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

• Published in: Epidemiology and infection Vol. 143; no. 3; pp. 461 - 469
• Main Authors: SHELLEY, E. B., O'ROURKE, D., GRANT, K., McARDLE, E., CAPRA, L., CLARKE, A., McNAMARA, E., CUNNEY, R., McKEOWN, P., AMAR, C. F. L., COSGROVE, C., FITZGERALD, M., HARRINGTON, P., GARVEY, P., GRAINGER, F., GRIFFIN, J., LYNCH, B. J., McGRANE, G., MURPHY, J., NI SHUIBHNE, N., PROSSER, J.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.02.2015
• Subjects: Animals; Botulinum Antitoxin - therapeutic use; Botulinum Toxins - analysis; Botulism; Botulism - diagnosis; Botulism - pathology; Botulism - therapy; Breastfeeding & lactation; Cheese; Clostridium botulinum; Clostridium butyricum; Clostridium butyricum - classification; Clostridium butyricum - genetics; Clostridium butyricum - isolation & purification; Feces - chemistry; Food; Gastrointestinal infection and food poisoning; Humans; Infant, Newborn; Intensive care; Laboratories; Male; Molecular Typing; Original Papers; Pets; Public health; Reptiles; Trachemys scripta scripta; Treatment Outcome; United Kingdom; Ventilators; Water Microbiology; United States > US; British Isles; Clostridium; zoonoses; Botulism; public health; toxins
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268814002672

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.