1
|
Almomen M, Memish Z. Botulism in the Highlands: Understanding the High-Altitude Effect. J Epidemiol Glob Health 2025; 15:56. [PMID: 40198475 PMCID: PMC11978557 DOI: 10.1007/s44197-025-00403-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2024] [Accepted: 03/31/2025] [Indexed: 04/10/2025] Open
Abstract
Botulism is a foodborne, life-threatening neuroparalytic disease caused by Clostridium botulinum, an anaerobic, gram-positive, spore-forming bacteria. Its incidence is unknown and underestimated due to missed diagnoses, especially in remote areas. It is divided into four main clinical types: Infant, adult-onset foodborne, iatrogenic, and wound botulism. The overall goal of the article is to focus on the geographic differences in incidence, including its propensity to high-altitude areas, and shed light on the theories behind this propensity.
Collapse
Affiliation(s)
- Momen Almomen
- Department of Pediatric Neurology, Neuroscience Center, King Fahad Specialist Hospital, Dammam, Kingdom of Saudi Arabia.
| | - Ziad Memish
- King Salman Humanitarian Aid & Relief Center, Riyadh, Saudi Arabia
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| |
Collapse
|
2
|
Li G, Wang H, Zhang Y, Yan J, Duan Z, Pang L, Xiong X, Cha Q, Zhao S, Hou M, Liu Y. Genomic characterisation and traceability analysis of a Clostridium botulinum strain involved in a food poisoning incident. BMC Infect Dis 2025; 25:323. [PMID: 40050811 PMCID: PMC11887133 DOI: 10.1186/s12879-025-10700-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/20/2025] [Indexed: 03/09/2025] Open
Abstract
OBJECTIVE To identify the source of Clostridium botulinum (C. botulinum) involved in a food poisoning case in Kunming and analyze its molecular characteristics. RESULTS This study examined samples from a clustered food poisoning incident, including pickled pig liver consumed by three patients, hospital vomit from a deceased patient, and household waste mixed with vomit. Enrichment culture, microscopic examination, and real-time quantitative PCR confirmed the presence of C. botulinum (designated KM001) with type E botulinum toxin. The full-length genomic sequence of this strain was obtained through second and third-generation sequencing, revealing a genome size of 3,713,470 bp. KEGG annotation indicated that 1,840 single genes were assigned to 44 KEGG pathways. Whole-genome sequencing revealed genetic diversity among toxin gene clusters, with 94.76% homology to C. botulinum E3 strain (Alaska E43) and 93.65% homology to C. botulinum B strain (Eklund 17B, NRP). Evolutionary analysis, incorporating complete genomes of foodborne and environmental C. botulinum strains worldwide along with KM001, showed stronger phylogenetic affinity of KM001 to other type E strains. CONCLUSION Overall, this study identified KM001 as the causative agent in a food poisoning incident, marking the first report of type E botulinum toxin poisoning in the region. Genomic analysis revealed the serotype and genetic diversity among toxin gene clusters, providing insights into its gene function, virulence, and evolutionary relationships. Understanding the genetic relationships and evolutionary pathways of different C. botulinum strains is crucial for predicting infection risks and implementing effective control measures.The findings contribute to the documentation of botulinum toxin incidents in Yunnan, China, but do not examine the antimicrobial resistance of C. botulinum or its interactions with other microorganisms; further research is needed to address these aspects.
Collapse
Affiliation(s)
- Guiman Li
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Huiwen Wang
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Yan Zhang
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Jun Yan
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Zhongwen Duan
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Lei Pang
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Xianhui Xiong
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Qiyan Cha
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Siwen Zhao
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China
| | - Min Hou
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China.
| | - Yanyan Liu
- Microbiology Testing Department, Kunming Center for Disease Control and Prevention, Kunming, Yunna, 650228, China.
