Botulism in Argentina from 1922 to 2006

FERNÁNDEZ R, CICCARELLI A, FARACE M, ESPETXE S, MARZANO M, VANELLA E, DE JONG L, BIANCO MI, DEGARBO S, CABALLERO P, LÚQUEZ C.

Acilomar, California, USA.

Otro; The 44th Annual Interagency Botulism Research Coordinating Committee (IBRCC) Meeting.; 2007

Four forms of the disease were reported in Argentina: Fodd (FB, 1922), infant (IB, 1982, wound (WB, 1992), and cryptic (CB, 2002) botulism. The serotypes identified were: A, B, E, F, and Af. The principal reservoir of spores of Clostridium botulinum (Cb), and source of contamination, is the soil. We were studied 2009 samples, with a prevalence of 23.4% of positive samples, and a multiplicity of serotypes: A 56.7%, B 15.3%, F 3.8%, G 0.4%, Af 3.6%, A+B 3.0%, A+F 0.2%, B+F 0.2%, non specific 16.6%. FB: Between 1922 and 2000 were reported 695 outbreaks, with 294 cases (3.5 cases/year and 3.1 cases/outbreak) and 114 deaths, with a lethality of 38.8% (14.4% in the last 17 years). Of 77 outbreaks in which the food was identified, in 73 of them it was possible to know how they were made: 83.6% home and 16.4% industrial; and the origen: 53.2% vegetable, 16.9% animal, 29.9% both, with a high percentage of marinades, 32.5% (25/77). The botulinum toxin (BoT) types identified were: A 71.6%, B 9.0%, E 3.0%, F 1.5%, A+F 1.5%, Af 1.5%, and non specific 11.9%. IB: Between 1982 and 2006 were reported 410 cases, 93.6% under 6 months of age, with 5.4 cases/year in the first 13 years, and 26.2 in the last. With the exception of 1 case, in which was identified BoT type B, they all were caused for the type A. BoT/A was identified in all stool specimen cultures, and 69.0% of the sera samples of 87 cases of IB belonging to Mendoza. No cases were registered in only 3 of 23 provinces, possible because of an erroneous diagnosis. As for possible vehicles of spores, 227 samples of honey were analyzed, detecting Cb in 8 (3.5%), and only 4 were associated with cases of IB. Infusions of medicinal herbs can be another potential source of spores, in Argentina Cb type A was identified in 66 vegetables species. WB: The first case was registered in 1922. Then 2 cases in 1995, 1 type A; and finally 1 type B in 2001. Two died. CB: Between 2002 and 2004 were confirmed 4 cases of type A botulism, without being able to demostrated either suspìcious food or an infected wound. Use of botulinal antitoxin (a-BoT) in IB: The possibility of use of BoT as biological weapon has produced a world shortage of equine a-BoT. Its production is very limited in Argentina and insufficient to cover the local need. Although without widespread consensus, and only in Mendoza province (one with the higher number of cases), it was used to treat 32/64 IB cases (500 IU/kg), between 1993 and 2004. None showed adverse reactions. Although the results were not statistically significant, in the treated cases the mean of mechanical ventilation was reduced from 27 to 17 days (p=0.08) and the mean of stay in ICU from 29 to 20 days (p=0.11). At the present we were considering human botulinal antitoxin production in our country. Prevention of IB: We believe that, similar to tetanus prevention, we should discuss the use of botulinal toxoids at least with the predominant serotypes identified in IB cases at each country.