022] Open
Abstract
We report here the laboratory investigation of the first known case of botulism in the United States caused by Clostridium butyricum type E. This investigation demonstrates the importance of extensive microbiological examination of specimens, which resulted in the isolation of this organism.
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Affiliation(s)
- Janet K Dykes
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carolina Lúquez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brian H Raphael
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Loretta McCroskey
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan E Maslanka
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Lúquez C, Bianco M, Sagua M, Barzola C, de Jong L, Degarbo S, Fernández R. Relationship between the incidence of infant botulism and the presence of botulinum-toxin producing clostridia in the soil of Argentina from 1982–2005. J Pediatr Neurol 2015. [DOI: 10.1055/s-0035-1557408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Carolina Lúquez
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - María Bianco
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - María Sagua
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Cristian Barzola
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Laura de Jong
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Stella Degarbo
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Rafael Fernández
- Departamento de Patología, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
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Maslanka SE, Lúquez C, Dykes JK, Tepp WH, Pier CL, Pellett S, Raphael BH, Kalb SR, Barr JR, Rao A, Johnson EA. A Novel Botulinum Neurotoxin, Previously Reported as Serotype H, Has a Hybrid-Like Structure With Regions of Similarity to the Structures of Serotypes A and F and Is Neutralized With Serotype A Antitoxin. J Infect Dis 2015; 213:379-85. [PMID: 26068781 DOI: 10.1093/infdis/jiv327] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/16/2015] [Indexed: 01/13/2023] Open
Abstract
Botulism is a potentially fatal paralytic disease caused by the action of botulinum neurotoxin (BoNT) on nerve cells. There are 7 known serotypes (A-G) of BoNT and up to 40 genetic variants. Clostridium botulinum strain IBCA10-7060 was recently reported to produce BoNT serotype B (BoNT/B) and a novel BoNT, designated as BoNT/H. The BoNT gene (bont) sequence of BoNT/H was compared to known bont sequences. Genetic analysis suggested that BoNT/H has a hybrid-like structure containing regions of similarity to the structures of BoNT/A1 and BoNT/F5. This novel BoNT was serologically characterized by the mouse neutralization assay and a neuronal cell-based assay. The toxic effects of this hybrid-like BoNT were completely eliminated by existing serotype A antitoxins, including those contained in multivalent therapeutic antitoxin products that are the mainstay of human botulism treatment.
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Affiliation(s)
| | - Carolina Lúquez
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Janet K Dykes
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - William H Tepp
- Department of Bacteriology, University of Wisconsin-Madison
| | | | - Sabine Pellett
- Department of Bacteriology, University of Wisconsin-Madison
| | - Brian H Raphael
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne R Kalb
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John R Barr
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam Rao
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric A Johnson
- Department of Bacteriology, University of Wisconsin-Madison
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Kalb SR, Baudys J, Raphael BH, Dykes JK, Lúquez C, Maslanka SE, Barr JR. Functional characterization of botulinum neurotoxin serotype H as a hybrid of known serotypes F and A (BoNT F/A). Anal Chem 2015; 87:3911-7. [PMID: 25731972 DOI: 10.1021/ac504716v] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A unique strain of Clostridium botulinum (IBCA10-7060) was recently discovered which produces two toxins: botulinum neurotoxin (BoNT) serotype B and a novel BoNT reported as serotype H. Previous molecular assessment showed that the light chain (LC) of the novel BoNT most resembled the bont of the light chain of known subtype F5, while the C-terminus of the heavy chain (HC) most resembled the binding domain of serotype A. We evaluated the functionality of both toxins produced in culture by first incorporating an immunoaffinity step using monoclonal antibodies to purify BoNT from culture supernatants and tested each immune-captured neurotoxin with full-length substrates vesicle-associated membrane protein 2 (VAMP-2), synaptosomal-associated protein 25 (SNAP-25), syntaxin, and shortened peptides representing the substrates. The BoNT/B produced by this strain behaved as a typical BoNT/B, having immunoaffinity for anti-B monoclonal antibodies and cleaving both full length VAMP-2 and a peptide based on the sequence of VAMP-2 in the expected location. As expected, there was no activity toward SNAP-25 or syntaxin. The novel BoNT demonstrated immunoaffinity for anti-A monoclonal antibodies but did not cleave SNAP-25 as expected for BoNT/A. Instead, the novel BoNT cleaved VAMP-2 and VAMP-2-based peptides in the same location as BoNT/F5. This is the first discovery of a single botulinum neurotoxin with BoNT/A antigenicity and BoNT/F light chain function. This work suggests that the newly reported serotype H may actually be a hybrid of previously known BoNT serotype A and serotype F, specifically subtype F5.
