Advertisement

Type B botulism in man

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      An outbreak of type B botulism occurring in four of eight family members consuming a meal of home-canned “pickled” beans is reported. With the exception of somnolence, which has not been emphasized previously, the symptoms and signs were virtually identical with those noted previously in an outbreak of type E disease studied by the same group.
      Routine laboratory studies were of no aid in establishing a diagnosis. Electromyographic and electroencephalographic studies were likewise unrevealing. However, electrocardiograms in three of the four patients showed changes in the T waves adding to the mounting evidence that botulinus toxins exert a direct cardiac action.
      The mouse inoculation test again proved to be a useful tool in confirming the diagnosis of botulism. Serum obtained from all four patients seven to nine days after toxin ingestion contained a mouse-toxic substance which in two cases could be definitely identified as type B toxin by neutralization tests. As noted in past outbreaks of botulism, the clinical disease did not develop in all who ate the toxin-contaminated food. Studies on those who escaped disease in this outbreak failed to demonstrate pre-existing botulinus antitoxin. The 50 per cent attack rate and the possible presence of toxin in the blood stream of one asymptomatic subject who consumed the contaminated beans suggest that certain individuals may possess inherent resistance mechanisms to botulinus toxins which are not yet defined.
      As with type E disease, type B botulism did not result in detectable antibody response. Type B antitoxin was found only in those subjects who received antitoxin therapy; it did not appear after recovery from clinical botulism and was not evoked by botulinus toxoid.
      All the patients in the present series recovered completely. Ophthalmologic abnormalities were the last to return to normal. Contrary to experience with type E disease, antitoxin therapy was not accompanied by dramatic clinical improvement. However, the demonstration of toxin in the blood stream of patients long after toxin ingestion suggests that all persons with moderate or severe clinical botulism should be treated with antitoxin when the diagnosis is made to neutralize toxin as yetunbound.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. 3rd ed. Morbidity and Mortality Weekly Report. vol. 13. U. S. Department of Health, Education and Welfare, Atlanta, Georgia1964: 373 (Public Health Service)
        • Rogers D.E.
        • Koenig M.G.
        • Spickard A.
        Clinical and laboratory manifestations of Type E botulism in man.
        Tr. A. Am. Physicians. 1964; 77: 134
        • Koenig M.G.
        • Spickard A.
        • Cardella M.A.
        • Rogers D.E.
        Clinical and laboratory observations on type E botulism in man.
        Medicine. 1964; 43: 517
        • Petty C.S.
        Botulism. The disease and the toxin.
        Am. J. M. Sc. 1965; 249: 345
        • Ager E.A.
        • Dolman C.E.
        Type E botulism. Report of an outbreak in Washington.
        J.A.M.A. 1964; 187: 588
        • Whittaker R.L.
        • Gilbertson R.B.
        • Garrett Jr., A.S.
        Botulism, type E. Report of eight simultaneous cases.
        Ann. Int. Med. 1964; 61: 448
        • Rogers D.E.
        Botulism, Vintage 1963.
        Ann. Int. Med. 1964; 61: 581
      2. Botulism.
        in: Proceedings of Symposium. 3rd ed. PHS Publication No. 999-FP-1. Public Health Service, Cincinnati, Ohio1964
        • Wright G.G.
        • Duff J.T.
        • Fiock M.A.
        • Devlin H.B.
        • Soderstrom R.L.
        Studies on immunity to toxins of Clostridium botulinum. V. Detoxification of purified type A and type B toxins, and the antigenicity of univalent and bivalent aluminum phosphate adsorbed toxoids.
        J. Immunol. 1960; 84: 384
        • Dickson E.C.
        • Shevky E.
        Botulism. Studies on the manner in which the toxin of Clostridium botulinum acts upon the body. I. The effect upon the autonomic nervous system.
        J. Exper. Med. 1923; 37: 711
        • Dickson E.C.
        • Shevky E.
        Botulism. Studies on the manner in which the toxin of Clostridium botulinum acts upon the body. II. The effect upon the voluntary nervous system.
        J. Exper. Med. 1923; 38: 327
        • Guyton A.C.
        • MacDonald M.A.
        Physiology of botulinus toxin.
        Arch. Neurol. Psych. 1947; 57: 578
        • Ambache N.
        The peripheral action of Cl, botulinum toxin.
        J. Physiol. 1949; 108: 127
        • Brooks V.B.
        Motor nerve filament block produced by botulinum toxin.
        Science. 1953; 117: 334
        • Wright G.P.
        The neurotoxins of Clostridium botulinum and Clostridium tetani.
        Pharmacol. Rev. 1955; 7: 413
        • Iida H.
        • Nakamura Y.
        • Nakagawa I.
        • Karashimada T.
        Additional type E botulism outbreaks in Hokkaido, Japan.
        Japan J. M. Sc. & Biol. 1958; 11: 215
        • Bishop G.H.
        • Bronfenbrenner J.J.
        The site of action of botulinus toxin.
        Am. J. Physiol. 1936; 117: 393
        • Erzina G.A.
        • Mikhailov V.V.
        On the mechanism of the action of botulinus type A toxin on frog heart.
        Bull. Exper. Biol. & Med. (U.S.S.R.). 1956; 41: 129
        • Erzina G.A.
        Effect of adenosinetriphosphoric acid and cysteine on the contraction of isolated frog heart poisoned by botulinus toxin.
        Bull. Exper. Biol. & Med. (U.S.S.R.). 1956; 42: 933
        • Pedersen J.
        • Christensen A.
        Shock in botulism treated with dextran and blood.
        Lancet. 1952; 2: 560
        • Meyer K.F.
        Food poisoning.
        New England J. Med. 1953; 249: 843
        • Neussle W.F.
        • Miller H.E.
        • Schaaf F.H.K.
        A case report of suspected botulism.
        Minnesota Med. 1961; 44: 192
        • Tyler H.R.
        Botulism.
        Arch. Neurol. 1963; 9: 652
        • Petersén I.
        • Broman A.
        Electromyographic findings in a case of botulism.
        Nord. Med. 1961; 65: 259
        • Tyler H.R.
        Physiological observations in human botulism.
        Arch. Neurol. 1963; 9: 661
        • Tyler H.R.
        Botulinus toxin. Effect on the central nervous system of man.
        Science. 1963; 139: 847
        • Polley E.H.
        • Vick J.A.
        • Ciuchta H.P.
        • Fischetti D.A.
        • MacChitelli F.J.
        • Montarnarelli N.
        Botulism toxin, type A. Effects on central nervous system.
        Science. 1965; 147: 1036
        • Johnson H.M.
        • Brenner K.
        • Angelotti R.
        • Hall H.E.
        Serological studies of types A, B, and E botulinal toxins by passive hemagglutination and Bentonite flocculation.
        J. Bact. 1966; 91: 967
      3. 3rd ed. Morbidity and Mortality Weekly Report. vol. 13. U. S. Department of Health, Education and Welfare, Atlanta, Georgia1964: 423 (Public Health Service)
        • Schroeder K.
        • Tollefsrud A.
        Botulism from fermented trout.
        T. Norske Laegeforen. 1962; 82: 1084
        • Burke V.
        • Elder J.C.
        Treatment in botulism.
        Arch. Int. Med. 1921; 27: 265
        • Dack G.M.
        Food Poisoning.
        3rd ed. The University of Chicago Press, Chicago1962