Eur. J. Epidemiol. 0392-2990 September 1992, p. 750-752 EUROPEAN JOURNAL OF EPIDEMIOLOGY Vol. 8, No. 5 BRIEF REPORTS WOUND BOTULISM: CLINICAL AND MICROBIOLOGICAL FINDINGS OF AN ITALIAN CASE P. AURELI*', L. FENICIA*, A.M. FERRINI*, M. MARTINI** and G. BECCIA** *Laboratorio di Alimenti - Istuto Superiore di Sanith - V.le Regina Elena, 299 - 00161 Roma - Italy. **Centro di Rianimazione - Cattedra di Anestesia e Rianimazione - Ospedale Civile "SS. Annunziata" - Chieti - Italy. Key words: Wound botulism - Botulinal toxin type B A case of wound botulism in a 41-year old man is reported. The patient had accidently been wounded when he fell on an iron bar. Some days later he developed typical clinical manifestations of botulism. Wound botulism was confirmed by detection and quantification of type B botulinal toxin in the serum. Ventilatory supportive care was necessary and botulinal antitoxin was not given. The patient was hospitalized for 30 days and recovery was complete. Botulism (b.) is an acute flaccid paralysis caused by botulinal neurotoxin (2). The toxin may be introduced into the organism by food intake (foodborne b.) or produced in vivo by viable cells of Clostridium botulinum or of other clostridia-producing botulinal toxin in various human tissues (wound b., infant b., other b.) (6, 7). In the past ten years, the number of cases of foodborne b. has decreased while infectious cases, particularly infant b., are becoming prevalent (8, 12). In Italy, most of the recognized cases of botulism are foodborne although, since 1984, 8 cases of infant botulism have been reported (4, 15). Among the infectious forms of botulism, wound b. results from toxin produced by C. botulinum that has infected a wound (7, 13). To our knowledge, various countries have report approximately 50 cases of wound botulism, with a high fatality rate (10, 11, 12, 16, 17). In Italy, only one case of wound botulism was diagnosed, in 1979, but it was not confirmed by microbiological and toxicological assays (9). The present is the report of a case of wound botulism occurring in Italy in 1991. 1 Corresponding author. Case report A 41-year old male, working as a carpenter, fell on 20 March 1991 from a height of 3 m onto an iron bar and was deeply injured in his right gluteus. The wound was properly sutured at a first aid station. Subsequently, the patient developed hyperpyrexia and obstinate constipation and, ten days after the injury, began to show neurologic symptoms of botulism. The patient's symptoms, upon admission to the hospital on 31 March 1991, were: bilateral ptosis, mydriasis, pupils unreactive to light, opthalmoplegia, dysphagia, disphonia and dry throat. Differential diagnosis at admission included infection of the CNS, Guillain-Barr6 syndrome, myasthenia gravis, Miller-Fischer syndrome and botulism. An EEG demonstrated diffuse slowing, however NMR and EMG showed no alterations. Rachicentesis was lightly positive to proteins and routine blood testes showed a white cell count of 14600/mm. Three days after admission (April 3rd) the patient was transferred to the intensive care unit because of a progressive difficulty in swallowing and breathing. As the other diseases appeared less likely, the diagnosis of botulism was suspected. Initially the patient 750