-''f/ -'lla'pport hebdomadaire des Canada Disease maladies au Canada

-''f/ -'lla'pport  hebdomadaire  des Canada Disease maladies  au  Canada
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-'lla'pport hebdomadaire des
Canada Disease
Weekly Reportt
r.
maladies au Canada
March 29, 1986
29 mars 1986
ISSN 0382-232X
CONTAINED IN THIS ISSUE:
Vol. 12-13
CONTENU DU PRESENT NUMERO:
53
Botulism in Canada - Summary for 1985
A Case of Infant Botulism - British Columbia
A Fatal Outbreak of Type E Botulism on the
Queen Charlotte Islands - British Columbia
Le botulisme au Canada - Resume pour 1985.
Cas de botulisrne infantile
ColombieBritannique . . . . . . • . • • • . . . .
Poussee mortelle de botulisrne de type E aux
fies de la Reine Charlotte - ColombieBritannique .
. . . . .
54
55
53
54
55
BOTULISM IN CANADA - SUMMARY FOR 1985
LE BOTULISME AU CANADA - RESUME POUR 1985
Six incidents of foodborne botulism involving a total
of 43 cases with 2 deaths, and 2 cases of -tnfant botulism
with no deaths were confirmed in 19B5.
En 1985, on a confirme 6 episodes de botulisme d'origine
alimentaire mettant en cause en tout 43 cas (dont deux
mortels); on a aussi enregistre deux cas de botulisme du
nourrisson dont l'issue n'a pas ete mortelle.
Incident l (Table 1), the largest botulism outbreak in
Canada reported to date, actually was comprised of 2
Le premier episode mentionne au Tableau l constituait
la plus importante poussee de botulisrne jarnais enregistree au
Table 1. Incidents of F oodborne Botulism in Canada, 1985/
Table au 1. Episodes de botulisme au Canada, 1985
Incident/
Episode
Month/
Mais
Location/
Endroit
1:i.c./
July-September/
Juillet-septembre
Vancouver, C.-B.
2
July/
Juillet
Aklavik, N.W. Tl
Aklavik, T.N.-0.
3
August/
AoOt
Lake Harbour, N.W. T./
Lake Harbour, T.N.-0.
1
Vancouver,
Suspect Food/
Aliment soup9onne
Commerical garlic
in oil/
Preparation
commerciale
d 'ail dans de
l 'huile
Total
Cases/
Total
des
cas
Fatal
Cases/
Cas
mortels
Toxin
Type/
Type
de
toxine
37
0
B
Muktuka) /
Muktuka)
1
0
E
Fermented walrus
meat/Viande
1
0
E
Specimens with C. botulinum/
Echantillons contenant C. botulinum
Toxin/
Toxine
Microorganism/
Microorganisme
Serum/
Serum
Stool/
Sell es
Serum, stool/
Serum, sell es
Food/
Aliments
de morse
fermentee
a)
4
August/
AoOt
Montreal, Que./
Montreal, Que.
Home-canned
mushrooms/
Conserves maison
de champignons
1
0
B
Food/
Aliments
5
September/
Septembre
Fort Chima, Que./
Fort Chima, Que.
Seal Meat/
Viande de phoque
1
0
E
Serum/
Serum
6
December/
Decembre
Mass et, B.C./
Masset, C.-B.
Fermented salmon
eggs/Oeufs de
saumon fermentes
2
2
E
Serum, stomach
contents,
stool, food/
Serum, contenu,
de 1 'estomac,
selles,
aliments
Food/
Aliments
Stomach
contents,
stool, liver
food/Contenu
de 1 'estomac,
selles, foie,
aliments
Fermented whale blubber with skin and meat/Graisse et chair fermentees de baleine avec la peau
!second Class Mail Registration No. 5670!
Courrier de la deuxieme classe - Enre istrement n° 5670
- 53 Health and Welfare
Canada
Santa et Bien-etre social
Canada
Canada
clusters of cases.
The first group (11 cases) occurred
between 26 July and 2 August, and the second (26 cases),
between 29 August and 5 September. Each cluster of cases
was apparently associated with a single bottle of chopped
garlic in soybean oil. This was the first commercial product
to be incriminated in a botulism outbreak in Canada since
1973. Some details of the outbreak were reported in an
earlier issueCl),
Canada; deux gfoupes distincts de cas etaient en cause.