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Affiliation(s)
- Suzanne R Kalb
- †Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy NE, Atlanta, Georgia 30341, United States
| | - Jakub Baudys
- †Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy NE, Atlanta, Georgia 30341, United States
| | - Brian H Raphael
- ‡Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, 1600 Clifton Road, Atlanta, Georgia 30329, United States
| | - Janet K Dykes
- ‡Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, 1600 Clifton Road, Atlanta, Georgia 30329, United States
| | - Carolina Lúquez
- ‡Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, 1600 Clifton Road, Atlanta, Georgia 30329, United States
| | - Susan E Maslanka
- ‡Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, 1600 Clifton Road, Atlanta, Georgia 30329, United States
| | - John R Barr
- †Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy NE, Atlanta, Georgia 30341, United States
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Kalb SR, Krilich JC, Dykes JK, Lúquez C, Maslanka SE, Barr JR. Detection of Botulinum Toxins A, B, E, and F in Foods by Endopep-MS. J Agric Food Chem 2015; 63:1133-1141. [PMID: 25578960 PMCID: PMC4523457 DOI: 10.1021/jf505482b] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Botulism is caused by exposure to botulinum neurotoxins (BoNTs). BoNTs are proteins secreted by some species of clostridia; these neurotoxins are known to interfere with nerve impulse transmission, thus causing paralysis. Botulism may be contracted through consumption of food either naturally or intentionally contaminated with BoNT. The human lethal dose of BoNT is not known but is estimated to be between 0.1 and 70 μg; thus, it is important to be able to detect small amounts of this toxin in foods to ensure food safety and to identify the source of an outbreak. Our laboratory previously reported on the development of Endopep-MS, a mass-spectrometric-based endopeptidase method for the detection and differentiation of BoNT. This method can detect BoNT at levels below the historic standard mouse bioassay in clinical samples such as serum, stool, and culture supernatants. We have now expanded this assay to detect BoNT in over 50 foods including representative products that were involved in actual botulism investigations. The foods tested by the Endopep-MS included those with various acidities, viscosities, and fat levels. Dairy and culturally diverse products were also included. This work demonstrates that the Endopep-MS method can be used to detect BoNT/A, /B, /E, and /F in foods at levels spiked below that of the limit of detection of the mouse bioassay. Furthermore, we successfully applied this method to investigate several foods associated with botulism outbreaks.
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Affiliation(s)
- Suzanne R. Kalb
- Centers for Disease Control and Prevention, National Center of Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, NE, Atlanta, GA 30341
| | - Joan C. Krilich
- Battelle Memorial Institute under contract at the Centers for Disease Control and Prevention, Atlanta, GA
| | - Janet K. Dykes
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, Atlanta, GA 30329
| | - Carolina Lúquez
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, Atlanta, GA 30329
| | - Susan E. Maslanka
- Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Enteric Diseases Laboratory Branch, Atlanta, GA 30329
| | - John R. Barr
- Centers for Disease Control and Prevention, National Center of Environmental Health, Division of Laboratory Sciences, 4770 Buford Hwy, NE, Atlanta, GA 30341
- Corresponding Author: Tel: 770-488-7848; Fax: 770-488-4609;
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Kalb SR, Baudys J, Raphael BH, Dykes JK, Lúquez C, Maslanka SE, Barr JR. 115. Functional characterization of a novel botulinum neurotoxin F/A hybrid. Toxicon 2015. [DOI: 10.1016/j.toxicon.2014.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
Pulsed-field gel electrophoresis (PFGE) has been extensively used to estimate the genetic diversity of Clostridium botulinum. In addition, PFGE is the standard method for investigating foodborne outbreaks associated with various enteric pathogens, including C. botulinum. PFGE can be used to exclude a suspected but not confirmed food source when the patterns of the food and clinical isolates are different. Indistinguishable PFGE patterns may also be useful for linking isolates between patients or to a food source, but results must be interpreted within an epidemiological context to ensure isolates are truly related. Here, we describe a standardized laboratory protocol for molecular subtyping of C. botulinum by PFGE.
