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Un caso di botulismo infantile trattato con siero equino antitossina botulinica
No full textll botulismo infantile è una sindrome neuroparalitica, che colpisce i neonati sotto l’anno di età ed è caratterizzata da costipazione, difficoltà di suzione, progressiva debolezza e difficoltà respiratoria. La malattia è provocata dall’azione delle tossine botuliniche prodotte nel lume intestinale da microrganismi del genere Clostridium (C. botulinum, C. baratii, C. butyricum) che vengono ingeriti o inalati sotto forma di spora (1,2) . Nel Dicembre 2012 il Centro Antiveleni (CAV) dell’ Umberto I, Policlinico di Roma, fu contattato dal reparto di pediatria dello stesso Ospedale per un paziente di 5 mesi, ricoverato per: ipotonia, stipsi, difficoltà nella suzione, strabismo, ptosi palpebrale e dispnea. Il lattante era al secondo ricovero in un mese e veniva alimentato per via enterale. Trasferito, un mese prima della nostra osservazione, dall’Ospedale di Colleferro all’Umberto I per ipotonia e sonnolenza, veniva dimesso in settima giornata per risoluzione del quadro clinico e programmato follow-up neurologico dopo 10 giorni per ulteriore definizione diagnostica. Il bambino in buone condizioni di salute fino all’età di tre mesi, aveva iniziato a presentare difficoltà nella suzione, stipsi e sonnolenza una settimana dopo la somministrazione di vaccino esavalente. Al follow-up il paziente venne nuovamente ricoverato per stipsi e difficoltà nella suzione. Il sospetto clinico di botulismo fu posto dopo che la madre riferì che il bambino aveva assunto miele. Vennero prelevati i campioni fecali e inviati insieme al residuo di miele al CNRB dell’ISS per la ricerca dei Clostridi produttori di tossine botuliniche e loro tossine. I test diagnostici confermarono il sospetto clinico di botulismo dimostrando la presenza di C. botulinum tipo A nei campioni fecali. Il miele risultò negativo. Su indicazione del CAV dell’Umberto I e in accordo con il CAV di Pavia, al paziente fu somministrato Siero Equino Antitossina Botulinica (Botulismus-Antitoxin Behring - Novartis) (infusione 10 ml/kg in 120’) e trasferito nel reparto di terapia intensiva perinatale. Dopo 48 ore dalla somministrazione del siero le condizioni generali apparivano migliorate con lieve ripresa della motilità spontanea degli arti superiori. Il paziente fu trasferito nel reparto di pediatria dopo ulteriori dieci giorni e, dopo quattro settimane dalla somministrazione del siero il quadro clinico generale appariva sostanzialmente risolto, persistevano lieve ptosi, strabismo e ipotono assiale. Il caso descritto: i) evidenzia la difficoltà della diagnosi di botulismo infantile, sindrome rara e ancora poco conosciuta, caratterizzata da sintomi sovrapponibili a quelli di altre patologie e con esordio subclinico, ii) sottolinea l’importanza di un’accurata formazione e informazione dei medici, in particolare pediatri e tossicologi, iii) ribadisce che il siero antitossina botulinica equino può essere utilizzato con successo nel trattamento del botulismo infantile; iv) conferma che il consumo di miele non rappresenta il veicolo principale di spore di Clostridi produttori di tossine botuliniche, e che, presumibilmente anche in questo caso, il veicolo più accreditato sia la polvere (dei vestiti del padre, operaio edile).
1. Fenicia L, Anniballi F. Infant Botulism. Ann Ist Super Sanità. 2009; 45(2):134-146
2. Lonati D, et al. Progetto Italia-Usa: “Rare Diseases”- Infant Botulism (2007-2009). Atti del Congresso “Antidotes in Depth 2008 and Chemical Emergencies”, 180-192
Occurrence and molecular characterization of Bacillus spp. strains isolated from gnocchi ingredients and ambient gnocchi stored at different temperatures
No full textAmbient gnocchi is a potato-based product with a shelf-life of 12 months at room temperature, due to pasteurisation and incorporation of organic acids. Aim of this study was to investigate the microbiological characteristics of ambient gnocchi and their ingredients. In addition to their industrial formulation, ambient gnocchi were analysed when lactic and sorbic acids were partially or totally removed, at different storage temperatures, to identify the main microbial groups. Floury ingredients were the most contaminated, with total mesophilic count and presumptive Bacillus spp. up to 5 log CFU/g. Industrial gnocchi were stable, while gnocchi without acids showed loads up to 7 log CFU/g after 7 day at 37 °C. Bacillus spp. were isolated and characterized through rMLST, 7-loci MLST, and kSNP3 analysis. Virulence factors and antibiotic resistance determinants were detected in isolates of the Bacillus cereus group. Bacillus subtilis was the most frequently isolated species, showing spoilage potential, as observed by reddish slime on some samples during storage, but also interesting features evidenced by bacteriocin production genes. Therefore, we demonstrated that flour ingredients were the primary sources of contamination, and that Bacillus spp. was the microbial group of greatest interest for both safety and quality of this product
A case of infant botulism due to neurotoxigenic clostridium butyricum type E associated with clostridium difficile colitis
No full textReported here is the sixth case of intestinal toxemia botulism caused by Clostridium butyricum type E in Italy since 1984. In this case, the patient was concomitantly affected with colitis due to Clostridium difficile toxin. A review of previously reported cases revealed that some of these patients may also have had intestinal toxemia botulism associated with Clostridium difficile colitis, based on the reported symptoms. Given that this association has been shown to exist not only in Italy but also in the USA, it is recommended that individuals with intestinal botulism and symptoms of colitis undergo testing for Clostridium difficile and its toxins in fecal samples
Fatal course of foodborne botulism in an eigth.month-old infant.
No full textThe paper describes a case of food borne botulism in an 8-month old infant caused by ingestion of an improperly prepared home-canned homogenized turkey meal. To our knowledge this is the youngest fatal case reported in medical literature
The first case of botulism in a donkey
Full text linkBotulism, a severe neuroparalytic disease that can affect humans, all warm-blooded animals, and some fishes, is caused by exotoxins produced by ubiquitous, obligate anaerobic, spore-forming bacteria belonging to the genus Clostridium and named botulinum neurotoxin (BoNT)-producing clostridia. This report presents the case of a 3-year-old donkey mare referred for progressive and worsening dysphagia of four days' duration. Her voluntary effort in eating and drinking was conserved, and she was able to slow chew without swallowing. A complete neurological examination was performed, and botulism was strongly suspected. The ability to swallow feed and water returned on the tenth day of hospitalization and improved progressively. The jenny was discharged from the hospital after fifteen days. During the hospitalization, the Italian National Reference Centre for Botulism confirmed the diagnosis: mare's feces were positive for BoNT/B and Clostridium botulinum type B
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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