La
premiere poussee (11 cas) s'est produite entre le 26 juillet et le
2 aoOt, et la deuxieme (26 cas), entre le 29 aoOt et le 5 septembre.
Les deux groupes de cas etaient vraisemblablement associes au
meme pot d'ail hache dans de l'huile de soja. II s'agit du premier
produit commercial a etre incrimine dans une poussee de botulisme
au Canada depuis 1973. Certains details de cette poussee ant ete
communiques dans un numero anterieur du RHMc(l),
All but one (incident 4) of the remaining incidents
involved (lative Canadians. A recent review of botulism in
Canada(2J shows that the types of foods incriminated in
1985 (Table 1) were also associated with a number of earlier
outbreaks. Incidents 2, 3 and 6 were caused by "fermented"
meats and salmon eggs which are traditionally maturated
under exclusion of air.
For example, the walrus meat
implicated in the Lake Harbour incident had been enclosed
in pouches of walrus skin and held for 2 weeks at temperatures fluctuating between 4°C and 15°C. The common fault
of these processes is the lack of fermentable carbohydrates
which precludes any significant pH reductionC2). Details of
incident 6 are presented later in this issue.
A une exception pres (cas 4), taus Jes autres episodes touchaient
des autochtones. II ressort d'une etude recente des cas de botu!isrne
au Canada(2) que Jes types d'aliments incrimines en 1985 (Tableau 1)
avaient ete associes a un certain nombre de cas par le passe. En
effet, on constate que Jes episodes 2, 3 et 6 etaient attribues a de la
viande et a des oeufs de saumon "fermentes" de fai;on traditionnelle
en milieu aneorobie. La viande de morse incriminee dans !'episode
de Lake Harbour avait ete placee dans des poches de peau de mo:rse
et conservee pendant deux semaines a des temperatures variant de 4
a 15°C. Le defaut cornmun de ces methodes, c'est qu'elles ne
produisent pas de glucides fermentes(fjbles, ce qui rend impossible
toute diminution significative du pH • L'episode 6 est decrit en
details ai!leurs dans le present numero.
In 1984, the Botulism Reference Service confirmed a
fatal case of botulism by detecting viable Clostridium
botulinum in a Ii ver specimen. The analytical results for
1985 (incident 6) suggest again that, in cases of suspected
botulism, liver tissue should be included among autopsy
specimens.
Le Service de reference pour le botulisme au Canda a confirms
en 1984 un cas fatal de botulisme en decelant une toxine viable de
Clostridium botulinum dans un specimen de foie.
D'apres !es
resultats d'analyses effectuees en 1985 (episode 6), ii semble qu'il
soit toujours bon de faire analyser un specimen de tissu hepatique a
l'autopsie, chaque fois que !'on soupgonne un cas de botulisme.
Table 2. Cases of Infant Botulism in Canada, 1985/
Tableau 2. Cas de botulisme du nourrisson au Canada, 1985 .
Case/
Cas
Month/
Mo is
Location/
Endroit
Source of
Botulinal Spores/
Source des spores
botuliniques
Toxin
Type/
Type de
toxine
1
September/
Septembre
Quebec City, Quebec
Quebec, Que.
Honey/
Mi el
A
2
November/
Novembre
Vancouver, British Columbia
Vancouver, C.-B.
?
A
Two cases of infant botulism, both of type A, were
confirmed in 1985. The first case. was reported earlierC3);
details on the second one follow this summary. Case 1
(Table 2) was clearly associated with honey, the first such
case in Canada. The suspect honey sample, as well as a
sample retrieved from the same store, both contained
103-104 botulinal spores of type A per kg; other samples of
the same brand showed less than 10 spores per kg.