| |
Collapse
|
3
|
Wei Y, Li G, Wang Z, Qian K, Zhang S, Zhang L, Lei C, Hu S. Development and characterization of a novel neutralizing scFv vectored immunoprophylaxis against botulinum toxin type A. J Drug Target 2024; 32:213-222. [PMID: 38164940 DOI: 10.1080/1061186x.2023.2301418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/18/2023] [Indexed: 01/03/2024]
Abstract
Botulinum toxin is a protein toxin secreted by Clostridium botulinum that is strongly neurotoxic. Due to its characteristics of being super toxic, quick acting, and difficult to prevent, the currently reported antiviral studies focusing on monoclonal antibodies have limited effectiveness. Therefore, for the sake of effectively prevention and treatment of botulism and to maintain country biosecurity as well as the health of the population, in this study, we intend to establish a single chain antibody (scFv) targeting the carboxyl terminal binding functional domain of the botulinum neurotoxin heavy chain (BONT/AHc) of botulinum neurotoxin type A, and explore the value of a new passive immune method in antiviral research which based on adeno-associated virus (AAV) mediated vector immunoprophylaxis (VIP) strategy. The scFv small-molecular single-chain antibody sequenced, designed, constructed, expressed and purified by hybridoma has high neutralising activity and affinity level, which can lay a good foundation for the modification and development of antibody engineering drugs. In vivo experiments, AAV-mediated scFv engineering drug has good anti-BONT/A toxin neutralisation ability, has advantages of simple operation, stable expression and good efficacy, and may be one of the effective treatment strategies for long-term prevention and protection of BONT/A botulinum neurotoxin.
Collapse
Affiliation(s)
- Yongpeng Wei
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
- Hepatic Surgery Department V, The Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - Guangyao Li
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
- Department of Biomedical Engineering, College of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Zhuo Wang
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
- Hepatic Surgery Department V, The Third Affiliated Hospital, Second Military Medical University, Shanghai, China
| | - Kewen Qian
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
- Department of Biomedical Engineering, College of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai, China
| | - Shuyi Zhang
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
| | - Lingling Zhang
- Department of Central Laboratory, Clinical Research Center of Changhai Hospital, Shanghai, China
| | - Changhai Lei
- Department of Biophysics, College of Basic Medical Sciences, Second Military Medical University, Shanghai, China
| | - Shi Hu
- Department of Biomedical Engineering, College of Basic Medical Sciences, Naval Medical University (Second Military Medical University), Shanghai, China
| |
Collapse
|
4
|
Heilmann A, Lacy A, Koyfman A, Long B. High risk and low prevalence diseases: Botulism. Am J Emerg Med 2024; 82:174-182. [PMID: 38925095 DOI: 10.1016/j.ajem.2024.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 06/04/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Botulism is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of botulism, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Botulism is a neuromuscular disorder caused by toxin production of clostridium species bacteria and is a challenging diagnosis that mimics several other conditions. Children account for the majority of patients, with a foodborne source most common, followed by wound sources, typically from intravenous drug injection. Classically, patients with botulism develop bilateral cranial nerve palsies and symmetric, bilateral, descending paralysis. However, patients may initially present with vague symptomatology, such as weakness and dry mouth, which can make diagnosis challenging. A careful history elucidating exposures such as intravenous drug use or consumption of non-commercial canned products can help differentiate botulism from other disorders causing neuromuscular weakness. If suspected, the Centers for Disease Control should be notified to mobilize antitoxin for treatment as soon as the diagnosis is suspected even prior to confirmatory testing. Antibiotics should be avoided in these patients, as they can potentiate toxin release, unless there is a concomitant infection requiring antibiotic therapy. Patients with botulism can develop respiratory compromise requiring emergent airway management. Prolonged neuromuscular blockade from botulism will lead to a variety of symptoms that require comprehensive intensive care unit level care. CONCLUSION An understanding of botulism and its many potential mimics can assist emergency clinicians in diagnosing and managing this deadly disease.
Collapse
Affiliation(s)
- Adam Heilmann
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Aaron Lacy
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MO, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
| |
Collapse
|
5
|
Kaji R. A look at the future-new BoNTs and delivery systems in development: What it could mean in the clinic. Toxicon 2023; 234:107264. [PMID: 37657515 DOI: 10.1016/j.toxicon.2023.107264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023]
Abstract
Despite the expanding clinical utility of botulinum neurotoxins, there remain problems to be solved for attaining the best outcome. The efficacy and safety need to be reconsidered for commercially available preparations all derived from subtype A1 or B1. Emerging new toxins include A2 or A6 subtypes or engineered toxins with less spread, more potency, longer durations of action, less antigenicity and better safety profile than currently used preparations. Non-toxic BoNTs with a few amino acid replacements of the light chain (LC) may have a role as a drug-delivery system if the toxicity is abolished entirely. At present, efficacy of these BoNTs in animal botulism was demonstrated.