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Affiliation(s)
- Carolina Lúquez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, MS G-29, Atlanta, GA, 30329, USA,
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Raphael BH, Shirey TB, Lúquez C, Maslanka SE. Distinguishing highly-related outbreak-associated Clostridium botulinum type A(B) strains. BMC Microbiol 2014; 14:192. [PMID: 25031122 PMCID: PMC4112988 DOI: 10.1186/1471-2180-14-192] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the United States, most Clostridium botulinum type A strains isolated during laboratory investigations of human botulism demonstrate the presence of an expressed type A botulinum neurotoxin (BoNT/A) gene and an unexpressed BoNT/B gene. These strains are designated type A(B). The most common pulsed-field gel electrophoresis (PFGE) pattern in the C. botulinum PulseNet database is composed of A(B) strains. The purpose of this study was to evaluate the ability of genome sequencing and multi-loci variable number of tandem repeat analysis (MLVA) to differentiate such strains. RESULTS The genome sequences of type A(B) strains evaluated in this study are closely related and cluster together compared to other available C. botulinum Group I genomes. In silico multilocus sequence typing (MLST) analysis (7-loci) was unable to differentiate any of the type A(B) strains isolated from seven different outbreak investigations evaluated in this study. A 15-locus MLVA scheme demonstrated an improved ability to differentiate these strains, however, repeat unit variation among the strains was restricted to only two loci. Reference-free single nucleotide polymorphism (SNP) analysis demonstrated the ability to differentiate strains from all of the outbreaks examined and a non-outbreak associated strain. CONCLUSIONS This study confirms that type A(B) strains that share the same PFGE pattern also share closely-related genome sequences. The lack of a complete type A(B) strain representative genome sequence hinders the ability to assemble genomes by reference mapping and analysis of SNPs at pre-identified sites. However, compared to other methods evaluated in this study, a reference-free SNP analysis demonstrated optimal subtyping utility for type A(B) strains using de novo assembled genome sequences.
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Affiliation(s)
- Brian H Raphael
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Timothy B Shirey
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Carolina Lúquez
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Susan E Maslanka
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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20
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Raphael BH, Lautenschlager M, Kalb SR, de Jong LIT, Frace M, Lúquez C, Barr JR, Fernández RA, Maslanka SE. Analysis of a unique Clostridium botulinum strain from the Southern hemisphere producing a novel type E botulinum neurotoxin subtype. BMC Microbiol 2012; 12:245. [PMID: 23113872 PMCID: PMC3558463 DOI: 10.1186/1471-2180-12-245] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/30/2012] [Indexed: 01/01/2023] Open
Abstract
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.
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Affiliation(s)
- Brian H Raphael
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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21
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Juliao PC, Maslanka S, Dykes J, Gaul L, Bagdure S, Granzow-Kibiger L, Salehi E, Zink D, Neligan RP, Barton-Behravesh C, Lúquez C, Biggerstaff M, Lynch M, Olson C, Williams I, Barzilay EJ. National outbreak of type a foodborne botulism associated with a widely distributed commercially canned hot dog chili sauce. Clin Infect Dis 2012; 56:376-82. [PMID: 23097586 DOI: 10.1093/cid/cis901] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND On 7 and 11 July 2007, health officials in Texas and Indiana, respectively, reported 4 possible cases of type A foodborne botulism to the US Centers for Disease Control and Prevention. Foodborne botulism is a rare and sometimes fatal illness caused by consuming foods containing botulinum neurotoxin. METHODS Investigators reviewed patients' medical charts and food histories. Clinical specimens and food samples were tested for botulinum toxin and neurotoxin-producing Clostridium species. Investigators conducted inspections of the cannery that produced the implicated product. RESULTS Eight confirmed outbreak associated cases were identified from Indiana (n = 2), Texas (n = 3), and Ohio (n = 3). Botulinum toxin type A was identified in leftover chili sauce consumed by the Indiana patients and 1 of the Ohio patients. Cannery inspectors found violations of federal canned-food regulations that could have led to survival of Clostridium botulinum spores during sterilization. The company recalled 39 million cans of chili. Following the outbreak, the US Food and Drug Administration inspected other canneries with similar canning systems and issued warnings to the industry about the danger of C. botulinum and the importance of compliance with canned food manufacturing regulations. CONCLUSIONS Commercially produced hot dog chili sauce caused these cases of type A botulism. This is the first US foodborne botulism outbreak involving a commercial cannery in >30 years. Sharing of epidemiologic and laboratory findings allowed for the rapid identification of implicated food items and swift removal of potentially deadly products from the market by US food regulatory authorities.
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Affiliation(s)
- Patricia C Juliao
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Abstract
We report a case of type F botulism in a patient with bilateral but asymmetric neurologic deficits. Cranial nerve demyelination was found during autopsy. Bilateral, asymmetric clinical signs, although rare, do not rule out botulism. Demyelination of cranial nerves might be underrecognized during autopsy of botulism patients.