Deux cas de botulisme du nourrisson, taus deux de type A, ont
ete confirmes en 1985. Le premier cas a ete decrit dans un numero
anterieur(3); le second est traits un peu plus loin. Le premier
episode (Tableau 2) etait nettement associe a du miel, le premier
cas de ce genre au Canada. On a trouve dans l'echantillon du mier
incrimine, ainsi que dans un specimen preleve dans un autre pot pris
dans le meme magasin, de 103 a 104 spores botuliniques de type A
par kilo; d'autres echantillons de la meme marque contenaient mains
de 10 spores par kilo.
References:
References:
1.
Blatherwick FJ et al. CDWR 1985; 11:177-178.
1.
Blatherwick FJ et coll. RHMC 1985; 11:177-178.
2.
Hauschild AHW, Gauvreau L.
133:1141-1146.
2.
Hauschild AHW, Gauvreau L. J Assoc med can 1985; 133:11411146.
3.
Picard A-C et al. CDWR 1985; 11:201-202.
3.
Picard A-C et coll. RHMC 1985; 11:201-202.
SOURCE:
Can Med Assoc J 1985;
A Hauschild, PhD, Botulism Reference Service
for Canada, Health Protection Branch, Ottawa,
Ontario;. L Gauvreau, MD, Centre H ospitalier
de l'UniversitP Laval, Sainte-F'oy, QuPbec;
WA Rlack, MB, ChR, 13C Provincial Laboratories, Vancouver, British Columbia.
SOURCE:
- 54 -
A Hauschild, Phn, Service de rPf Prence pour le
botulisme au Canada, nirection !'.JPnPrale de la
protection
de
la
santP,
Ottawa,
Ontario;
nr L Gauvreau, Centre hospitalier de l'UniversitP
Laval, Sainte-Foy, Qupbec; WA Rlack, RM, BCh,
Laboratoires
provinciaux
de
C.-R.,
Vancouver,
Colombie-Rritanniaue.
CAS DE BOTUUSME INFANTILE
- COLOMBIE-BRITANNIQUE
A CASE OF INFANT BOTULISM
- BRITISH COLUMBIA
The patient was .a 4-week-old, previously healthy East
Indian female.
Over a period of 4 days beginning on
22 November 1985, she became progressively lethargic and
weak, with poor feeding, constipation, and feeble cry.
There was no history of exposure to drugs, toxins, infectious
contacts, home remedies or honey, except vitamins and one
dose of "grippe water" which was given on the day of
admission.
Il s'agit d'un nourrisson de 4 semaines de sexe feminin et
d'origine indienne asiatique, qui se porte bien jusqu' au 22 novembre
1985. Sur une periode de 4 jours a compter de cette date, le bebe
devient progressivement lethargique et faible; il mange ma!, est
constipe et geint. L'interrogatoire ne revele aucune exposition a des
medicaments, toxines, contacts ,infectieUX, remedes "maison", OU a
du miel; ii etablit toutefois que l'enfant a re9u des vitamines et une
dose de "grippe water" (calmant pour coliques infantiles) le jour de
son hospitalisation.
On admission to British Columbia's Children's Hospital,
Vancouver, the child was apyrexial but appeared ill with a
rapid pulse (140/rnin), shallow respirations (35/min), and a
blood pressure of 90/60 mm Hg. She was mildly dehydrated,
drowsy, hypotonic, had a feeble cry, and was inattentive to
visual stimuli.
A son admission au British Columbia's Children's Hospital, a
Vancouver, l'enfant est afebrile mais a !'air malade. Son pouls est
rapide (140/min), sa respiration est peu profonde (35/min) et sa ·
tension arterielle est de 90/60 mm Hg.
Elle est Iegerement
deshydratee, somnolente et hypotonique; ses pleurs sont faibles et
elle ne reagit pas a des stimuli visuels.
Throat, urine, blood and CSF cultures were unremarkable.
Antigen analysis tests were negative for
Streptococcus group B (CSF and urine), Haemophilus
influenzae type B (urine and CSF), Streptococcus
pneumoniae (CSF), and Neisseria meningitidis (CSF).
