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A survey on 80 cases of botulism and its clinical presentations as a public health concern
Iranian Journal of Clinical Infectious Diseases, 2007
Background: Botulism is a toxin-induced paralytic illness characterized by cranial nerve palsies and descending flaccid paralysis. Botulinum toxin is regarded as the most lethal ever-known substance. The diagnosis in sporadic cases and even in small outbreaks is the main physicians' challenge. The aim of this study was to assess clinical presentations of 80 cases of botulism referred to Loghman Hakim hospital in Tehran. Materials and methods: A total of 80 botulism cases referred during a 10-year period (1996-2006) were included. The diagnosis of botulism was verified on epidemiological data and a clinical score of severity. Patients were assigned in 3 groups: mild, intermediate and severe. Results: The study population included 40 males and 40 females with a mean age of 30.7±15.2 years (a range, 1-66 years). The suspected causative foods were cheese in 25 (31%), and seafood in 20 (25%). The mean incubation period was 1.1±1.8 days (a range, 4 hours-10 days). Nausea and vomiting was noted as the first symptom in 17 cases. Diagnosis was confirmed in 47 patients (58.8%). The most common toxin subgroups were A (in 22 cases) and E (in 15 cases). All the patients were treated with antitoxin and recovered without sequel, however, 6 patients were admitted to intensive care unit (ICU) and required ventilatory support. Only one patient (1.3%) died. Conclusion: The mainstays of therapy are meticulous intensive care (including mechanical ventilation, when necessary) and promptly treatment with antitoxin. Antitoxin should be given early in the course of illness, ideally <24 hours after onset of symptoms.
Botulism: Laboratory Methods and Epidemiology
Anaerobe, 1999
Although food botulism (FB) in Argentina was described by 1911, the first documented outbreak was recorded in 1922. In 1957, an outbreak of type A FB caused by red bell peppers was the first laboratory confirmation of botulism in Argentina. From 1922 to 1997, 70 FB outbreaks affecting 242 persons with 111 deaths (case fatality rate, 46%) were reported in Argentina. Infant botulism (IB) was recognized in 1976 and has been mostly diagnosed in the U.S.A. More than 146 IB cases have been reported in Argentina since 1982. Additional cases may go undiagnosed due to physician inexperience and limited access to diagnostic services. A single laboratory-confirmed case of wound botulism (WB) occurred in Argentina in 1995. The botulinal neurotoxins (BoNTs) identified in Argentina have been types A, B, E, F and Af in FB, and exclusively type A in IB and WB. For the laboratory diagnosis of botulism, serum, gastrointestinal sample, food, and wounds should be tested for BoNT. Gastrointestinal, wound and food sample must also be cultured for toxigenic organisms. When higher volumes of serum were tested, BoNT was found in 61% of IB patients in Mendoza compared with 13% in a previous series from the U.S.A. Reliable typing can only be achieved when the BoNT belongs to a known serotype and the toxin titer is above 4000 LD 50 /mL. When these criteria are not met, as in most clinical samples, bacterial isolation, purification and adequate toxin production in culture are required. Neutralization testing must be performed at not less than three 10-fold doses of toxin because of (1) the existence of subtypes, where a second, minor serotype is present, (2) the sharing of epitopes between certain serotypes, and (3) the occurrence of serological variants. Three basic properties of working antitoxins, specificity, protency and avidity, must be known for BoNT typing. The efficiency index (EI), which expresses the avidity of antitoxins, is an important instrument for recognizing BoNT subtypes.
Foodborne Botulism: Clinical Diagnosis and Medical Treatment
Toxins
Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical condit...
Our experience in the treatment of botulism
Vojnosanitetski pregled, 2017
Introduction. Botulism is a neuro -intoxication caused by a toxin secreted by Clostridium botulinum. Due to extremely high toxicity and lethality, this toxin can be used as an agent in a biological warfare. Case report. We presented six patients, mean age 28.8 years, who ate canned food and in whom the diagnosis of disease was made based on the typical clinical picture. Predominant symptoms were blurred vision, double vision (diplopia), dry mouth and constipation which were present in all patients. The patient whose disease was recognized only after 23 days and who did not receive the anti botulinum serum underwent the longest hospital treatment. All the patients received antibiotics and 4 patients received antitoxin. Neostigmine and enemas were used for the treatment of the disorder of intestinal motility and constipation. Conclusion. The diagnosis of botulinum was made based on afebrility, preserved states of consciousness, double vision, dry mouth and history data on consumption ...
Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 2013
Botulism is a severe neuroparalytic disease that affects humans, all warm-blooded animals, and some fishes. The disease is caused by exposure to toxins produced by Clostridium botulinum and other botulinum toxin-producing clostridia. Botulism in animals represents a severe environmental and economic concern because of its high mortality rate. Moreover, meat or other products from affected animals entering the food chain may result in a public health problem. To this end, early diagnosis is crucial to define and apply appropriate veterinary public health measures. Clinical diagnosis is based on clinical findings eliminating other causes of neuromuscular disorders and on the absence of internal lesions observed during postmortem examination. Since clinical signs alone are often insufficient to make a definitive diagnosis, laboratory confirmation is required. Botulinum antitoxin administration and supportive therapies are used to treat sick animals. Once the diagnosis has been made, euthanasia is frequently advisable. Vaccine administration is subject to health authorities' permission, and it is restricted to a small number of animal species. Several measures can be adopted to prevent or minimize outbreaks. In this article we outline all phases of management of animal botulism outbreaks occurring in wet wild birds, poultry, cattle, horses, and fur farm animals. B otulism is a severe neuroparalytic disease that affects humans, all warm-blooded animals, and some fishes. The illness is caused by exposure to botulinum neurotoxins (BoNTs), which are produced by anaerobic, spore-forming, ubiquitous microorganisms belonging to the genus Clostridium, referred to as BoNT-producing clostridia. BoNTs act on nerve endings blocking acetylcholine release. Their potency depends on 2 factors: their enzymatic activity and their selective affinity for binding neurons. 1,2 Human disease does not differ fundamentally
Botulism : A diagnostic challenge
2011
Botulism is a rare but serious illness caused by a bacterium called Clostridium botulinum, which occurs in soil. It produces a neurotropic toxin. There are three kinds of botulism viz., foodborne botulism, wound botulism and infant botulism. Foodborne botulism comes from eating foods contaminated with the toxin. Wounds infected with toxin-producing bacteria result in wound botulism. And infant botulism occurs when C. botulinum spores germinate and produce toxin in the gastrointestinal tract of infants by consuming the bacteria, usually from honey. All these three forms of botulism can be deadly and are medical emergencies. C. botulinum is an anaerobic, Gram-positive, spore-forming rod shape bacteria that produce botulinum toxin. Botulinum toxin is one of the most powerful known toxins (about one microgram is lethal to humans) that causes the severe neuroparalytic illness. There are seven serologically distinct types of botulinum neurotoxin – types A, B, C, D, E, F, and G1. Compariso...
Botulism in the United States: A Clinical and Epidemiologic Review
Annals of Internal Medicine, 1998
Botulism is caused by a neurotoxin produced from the anaerobic, spore-forming bacterium Clostridium botulinum. Botulism in humans is usually caused by toxin types A, B, and E. Since 1973, a median of 24 cases of foodborne botulism, 3 cases of wound botulism, and 71 cases of infant botulism have been reported annually to the Centers for Disease Control and Prevention (CDC). New vehicles for transmission have emerged in recent decades, and wound botulism associated with black tar heroin has increased dramatically since 1994. Recently, the potential terrorist use of botulinum toxin has become an important concern. Botulism is characterized by symmetric, descending, flaccid paralysis of motor and autonomic nerves, usually beginning with the cranial nerves. Blurred vision, dysphagia, and dysarthria are common initial complaints. The diagnosis of botulism is based on compatible clinical findings; history of exposure to suspect foods; and supportive ancillary testing to rule out other causes of neurologic dysfunction that mimic botulism, such as stroke, the Guillain-Barré syndrome, and myasthenia gravis. Laboratory confirmation of suspected cases is performed at the CDC and some state laboratories. Treatment includes supportive care and trivalent equine antitoxin, which reduces mortality if administered early. The CDC releases botulism antitoxin through an emergency distribution system. Although rare, botulism outbreaks are a public health emergency that require rapid recognition to prevent additional cases and to effectively treat patients. Because clinicians are the first to treat patients in any type of botulism outbreak, they must know how to recognize, diagnose, and treat this rare but potentially lethal disease.
Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review
Clinical Infectious Diseases, 2017
Background. Botulism manifests with cranial nerve palsies and flaccid paralysis in children and adults. Botulism must be rapidly identified and treated; however, clinical presentation and treatment outcomes of noninfant botulism in children are not well described. Methods. We searched 12 databases for peer-reviewed and non-peer-reviewed reports with primary data on botulism in children (persons <18 years of age) or botulinum antitoxin administration to children. Reports underwent title and abstract screening and full text review. For each case, patient demographic, clinical, and outcome data were abstracted. Results. Of 7065 reports identified, 184 met inclusion criteria and described 360 pediatric botulism cases (79% confirmed, 21% probable) that occurred during 1929-2015 in 34 countries. Fifty-three percent were male; age ranged from 4 months to 17 years (median, 10 years). The most commonly reported signs and symptoms were dysphagia (53%), dysarthria (39%), and generalized weakness (37%). Inpatient length of stay ranged from 1 to 425 days (median, 24 days); 14% of cases required intensive care unit admission; 25% reported mechanical ventilation. Eighty-three (23%) children died. Median interval from illness onset to death was 1 day (range, 0-260 days). Among patients who received antitoxin (n = 193), 23 (12%) reported an adverse event, including rash, fever, serum sickness, and anaphylaxis. Relative risk of death among patients treated with antitoxin compared with patients not treated with antitoxin was 0.24 (95% confidence interval, .14-.40; P < .0001). Conclusions. Dysphagia and dysarthria were the most commonly reported cranial nerve symptoms in children with botulism; generalized weakness was described more than paralysis. Children who received antitoxin had better survival; serious adverse events were rare. Most deaths occurred early in the clinical course; therefore, botulism in children should be identified and treated rapidly.
Botulism Foodborne Disease: A Review
2011
Botulism is lethal disease also known as botulinus intoxication is a rare but serious paralytic illness caused by botulinum toxin, which is produced by the bacterium Clostridium botulinum under anaerobic conditions. The toxin enters the body in one of four ways: by colonization of the digestive tract by the bacterium in children or adults, by ingestion of toxin from foods or by contamination of a wound by the bacterium and leads to paralysis that typically starts with the muscles of the face and then spreads towards the limbs. In severe forms, it leads to paralysis of the breathing muscles and causes respiratory failure. In view of this life-threatening complication, all suspected cases of botulism are treated as medical emergencies and public health officials are usually involved to prevent further cases from the same source. In the present review knowledge of botulism, its epidemiology, mechanism of disease, its signs and symptoms, types, clinical features, diagnosis, treatment and vaccination has been focused.This ailment occurs worldwide, afflicts human of all age groups from infants to elderly people. Botulism is a rare yet potentially common form of food poisoning that can be fatal.