A case of infant botulism with a possible link to infant formula milk powder: evidence for the presence of more than one strain of Clostridium botulinum in clinical specimens and food

1 Health Protection Agency Food Safety Microbiology Laboratory, Centre for Infections, 61 Colindale Avenue, London NW9 5HT, UK 2 Central Science Laboratory, Sand Hutton, York YO41 1LZ, UK 3 Health Protection Agency Communicable Disease Surveillance Centre, Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK 4 Health Protection Agency North of Tyne Communicable Disease Control Unit, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK 5 Department of Child Health, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK Correspondence J. McLauchlin jim.mclauchlin{at}hpa.org.uk Received December 24, 2004 Accepted April 28, 2005 Infant botulism was confirmed in a 5-month-old female by both isolation of Clostridium botulinum type B and by detection of type B botulinum neurotoxin in rectal washout and faeces. DNA fingerprinting of nine isolates from faeces yielded two different amplified-fragment length polymorphism (AFLP) patterns. C. botulinum was isolated from two of 14 food and drink items from the patient's home: C. botulinum type A was recovered from an opened container of dried rice pudding and C. botulinum type B from opened infant formula milk powder. Ten C. botulinum type B isolates from the opened infant formula yielded four AFLP patterns, two of which were indistinguishable from the clinical isolates. Fifteen unopened foods were tested and C. botulinum type B of a unique AFLP pattern was recovered from one unopened infant formula of the same batch as the opened container. It is suggested that multiple C. botulinum were present in both food and the intestine during infant botulism. Present address: Hope Clinical Academic Group, Clinical Sciences Building, Hope Hospital, Stott Lane, Salford, Manchester, UK. Present address: Health Protection Agency Local and Regional Services Division, Manchester Medical Microbiology Partnership, Manchester Royal Infirmary, Oxford Road, Manchester, UK. Abbreviation: AFLP, amplified-fragment length polymorphism.