Laboratory findings (normal range) were as follows: WBC
17 .0 (5.5 - 18.0) x 109 /L with an elevated neutrophil count
9.75 (2.0 - 5.5) x lQ9/L, elevated monocyte count 1.45
(0.36 - 0.90) x 109 /L and elevated hemoglobin 169 (107 147) g/L, and hematocrit 0.505 (0.34 - 0.40). No organisms
were detected on culture of a traumatic CSF tap. Serum
electrolytes, glucose, calcium, magnesium, phosphate, and
blood gases were normal. Metabolic studies including serum
lactate, liver function studies, serum ammonia, serum amino
acids, and urine organic acids were normal. Chest X-ray,
ultrasound and computerized tomographic scan of the head,
electroencephalogram
and
brainste m auditory-evoked
responses were normal.
La culture de prelevements pharynges, d'urine, de sang et de
LCR ne revele rien d'anormal. L'analyse antigenique ne permet de
deceler ni Streptococcus de groupe B ou Haemophilus influenzae de
type 8 dans !'urine et le LCR, ni Streptococcus pneumoniae ou
Neisseria meningitidis dans le LCR. Les resultats des analyses de
laboratoire (dans les limites de la normale) se lisent comme suit:
Leucocytose 17 ,O (5,5 - 18,0) x 109/L avec une proportion elevee de
neutrophiles - 9, 75 (2,0 - 5,5) x 109 /L, et de monocytes - 1,45
(0,36 - 0,90) x 109/L, taux eleve d'hemoglobine 169 (107 - 147) g/L
et d'hematocrites - 0,505 (0,34 - 0,40). · Le LCR preleve par
ponction lombaire ne cultive aucun microorganisme. On obtient des
valeurs normales pour les electrolytes, le glucose, le calcium, le
magnesium, le phosphate et les gaz sanguins.
Les tests de
metabolisme, dont le dosage du lactate dans le serum, !es analyses
de la fonction hepatique, l'ammoniemie, l'aminoacidemie et
l'organoacidurie, sont taus dans la normale.
La radiographie
thoracique, l'ultrasonographie et la tomographie informatisee de la
tete, l'electroencephalographie et !es reponses provoquees au niveau
du tronc cerebral par des stimuli auditifs, sont toutes normales.
Twenty minutes after receiving a dose of ampicillin and
gentamicin intravenously, the patient became apneic and
required resuscitation. Frequent episodes of apnea occurred
during the next 12 hours which necessitated intubation and
mechanical ventilation. The infant was drowsy and had
sluggish pupillary responses to light, impaired extraocular
muscle function, diminished corneal responses, facial
diplegia, weak gag and suck reflexes. The child became
very hypotonic with diminished spontaneous movements and
absent tendon reflexes. Sensation was normal.
La petite cesse subitement de respirer 20 minutes apres avoir
re9u une dose d'ampicilline et de gentamicine i. v. et do it etre
reanimee. Comme elle a plusieurs episodes d'apnee au cours des 12
heures qui suivent, il faut l'intuber et assurer une assistance
ventilatoire. L'enfant est somnolente et ses pupilles reagissent
lentement a la lumiere; on consta~e une diminution fonctionnelle de
la musculature extrinseque de l'oeil, une diminution du reflexe
corneen, une diplegie faciale et un affaiblissement des reflexes
pharynge et de succion. L'enfant devient gravement hypotonique; ii
y a diminution de ses mouvements spontanes et absence de reflexes
osteotendineux. La sensation est nor male.
The child required assisted ventilation for 7 days.
Ampicillin, gentamicin and cloxacillin were administered
during this time. Edrophonium (0.1 mg IV) and neostigmine
(0.3 mg IM) appeared to produce a mild improvement in
muscle strength. This raised the possibility of a diagnosis of
myasthenia gravis. · However, the observation is not inconsistent with infant botulism.
Motor nerve conduction
velocities of the median and lateral popli teal nerves were
normal. Electromyography of deltoid and tibialis anterior
muscles demonstrated an excess of small amplitude motor
unit potentials of brief duration, which are consistent with
the diagnosis of infant botulism.
II faut maintenir !'assistance ventilatoire pendant 7 jours.
