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Volume 18, Number 1—January 2012

CME ACTIVITY

Intestinal Toxemia Botulism in 3 Adults, Ontario, Canada, 2006–2008

Yolanda D. Sheppard, Dean Middleton, Yvonne Whitfield, Felix Tyndel, Shariq Haider, Jamie Spiegelman, Richard H. Swartz, Mark P. Nelder, Stacey L. Baker, Lisa Landry, Ross MacEachern, Sherri Deamond, Lorrie Ross, Garth Peters, Michelle Baird, David Rose, Greg Sanders, and John W. Austin
Author affiliations: Ministry of Health and Long-Term Care, Toronto, Ontario, Canada (Y.D. Sheppard, Y. Whitfield, M.P. Nelder, S.L. Baker); Ontario Agency for Health Protection and Promotion, Toronto (D. Middleton); Scarborough Hospital–Birchmount, Toronto (F. Tyndel); McMaster University Medical Center, Hamilton, Ontario, Canada (S. Haider); Humber River Regional Hospital, Toronto (J. Spiegelman); Sunnybrook Health Sciences Centre, Toronto (R.H. Swartz); Public Health Agency of Canada, Guelph, Ontario, Canada (L. Landry); Durham Region Health Department, Whitby, Ontario, Canada (R. MacEachern, S. Deamond); Niagara Region Public Health, Thorold, Ontario, Canada (L. Ross); Toronto Public Health, Toronto (G. Peters); Hamilton Public Health Services, Hamilton (M. Baird); The Scarborough Hospital, Toronto (D. Rose); Health Canada, Ottawa, Ontario, Canada (G. Sanders, J.W. Austin)

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Table

Clinical summary of 3 intestinal toxemia botulism cases in adults, Ontario, Canada, 2006–2008

Case-patient no. Age, y/sex Dates admitted to hospital and discharged Clinical findings Gastrointestinal history Clostridium botulinum serotype No. days stool sample positive for C. botulinum* Supportive care; antitoxin; administration date
1 63/F 2006 Nov 22 Abdominal pain, diarrhea, dysphagia, diplopia, weakness Crohn disease, short bowel syndrome, remote bowel surgery A 61 Intubation and ventilation; bivalent type A and B, monovalent type E; 2006 Nov 23
2 50/F 2007 Feb 8; 2007 Sep Dysphagia, double vision, weakness, difficulty breathing Crohn disease, bowel resections A and B 56 Intubation and ventilation; bivalent type A and B, monovalent type E; 2007 Feb 23
3 45/M 2008 Jan 8; 2008 Feb 27 Abdominal distension and obstruction, aphonia, diplopia, dry mouth, dysphagia, dysphonia, ptosis Unremarkable B 41 Bivalent type A and B, monovalent type E; 2008 Jan 14

*Total number of days that C. botulinum spores or neurotoxins were detected in clinical samples.

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