Family files lawsuit over botulism case

Soil dumped by Army linked to ill child, they say

August 26, 2007|By Bradley Olson | Bradley Olson,Sun reporter

An Army investigation into why two babies living about 100 yards apart at Fort Meade contracted infant botulism within several months of each other confirmed what the Army has said all along: that the bacteria had been naturally occurring.

Yet one of the two families -- whose children have recovered -- has filed a $3 million claim against the federal government, alleging that the Army was negligent when it allowed a giant pile of dirt and construction debris to be dumped near both of the homes in a residential community.

While the Army's investigative report did not list the dirt mound as the cause of the two infections last fall, the team of epidemiologists determined that "the most likely source of infection was airborne dust particles that directly entered, or were carried into, the mouths of these infants."

A map in the report also measures the distance between the two homes and the dirt mound -- 489 feet from one house and 781 feet from the other -- and lists it as a "possible soil or dust exposure."

But, noting the extreme rarity of infant botulism cases, the Army investigators and outside experts have said isolating one area of dirt as a direct cause of the illness is impossible, because the bacteria that brings about the infection are ubiquitous. Noting advice from numerous public health officials at the Centers for Disease Control and Prevention and California specialists on infant botulism, the Army declined to test the soil at the post, which is monitored by the Environmental Protection Agency as a Superfund site because much of its infrastructure was built on a landfill.

"Outside your office right now, you might find botulism in the soil sample we took, and just as much outside your office as in a sample we've taken on post," said Lt. Col. Stephen Tobler, an Army epidemiologist and one of the investigators. "We need to do more research on botulism. This is not an easy substance to test for."

Christine Cook, the mother of one of the sick infants whose attorney has filed the claim, believes they should have tested the soil and has faulted Army officials for conducting a poor investigation.

"They shouldn't be able to use a space right next to a housing area to store refuse and dirt," said Michael Archuleta, who is representing Cook. "This is very unusual. And then when they did it, up come two botulism cases."

The family of the second baby has not been identified and has said it does not blame the military.

Only about 100 babies a year contract infant botulism, not to be confused with foodborne botulism, which afflicts children older than 1 and adults and is caused by contaminated food.

The infant variety is caused by a nerve toxin released when swallowed spores of the C. botulinum bacterium colonize in a baby's large intestine and produce botulinum toxin, according to the Web site of California's Infant Botulism Treatment and Prevention Program. Primary symptoms of infection are weakness, difficulty feeding and loss of muscle tone. With treatment, most infants recover.

But scientists still know little about why infants contract the infection from the bacterium when adults are able to ingest it without getting sick.

A cluster of infant botulism cases is extremely rare, although not unprecedented. The Army report details one last year at Vandenberg Air Force Base in southern California. Two babies living about two miles from each other were infected in March 2006 and May 2006. As in this case, ingested spores were identified as the likely cause, possibly from construction at a nearby service station, the report said.

Army officials at Fort Meade confirmed in February that both cases, the first diagnosed in October and the second in December, came from the same strain of Clostridium botulinum bacteria.

The report was concluded about a month later, and although the investigation suggested it be made public, only an executive summary was posted on a Fort Meade Web site in June. The summary didn't mention dust as the probable cause of the infection. The full report was obtained by The Sun.

Stool samples from the two babies were sent to the CDC at the request of the Maryland Department of Health and Hygiene. Results of those tests are pending, said John Hammond, spokesman for the department. Though the report suggested environmental samples could be taken for research at the California infant botulism center, that was not done, officials from the West Coast center said.

Still, several physicians and researchers not affiliated with the Army noted that environmental testing would not have been able to definitively link the two cases. One researcher noted that epidemiologists decades ago traveled the country taking samples from soil and comparing them, finding the bacterium virtually everywhere.

"I agree with their conclusion that they do not need to test the environment," said Dr. Jakub Simon, a specialist in pediatric infectious diseases at the University of Maryland School of Medicine who reviewed the full report at The Sun's request. "We know that the bacterium that causes this is not a contaminant. This organism is naturally occurring."

Cook and Archuleta believe Army officials could do more.

"We can identify whether it came from that soil," Archuleta said. "As opposed to milk or honey, we can look at the subtype [to find where it came from]. The base said they were going to subtype the botulism specimen, and as far as we know, they haven't done that."

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