Pendant cette periode, on lui administre de l'ampicilline, de la
gentamicine et de la cloxacilline. On constate une legere amelioration de la force musculaire apres !'administration d'edrophonium
(O,l mg i. v.) et de neostigmine (0,3 mg i. m.), ce qui laisse penser a
un diagnostic de myasthenie. Cette constatation toutefois ne va pas
a l'encontre d'un diagnostic de botulisme infantile. La vitesse de
conduction des nerfs sciatiques poplites externe et interne est
normale. L'electromyographie du muscle delto'lde et du jambier
anterieur revele une augmentation transitoire du potentiei de plaque
motrice de faible amplitude, ce qui peut aller de pair avec un
diagnostic de botulisme infantile.
Clostridium botulinum type A was isolated from stool
cultures obtained on t.he 12th day of illness. The organism
and toxin of the same type were detected in 3 subsequent
stool specimens. No organism or toxin was detected in a
specimen of "SMA" infant formula which had been given to
the child prior to admission.
On isole Clostridium botulinum de type A des cultures de selles
prelevees le ize jour de la maladie. Ce microorganisme et la toxine
correspondante sont isoles de trois prelevements de selles
subsequents. On n'en trouve pas dans la preparation lactee "SMA"'
donnee a l'enfant avant son hospitalisation.
During the following month, the infant gradually
recovered some muscle strength. There was no further
apnea. Extraocular muscle movements improved and pupillary responses became normal. However, the infant remains
hypotonic and requires supplementary gavage feeding.
Le nourrisson retrouve une certaine force musculaire au cours
du mois qui suit. On n'enregistre aucun nouvel episode d'apnee. Il y
a amelioration des mouvements des muscles externes de l'oeil et !es
pupilles reagissent de fa9on normale. Toutefois, l'enfant demeure
hypotonique et doit etre gavee.
- 55 -
This is the third case of infant botulism to be reported
in Canada.
SOURCE:
.TD Anderson, MD, V.J Ehelt, MD, A Hill, Mn,
EH Roland, Mn, CL Trombley, ART, British
Columbia's Children's Hospital, WA Black, MR,
ChB, BC Provincial Laboratories, Vancouver; A
Hauschild, PhD, Botulism Reference Service for
Canada, Health Protection Branch, Ottawa.
II s'agit du 3e cas de botulisme infantile
Canada.
SOURCE:
A FATAL OUTBREAK OF TYPE E
BOTULISM ON THE QUEEN CHARLOTTE
ISLANDS - BRITISH COLUMBIA
a
etre signale au
nrs Jn Anderson, V.T Ehelt, A Hill et EH Roland, CL
Trombley, t.a., Rritish Columhia's Children's Ffospital;
WA Rlack, BM, RCh, Lahoratoires provinciaux de C.-R.,
Vancouver; A Hauschild, nPh, Service de rP{ffrence sur
le botulisme au Canada, Direction pffnffrale de la protection de la santff, Ottawa.
POUSSEE MORTELLE DE BOTULISME DE
TYPE E AUX !LES DE LA
REINE CHARLOTTE - COLOMBIE-BRIT ANNIQUE
At approximately noon on 3 December 1985, a 74-yearVers midi le 3 decembre 1985, un Indien haida age de 74 ans,
old Haida man, his 72-year-old wife, his mother, and a sister son epouse de 72 ans, sa mere et une des ses soeurs consomment des
ate salmon eggs which had been fermented and prepared in oeufs de saumon qui avaient ete fermentes et prepares de fagon
the traditional native manner on the Masset reserve on the traditionnelle a la reserve Masset, aux !Ies de la Reine Charlotte.
