Botulism

Botulism is a life-threatening neuroparalytic syndrome caused by the neurotoxins of Clostridium botulinum1. C. botulinum is a gram positive, spore forming bacillus found naturally in soil and aquatic sediments1. Most human cases of botulism are caused by types A, B and E1. The toxin binds to receptors on presynaptic terminals of cholinergic synapses and produces an irreversible disruption in stimulation-induced acetylcholine release by that presynaptic nerve terminal 2. Return of synaptic function occurs with growth of new terminals and formation of a new synapse2. There are five common manifestations of the disease: foodborne(most common in Canada), infantile, wound, and adult enteric botulism(or colonization botulism)1.

Patients with colonization botulism develop enteric colonization with Clostridia after ingesting a food that contains spores of C. botulinum1. The normal gastrointestinal (GI) tract, except in infants, is resistant to colonization by C. botulinum2. It is thought that achlorhydria, GI diseases especially Crohn’s disease, or the post-operative state predispose to colonization2,4. Colonization botulism resembles infant botulism in its pathogenesis and clinical status2. It is extremely rare syndrome and approximately 10 cases have been documented worldwide between 1973 and 20074. In late 2006, 2 patients in Ontario were confirmed as having colonization botulism. To our knowledge, this is the first documented report of a link between a food and colonization botulism.

The clinical presentation of botulism has a stereotypical pattern1. Vomiting, diarrhea, nausea, and fatigue are usually the initial symptoms. Invariably, cranial nerve palsies develop and are followed by descending limb muscle weakness and, in severe cases, by respiratory failure1. The sensory system and mentation are spared1. Laboratory proof is established with detection of the toxin in the patient’s serum or stool (or wound) or through culture of C. botulinum from gastric...