Botulism with intestinal colonization

The least common form of human botulism, botulism from intestinal colonization, includes cases in patients greater than 1 year of age not associated with ingestion of contaminated food or wound infection with the only possibility being intestinal colonization (38). Stool in these patients will contain toxin and C. botulinum, and the suspected food may contain spores without preformed toxin. Some cases occur in patients with a history of gastrointestinal surgery or inflammatory bowel disease, conditions that could support enteric colonization of B. botulinum (38). In 2001, in the United States, one case of adult colonization botulism occurred in a 45 year old who survived (39). 

Type F toxin was only associated with two reported outbreaks of human foodbome botulism prior to 1998 (Maselli, 1998). The first of these outbreaks occurred in Denmark (on the Island of Langeland) and was attributed to a contaminated liver paste product (Muller and Scheibel, 1960 Richardson et al, 2004). The second outbreak, in 1966, affected three individuals in California and was associated with home-made venison jerky (Midura et al, 1972 Richardson et al, 2004). While a few other type F botulism cases have been reported, they are generally thought to have resulted from intestinal colonization and type F toxin production by another related species, C. baratii (Hall et al, 1985 Richardson et al, 2004). A recent report of a type F botulism case in California provided some additional insight into this uncommon toxin... 

Botulism is a disease caused by ingestion of foods contaminated with Clostridium botulinum (food-borne botulism) or, very rarely, by wound infection (wound botulism) or colonization of the intestinal tract with Clostridium botulinum (infant botulism). The toxins block the release of acetylcholine. Botulism is characterized by generalized muscular weakness, which first affects eye and throat muscles and later extends to all skeletal muscles. Flaccid paralysis can lead to respiratory failure. 

Ingestion is the primary exposure pathway for botulism. Wound botulism occurs when the bacterium encounters devitalized human tissue, synthesizes toxin, and thus causes disease. Intestinal (adult and infant types) botulism involves ingestion of spores or the live bacterium and, due to impaired intrinsic defenses, the gastrointestinal tract becomes colonized with Clostridium botulinum. In infant type, the mucosal surface of the intestines is susceptible to colonization due to multiple factors including decreased acidity of the stomach and lack of bile of acids, which are natural barriers. In adult-type intestinal botulism, patients have had surgical vagotomy/... 

In adults, botulinum intoxication generally results from ingestion of preformed toxin elaborated in contaminated foods (foodbome), or from colonization by Clostridium botulinum of deep wounds with subsequent production of toxin (wound botulism). A third form, termed infant botulism, is observed in young infants and originates from colonization of the large intestine by Clostridium botulinum with subsequent production and absorption of toxin. Rarely, adults also exhibit a syndrome resembling infant botulism and some authors regard this as the fourth manifestation of botulism. ... 

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