Queen Charlotte Islands. The eggs, taken from a chum Les oeufs, qui provenaient d'un saumon keta pris a la fin de
salmon caught in the late fall, had been stored in a crock l'automne, avaient ete places dans un pot de terre cuite, rinces a
pot, washed with rain water every 2 to 3 days for a month, l'eau de pluie taus !es deux ou trois jours pendant un mois, puis
then covered and placed in a cool indoor environment prior couverts et places au frais a l'interieur avant d'etre consommes. la
to being eaten. The 72-year-old woman became ill during femme de 72 ans se sent mal le 5 decembre au matin. Le medecin
the morning of 5 December, and was seen by a physician qu'e!le consulte constate une insuffisance respiratoire aigu~ et
who found her in severe respiratory distress and admitted !'hospitalise. On attribue sa dyspnee a une insuffisance cardiaque, a
her to hospital. Congestive heart failure, a pleural effusion, un epanchement pleural,..QU a une pneumonie et on amorce une
or pneumonia were considered possible causes for her therapie a base de Lasix~ i.v. Apres un legere amelioration, e!le
dyspnea and she was started on IV Lasix ® with some initial decede vers 17 h. Son mari, que le medecin avait examine a son
improvement, but she expired around 1700 h. Her husband domicile le matin meme pour des malaises et une Iegere gene
whom the physician had also seen in the home that morning respiratoire, est amene inconscient a l'hopital en ambulance vers
with minor complaints of slight shortness of breath and 19 h 45. II ne peut etre ranime et l'interrogatoire revele qu'il a
malaise, Was brought into hospital by ambulance at 1945 h consomme des oeufs de saumon fermentes. La mere et la soeur
unconscious and severely obtunded. He could not be resus- demeurent asymptomatiques bien qu'elles aient aussi mange des
citated and a history of exposure to fermented salmon eggs oeufs suspects. Les autopsies sont effectuees a Vancouver et on
was obtained at this time. The mother and sister who had envoie des specimens de serum, du contenu stomacal, des se!les et
also eaten the eggs remained asymptomatic. Autopsies du foie des victimes, ainsi que des oeufs de saumon incrimines au
were conducted in Vancouver and specimens of serum, laboratoire provincial et au Service de reference pour le botulisme
stomach contents, stool, liver, and the implicated salmon au Canada, a Ottawa. On trouve la toxine de type E de Clostridium
eggs were sent to the Provincial Laboratory and to the botulinum dans le contenu stomacal et !es se!les des deux victimes,
Botulism Reference Service in Ottawa. Type E Clostridium dans le serum de la femme, ainsi que dans les oeufs de saumon.
botulinum toxin was found in stomach contents and stool of
both victims, in the serum of the woman, and in the salmon
eggs.
SOURCE:
J Gibbons, MJJ, Haida Health Centre, Masset; D
SOURCE:
Bowering,. MD, Field Epidemiologist, LCJlC,
Victoria; D Brown, Community Health Representative, Skidegate; S Rannerjee, PhD, Food
Poisoning Scientist .and W Black, MR, ChR,
Director,
BC
Provincial
Laboratories,
Vancouver, Rritish Columbia.
J
Gibbons, 9entre .de santff Haida, Masset;
Flowering,
Epidffmiologiste
rffgional,
LLCM,
Victoria; D Brown, Reprffsentant en santff communautaire, 9ddegate; S Rannerjee, PhD, Spffcialiste des toxiinfections alimentaires et W Rlack', RM, RCh, nirecteur
des laboratoires provinciaux d'hypiene µ;.bliaue de
C.-R., Vancouver, Colombie-Britanniaue.
nr
nr J1
The Canada Diseases We6kly Report presents current information on infectious
and other diseases for surveillance purposes and is available free of charge upon
request. Many of the articles contain preliminary information and further
confirmation may be obtained from the sources quoted. The Department of
National Health and Welfare does not assume responsibility. for accuracy or
authenticity. Contributions are welcome (in the official language of your
choice) from anyone working in the health field and will not preclude
publication elsewhere.
Le Rapport hebdomadaire des maladies au Canada, qui fournit des donnees pertinentes sur
les maladies infectie1..1see et les autres maladies dans le but de feciliter leur surveillance.
peut Btre obtenu gratuitement sur demands. Un grand nombre d'articles ne contiennent
qua des donn8es sommaires mais des renseignements compl8mentaires peuvent Btre
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Toute personne oauvrant dens la domeine de la sante est invitee h collaborer (dens la
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Editor: Dr. S.E. Acres
Managing Editor: Eleanor Paulson
Redacteur en chef: Dr S.E. Acres
Redactaur administrati f: Eleanor Paulson
Bureau of Epidemiology
Laboratory Centre for Disease Control
T urviey'e Pasture
OTTAWA, Ontario
Canada KlA cx._2
(613) 990-8964 .
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Laboratoire de lutte contra la maladie
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- 56 -
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