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Affiliation(s)
- Alina Filozov
- Division of Infectious Diseases, Middlesex Hospital, 80 S Main St, Middletown, CT 06457, USA. alina.fi
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Vanella de Cuetos EE, Fernandez RA, Bianco MI, Sartori OJ, Piovano ML, Lúquez C, de Jong LIT. Equine botulinum antitoxin for the treatment of infant botulism. Clin Vaccine Immunol 2011; 18:1845-9. [PMID: 21918119 PMCID: PMC3209035 DOI: 10.1128/cvi.05261-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 09/01/2011] [Indexed: 11/20/2022]
Abstract
Infant botulism is the most common form of human botulism in Argentina and the United States. BabyBIG (botulism immune globulin intravenous [human]) is the antitoxin of choice for specific treatment of infant botulism in the United States. However, its high cost limits its use in many countries. We report here the effectiveness and safety of equine botulinum antitoxin (EqBA) as an alternative treatment. We conducted an analytical, observational, retrospective, and longitudinal study on cases of infant botulism registered in Mendoza, Argentina, from 1993 to 2007. We analyzed 92 medical records of laboratory-confirmed cases and evaluated the safety and efficacy of treatment with EqBA. Forty-nine laboratory-confirmed cases of infant botulism demanding admission in intensive care units and mechanical ventilation included 31 treated with EqBA within the 5 days after the onset of signs and 18 untreated with EqBA. EqBA-treated patients had a reduction in the mean length of hospital stay of 23.9 days (P = 0.0007). For infants treated with EqBA, the intensive care unit stay was shortened by 11.2 days (P = 0.0036), mechanical ventilation was reduced by 11.1 days (P = 0.0155), and tube feeding was reduced by 24.4 days (P = 0.0001). The incidence of sepsis in EqBA-treated patients was 47.3% lower (P = 0.0017) than in the untreated ones. Neither sequelae nor adverse effects attributable to EqBA were noticed, except for one infant who developed a transient erythematous rash. These results suggest that prompt treatment of infant botulism with EqBA is safe and effective and that EqBA could be considered an alternative specific treatment for infant botulism when BabyBIG is not available.
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Affiliation(s)
- Elida E Vanella de Cuetos
- Unidad de Terapia Intensiva, Hospital Pediátrico Humberto J. Notti, Suipacha 1479, CP M5501AWA, Godoy Cruz, Mendoza, Argentina.
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Wilder-Kofie TD, Lúquez C, Adler M, Dykes JK, Coleman JD, Maslanka SE. An alternative in vivo method to refine the mouse bioassay for botulinum toxin detection. Comp Med 2011; 61:235-242. [PMID: 21819693 PMCID: PMC3123756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 12/10/2010] [Accepted: 12/15/2010] [Indexed: 05/31/2023]
Abstract
Botulism is a rare, life-threatening paralytic disease of both humans and animals that is caused by botulinum neurotoxins (BoNT). Botulism is confirmed in the laboratory by the detection of BoNT in clinical specimens, contaminated foods, and cultures. Despite efforts to develop an in vitro method for botulinum toxin detection, the mouse bioassay remains the standard test for laboratory confirmation of this disease. In this study, we evaluated the use of a nonlethal mouse toe-spread reflex model to detect BoNT spiked into buffer, serum, and milk samples. Samples spiked with toxin serotype A and nontoxin control samples were injected into the left and right extensor digitorum longus muscles, respectively. Digital photographs at 0,8, and 24 h were used to obtain objective measurements through effective paralysis scores, which were determined by comparing the width-to-length ratio between right and left feet. Both objective measurements and clinical observation could accurately identify over 80% of animals injected with 1 LD(50) (4.3 pg) BoNT type A within 24 h. Half of animals injected with 0.5 LD(50) BoNT type A and none injected with 0.25 LD(50) demonstrated localized paralysis. Preincubating the toxin with antitoxin prevented the development of positive effective paralysis scores, demonstrating that (1) the effect was specific for BoNT and (2) identification of toxin serotype could be achieved by using this method. These results suggest that the mouse toe-spread reflex model may be a more humane alternative to the current mouse bioassay for laboratory investigations of botulism.
