zoonoses and communicable diseases common to ... - PAHO/WHO

38 BACTERIOSESDiagnosis: Clinical diagnosis should be confirmed with laboratory tests. Themost conclusive evidence is the presence of botulinum toxin in the serum of thepatient. Stomach contents and fecal material of persons exposed to the suspectedfood should also be examined for the toxin. The food in question should be culturedto isolate and identify the microorganism. In infant botulism, the attempt is made toisolate the agent and the toxin from the infant’s feces, since the toxin is rarelydetected in serum. An enzyme-linked immunosorbent assay (ELISA) test has beendeveloped for the detection of A and B toxin in children’s fecal samples; this maybe useful as a screening test in clinical specimens (Dezfulian et al., 1984). When awound is the suspected origin of the poisoning, fluid is aspirated from the woundand biopsies are performed for bacteriological examination.Control: With regard to man, control measures include: (a) regulation and inspectionof industrial bottling, canning, and food-preserving processes, and (b) healtheducation to point out the dangers of home canning and to make the public aware ofimportant factors in the preservation of home products, such as duration, pressure,and temperature of sterilization. Home-canned foods should be boiled before beingserved to destroy the toxins that are thermolabile. Foods from swollen cans or foodaltered in taste, smell, or appearance should not be eaten even after cooking. Anyfood that is bottled, canned, or prepared in some other way (salted, dried, etc.) andhas led to a case or outbreak should be seized.Immediate epidemiological investigation and prompt diagnosis of an outbreak areessential to both the prevention of new cases and the recovery of the patient.In areas where botulism in animals is a problem, the diet of livestock should besupplemented with feed rich in phosphorus to avoid osteophagia or pica; vaccinationof animals with the appropriate toxoid can yield good results. When bird beddingis used as silage for cattle or for pasture fertilizer, any remains of birds or otheranimals should be carefully eliminated. When an outbreak occurs in a fowl facility,carcasses must be removed as soon as possible to prevent its progression.BibliographyArnon, S.S. Infant botulism: Anticipating the second decade. J Infect Dis 154:201–206, 1986.Aureli, P.L., F.B. Pasolini, M. Gianfranceschi, et al. Two cases of type E infant botulismcaused by neurotoxigenic Clostridium butyricum in Italy. J Infect Dis 154:207–211, 1986.Benenson, A.S., ed. Control of Communicable Diseases in Man. 15th ed. An official reportof the American Public Health Association. Washington, D.C.: American Public HealthAssociation; 1990.Bienvenue, J.G., M. Morin, S. Forget. Poultry litter associated botulism (type C) in cattle.Can Vet J 31:711, 1990.Blood, D.C., O.M. Radostits, J.A. Henderson. Veterinary Medicine. 6th ed. London:Baillière Tindall; 1983.Castro, A.G.M., A.M. Carvalho, L. Baldassi, et al. Botulismo em aves de postura no estadode São Paulo. Arq Inst Biol 55:1–4, 1988.Cato, E.P., W.L. George, S.N. Finegold. Clostridium. In: Sneath, P.H.A., N.S. Mair, M.E.Sharpe, J.G. Holt, eds. Bergey’s Manual of Systemic Bacteriology. Vol 2. Baltimore: Williams& Wilkins; 1986.Ciccarelli, A.S., D.F. Giménez. Clinical and epidemiological aspects of botulism inArgentina. In: Lewis, G.E., Jr., ed. Biomedical Aspects of Botulism. New York: AcademicPress; 1981.