The epidemiology of botulism in Romania

Abstract number: P1535

Dobre D., Moroti R., Hristea A., Arama V., Lemeni D., Sisiroi M., Luka A.

Objectives: The aim of this study is to establish the incidence of botulism and the dominant type of the botulinic toxin in Romania.

Methods: This is a retrospective analytical study based on information provided by the Cantacuzino National Microbiology Institute (INCDMIC), The National Centre of Informatics of the Health Department (CNOASIIDSB) and by the Bals National Infectious Diseases Institute (INBI) – Bucharest.

Results: In a 7 years period (2000–2007) the total number of cases according to the CNOASIIDSB was 181.

INCDMIC confirmed the presence of the botulinic toxin in 92 biological samples received in the same period. Of these 92, 55 tested positive for type B toxin, in 36 cases the type of the toxin couldn't be identified because of insufficient amount of serum for serotyping, and one sample was positive for type E toxin (in 2007, related to fish products).

The disease had a sporadic evolution, most frequently appearing in familial outbreaks, usually associated with the consumption of home prepared meat products.

Most cases were reported from the western part of the country (116) and the fewest cases were in southern Romania (26 cases).

The average number of cases was about 22/year.

The highest incidence was reported in 2007 (0.18/100000), with 38 cases, the most affected being the western areas, almost half of them related to industrially prepared Romanian meat products (liver paste and canned fish). The lowest incidence was recorded in 2002 and 2006 (0.06/100000).

INBI reported 10 cases in 2007. All patients presented diplopia, palpebral ptosis, midriasis, xerosis and constipation. Nine patients presented urinary retention (severe in 2 cases) and 5 out of 10 developed respiratory failure, one patient requiering tracheostomy.

Conclusions: In Romania, type B botulinic infection was widely spread between 2000–2007, the ratio being 55:1 – B:E which explains the less severe forms of the disease due to the predominantly autonomic nervous system involvement in type B botulism. From an average of 20 cases per year during 2000–2006, the incidence increased rapidly (2 fold in 2007). The incidence is high in the western and central regions, sparing the southern area. Most cases occur from small familial outbreaks due to home prepared meat products, except in 2007, when industrially canned products were involved.