Food-borne Botulism Caused by Clay Cheese: A Case Report
Introduction: Recently, the use of metal and plastic containers instead of clay containers in producing this type of cheese has provided the anaerobic condition for growing the bacterium and producing the botulinum toxin. In this case report was to introduce "clay cheese dug in the ground" as a source of botulinum toxin for the first time. Case Report: A 34-year-old man with dizziness, asthma, and inability to swallow for four days referred to the hospital emergency department. He had diplopia and ptosis for two days. During admission to the emergency, the patient was conscious without fever, but with dysarthria and bilateral ptosis, an impaired gag reflex, slow right papillary reaction to light, a decreased eye movement, and a decreased power of facial muscles and limbs. The patient reported the use of clay cheese in a week before referring to the emergency. Hematological, biochemical, electrocardiogram, magnetic resonance imaging, and chest X-ray assays were normal. According to the Centers for Disease Control and Prevention classification, these symptoms were related to botulism. The evaluation of serum samples, emission, and gastric juice confirmed botulism by type A toxin. Conclusion: Considering the clinical results of this case study, clay cheese, which is produced in the west of Iran, can be introduced as a new source of the botulinum toxin.
2. Kaplan JE, Benson C, Holmes K, Brooks JT, Pau A, Masur H, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2009;58(RR-4):1-207.
3. Gaware VM, Kotade KB, Dolas RT, Dhamak KB, Somawanshi SB, Nikam VK. Journal of Chemical and Pharmaceutical Research. J Chem. 2011;3(1):84-92.
4. Erbguth FJ. Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin. Mov Disord. 2004;19(Suppl 8):S2-6.
5. Cato E. Endospore-forming gram-positive rods and cocci (Genus Clostridium). Bergey's Manual of Systematic Bacteriology Sneath, PA. 1986;2:1141-200.
6. Hall J, McCroskey L, Pincomb B, Hatheway C. Isolation of an organism resembling Clostridium barati which produces type F botulinal toxin from an infant with botulism. J Clin Microbiol. 1985;21(4):654–5.
7. McCroskey L, Hatheway C, Woodruff B, Greenberg J, Jurgenson P. Type F botulism due to neurotoxigenic Clostridium baratii from an unknown source in an adult. J Clin Microbiol. 1991;29(11):2618-20.
8. Aureli P, Fenicia L, Pasolini B, Gianfranceschi M, McCroskey LM, Hatheway CL. Two cases of type E infant botulism caused by neurotoxigenic Clostridium butyricum in Italy. J Infect Dis. 1986;154(2):207-11.
9. Woodruff BA, Griffin PM, McCroskey LM, Smart JF, Wainwright RB, Bryant RG, et al. Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975–1988. J Infect Dis. 1992;166(6):1281-6.
10. Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ. Clinical features of types A and B food-borne botulism. Ann Inter Med. 1981;95(4):442-5.
11. Duchen L. An electron microscopic study of the changes induced by botulinum toxin in the motor end-plates of slow and fast skeletal muscle fibres of the mouse. J Neurol Sci. 1971;14(1):47-60.
12. Tsujihata M, Kinoshita I, Mori M, Mori K, Shirabe S, Satoh A, et al. Ultrastructural study of the motor end-plate in botulism and Lambert-Eaton myasthenic syndrome. J Neurol Sci. 1987;81(2-3):197-213.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.