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From the Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office (Drs. Gupta and Castor), and the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases (Drs. Gupta, Maslanka, and Sobel), Centers for Disease Control and Prevention, Atlanta, GA; and the Neurogenetics Branch, NINDS, National Institutes of Health (Dr. Sumner), Bethesda, MD.
Address correspondence to Dr. Amita Gupta, Johns Hopkins University, Division of Infectious Diseases, Jefferson 2-121B, 600 North Wolfe Street, Baltimore, MD 21287; e-mail: agupta25{at}jhmi.edu. Address reprint requests to Foodborne & Diarrheal Diseases Branch, Centers for Disease Control & Prevention, 1600 Clifton Road, MS-A-38, Atlanta, GA 30333.
Background: Clostridium botulinum neurotoxin types A, B, and E cause most cases of the paralytic disease botulism. Little is known about the epidemiology, clinical features, or microbiology of botulism type F.
Methods: Cases of adult type F botulism were identified by review of data collected by CDC’s National Botulism Surveillance System between 1981 and 2002. A case was either an individual whose serum or stool demonstrated type F toxin or whose stool culture yielded an organism producing toxin type F. A detailed review of cases’ medical charts and laboratory data from CDC and local health departments was performed.
Results: Between 1981 and 2002, 1,269 cases of botulism among adults and infants were reported to CDC; 13 (1%) were adult type F. The median age of type F cases was 54 years; 7 (54%) were female. None were part of outbreaks. A toxigenic Clostridium baratii was identified in 9 (69%) of 13 cases. Among 11 cases for which clinical data were available, all required mechanical ventilation for a median duration of 17 days (range, 10 to 84); 8 (73%) were intubated within 24 hours of symptom onset. All patients had nearly complete or complete quadriplegia at the nadir of neurologic dysfunction, which occurred on average on day 5. On average by day 8, improvement in neuromuscular function was noted. The median duration of acute hospitalization was 31 days (range, 20 to 60). No deaths were reported. In only one case was a possible foodborne etiology identified.
Conclusions: Toxigenic C baratii are the sole documented causes of type F botulism in the United States since 1981. These cases are characterized by a fulminant course with rapid progression to respiratory failure and paralysis, making early recognition and intervention critical to appropriate management.
Disclosure: The authors report no conflicts of interest.
These data are based on surveillance data that are routinely collected by the state and federal public health agencies and were not funded by a specific grant.
Presented in part at the 2003 Interagency Botulism Research Coordinating Committee Meeting; November 6, 2003; and the 2004 International Conference of Emerging Infectious Diseases; Atlanta, Georgia; February 29, 2004. Abstract 86.
Received June 27, 2005. Accepted in final form July 29, 2005.
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Neurology 2005 65: 1686-1687.
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