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Affiliation(s)
- Temeri D Wilder-Kofie
- Divisions of Scientific Resources Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolina Lúquez
- Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Michael Adler
- Medical Research Institute of Chemical Defense, United States Army, Aberdeen Proving Ground, Maryland
| | - Janet K Dykes
- Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - JoAnn D Coleman
- Divisions of Scientific Resources Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan E Maslanka
- Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Raphael BH, Joseph LA, McCroskey LM, Lúquez C, Maslanka SE. Detection and differentiation of Clostridium botulinum type A strains using a focused DNA microarray. Mol Cell Probes 2010; 24:146-53. [PMID: 20056143 DOI: 10.1016/j.mcp.2009.12.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 12/11/2009] [Accepted: 12/24/2009] [Indexed: 10/20/2022]
Abstract
A focused oligonucleotide microarray featuring 62 probes targeting strain variable regions of the Clostridium botulinum strain ATCC 3502 genome sequence was developed to differentiate C. botulinum type A strains. The strain variable regions were selected from deletions identified among a panel of 10 type A strains compared to the strain ATCC 3502 genome sequence using high density comparative genomic hybridization microarrays. The focused microarray also featured specific probes for the detection of the neurotoxin genes of various serotypes (A-G), toxin gene cluster components (ha70 and orfX1), and fldB as a marker for proteolytic clostridia (Group I). Eight pairs of strains selected from separate type A botulism outbreaks were included in the 27 subtype A1-A4 strains examined in this study. Each outbreak related strain pair consisted of strains isolated from different sources (stool and food). Of the eight outbreak related strain pairs, six groups of strains with indistinguishable hybridization patterns were identified. Outbreak related strains were shown to have identical hybridization patterns. Strain pairs from three separate outbreaks involving strains harboring both the type A neurotoxin gene (bont/A) and an unexpressed type B neurotoxin gene (bont/B) shared the same probe hybridization profile. The focused microarray format provides a rapid approach for neurotoxin gene detection and preliminary determination of the relatedness of strains isolated from different sources.
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Affiliation(s)
- Brian H Raphael
- Enteric Diseases Laboratory Branch, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
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26
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Bianco MI, Lúquez C, De Jong LIT, Fernández RA. Linden flower (Tilia spp.) as potential vehicle of Clostridium botulinum spores in the transmission of infant botulism. Rev Argent Microbiol 2009; 41:232-236. [PMID: 20085187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
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.
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Affiliation(s)
- M I Bianco
- Area Microbiología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Parque General San Martín S/N, Mendoza, Argentina
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27
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Sagua MD, Lúquez C, Barzola CP, Bianco MI, Fernández RA. Phenotypic characterization of Clostridium botulinum strains isolated from infant botulism cases in Argentina. Rev Argent Microbiol 2009; 41:141-147. [PMID: 19831311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
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.
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Affiliation(s)
- M D Sagua
- Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo. Centro Universitario, Parque General San Martin S/N (5500) Mendoza, Argentina.
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Bianco MI, Lúquez C, de Jong LIT, Fernández RA. Presence of Clostridium botulinum spores in Matricaria chamomilla (chamomile) and its relationship with infant botulism. Int J Food Microbiol 2007; 121:357-60. [PMID: 18068252 DOI: 10.1016/j.ijfoodmicro.2007.11.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 10/02/2007] [Accepted: 11/06/2007] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- María I Bianco
- Area Microbiología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Parque General San Martín S/N, 5500, Mendoza, Argentina
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Lúquez C, Bianco MI, de Jong LIT, Sagua MD, Arenas GN, Ciccarelli AS, Fernández RA. Distribution of botulinum toxin-producing clostridia in soils of Argentina. Appl Environ Microbiol 2005; 71:4137-9. [PMID: 16000834 PMCID: PMC1168975 DOI: 10.1128/aem.71.7.4137-4139.2005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We studied the presence of botulinum toxin-producing clostridia in 2,009 soil samples from five geographical regions of Argentina. The prevalence was 23.5%, and the distribution was not homogeneous among the regions. We observed a great multiplicity of serological types and a higher prevalence in nonvirgin soils than in virgin soils.
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Affiliation(s)
- Carolina Lúquez
- Area Microbiología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Parque General San Martín S/N, 5500, Mendoza, Argentina
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Lúquez C, Fernández RA, Bianco MI, de Jong LIT, Saldaño V, Ciccarelli AS. [Presence of botulinum-producing clostridia in the soils of Entre Ríos]. Rev Argent Microbiol 2003; 35:45-8. [PMID: 12833680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Botulism, well known for centuries, continues to preoccupy the Public Health authorities, food and agricultural industries. In its oldest form it results from ingestion of food containing botulinum toxin. To correctly evaluate the incidence of botulism it is fundamental to know the distribution of botulinum toxin-producing clostridia (Clostridium botulinum, C. baratii, C. butyricum and C. argentinense) in nature, specially in the soil, its main reservoir. In our country, this study has been carried out in a partial way. With the aim to contribute to such knowledge, 240 soil samples from Entre Ríos province were examined for C. botulinum and 35 (14.6%) samples resulted positive.
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Affiliation(s)
- C Lúquez
- Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Casilla de correo 33, Mendoza, Argentina
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