Læknablaðið : fylgirit - 01.06.1982, Side 56

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BOTULISM CAUSED BY ENTERIC INFECTION BY C.BOTUUNUM AND IN
VIVO TOXIN PRODUCTION. S.B. Thorsteinsson+. C.L. Hathewayl.
A.V. Thorsson2, o. Jonsson^, 0. Steingrimsson^. + University
Hospital, Reykjavik, lCDC Atlanta, 2Landakot, Reykjavik,
^Saudarkrokur, 4Rannsoknastofa Haskolans, Reykjavik.
Ihe accepted doqma that botulism can only be caused by
ingestion of preformed toxin has been seriously challenged by
the elucidation of the pathogenesis for infant botulism.
Rarely, however, has in vivo toxin production been iirplicated
in adults.
In a recent outbreak in Iceland four pts developed
botulism due to non-proteolytic type B C.botulinum. The fifth
patient was found to harbour C.botulinum type B in his stools.
20 days after the presumed ingestion of the contaminated food.
He was then totally asyirptomatic and no circulating toxin found
in the serum. On day 44 he developed classic signs of botulism.
Stools were still positive for C.botulinum type B and now
circulating toxin was demonstrated in the serum. Epidemiological
evidenœ strongly negate the likelihood of re-exposure to toxin.
Vfe believe this case demonstrates that botulism in adults can
be caused by enteric infection by C.botulinum and toxin pro-
duction in the intestines.