Human Type A Botulism : The First Report Cases in Japan

SOGEN Shunichi, NAKAMURA Yukiyoshi, NOZAKI Kae, YAMADA Toshiko, HOSHINA Hiroki, HONJO Shigeru, ARAI Yuji

doi:10.11434/kyorinmed.10.25

In Japan the first documented instance of botulism was recorded in 1951. The majority of cases occurring thereafter have been of type E. No type A cases have been reported. With this information as background, we would like to present what we believe to be is the first occurrence of type A botulism in Japan. On August 11, 1976 two sisters living in Tokyo, aged 11 and 15 years, presented with malaise, ptosis, dysphasia, and dyspnea approximately 24 hours after eating bitter tasting, spoiled "Satsuma-age" (chopped-up fish rolled into the shape of balls and fried). Both patients were hospitalized and diagnosed as having botulism. Type E botulinum antitoxin was given but there was no clinical improvement. The younger sister died on day 8. The elder sister remained conscious but progressively developed generalized motor paralysis, respiratory paralysis, and paralysis of the throat and intestinal tract. She required ventilatory support by means of a respirator attached to a nasotracheal tube for 145 days, intravenous hyperalimentation for 115 days, and antibiotic therapy for 95 days. She was discharged 220 days after the onset of disease. Serum samples taken from both patients on August 16 were positive for type A botulinum toxin. Cl. botulinum spores were also found in the stools of the younger sister on August 17. We believe that these cases represent the first confirmed instance of type A botulism in Japan.

Human Type A Botulism : The First Report Cases in Japan

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