Collapse
Affiliation(s)
- Ryuji Kaji
- Tokushima University, Department of Clinical Neuroscience, 2-50-1 Kuramoto-cho, Tokushima, 770-8503, Japan.
| |
Collapse
|
6
|
Grabka M, Jasek K, Witkiewicz Z. Surface Acoustic Wave Immunosensor for Detection of Botulinum Neurotoxin. SENSORS (BASEL, SWITZERLAND) 2023; 23:7688. [PMID: 37765744 PMCID: PMC10534944 DOI: 10.3390/s23187688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
A Love-type acoustic wave sensor (AT-cut quartz substrate, SiO2 guiding layer) with a center frequency of approximately 120 MHz was used to detect a simulant of pathogenic botulinum neurotoxin type A-recombinant of BoNT-A light chain-in liquid samples. The sensor was prepared by immobilizing monoclonal antibodies specific for botulinum neurotoxin via a thiol monolayer deposited on a gold substrate. Studies have shown that the sensor enables selective analyte detection within a few minutes. In addition, the sensor can be used several times (regeneration of the sensor is possible using a low pH buffer). Nevertheless, the detectability of the analyte is relatively low compared to other analytical techniques that can be used for rapid detection of botulinum neurotoxin. The obtained results confirm the operation of the proposed sensor and give hope for further development of this label-free technique for detecting botulinum neurotoxin.
Collapse
Affiliation(s)
- Michał Grabka
- Institute of Chemistry, Faculty of Advanced Technologies and Chemistry, Military University of Technology, 00-908 Warsaw, Poland; (K.J.); (Z.W.)
| | | | | |
Collapse
|
7
|
Mallat F, Kaikati J, Kechichian E. Botulinum Toxins and Zinc: From Theory to Practice-A Systematic Review. Clin Neuropharmacol 2023; Publish Ahead of Print:00002826-990000000-00057. [PMID: 37335837 DOI: 10.1097/wnf.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The aims of this study were to determine whether zinc supplementation affects botulinum toxin's effect and longevity and to establish a transition from the molecular to the clinical aspect. METHODS We conducted a systematic review in which we included all published studies on PubMed and Embase using the combination of the following terms: "zinc" AND (botox OR botulinum OR onabotulinumtoxinA OR abobotulinumtoxinA OR incobotulinumtoxinA). RESULTS From the 260 yielded articles, 3 randomized control trials and 1 case report were retained. Three of them found a significant improvement with zinc supplementation in the toxin's effect and longevity. This was observed in neurological conditions and cosmetic uses. CONCLUSIONS Zinc supplementation could be an interesting asset in the potentialization of botulinum neurotoxin effect and longevity. Larger clinical trials and objective measurement tools should be used to further defining the role of zinc in maximizing botulinum neurotoxin effect.
Collapse
Affiliation(s)
- Farid Mallat
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Jerome Kaikati
- Dermatology Department, Hôtel Dieu de France, Beirut, Lebanon
| | | |
Collapse
|
8
|
The Light Chain Domain and Especially the C-Terminus of Receptor-Binding Domain of the Botulinum Neurotoxin (BoNT) Are the Hotspots for Amino Acid Variability and Toxin Type Diversity. Genes (Basel) 2022; 13:genes13101915. [PMID: 36292800 PMCID: PMC9601653 DOI: 10.3390/genes13101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 01/15/2023] Open
Abstract
Botulinum neurotoxins (BoNT) are the most potent toxins in the world. They are produced by a few dozens of strains within several clostridial species. The toxin that they produce can cause botulism, a flaccid paralysis in humans and other animals. With seven established serologically different types and over 40 subtypes, BoNTs are among the most diverse known toxins. The toxin, its structure, its function and its physiological effects on the neural cell and animal hosts along with its diversity have been the subjects of numerous studies. However, many gaps remain in our knowledge about the BoNT toxin and the species that produce them. One of these gaps involves the distribution and extent of variability along the full length of the gene and the protein as well as its domains and subdomains. In this study, we performed an extensive analysis of all of the available 143 unique BoNT-encoding genes and their products, and we investigated their diversity and evolution. Our results indicate that while the nucleotide variability is almost uniformly distributed along the entire length of the gene, the amino acid variability is not. We found that most of the differences were concentrated along the protein's light chain (LC) domain and especially, the C-terminus of the receptor-binding domain (HCC). These two regions of the protein are thus identified as the main source of the toxin type differentiation, and consequently, this toxin's versatility to bind different receptors and their isoforms and act upon different substrates, thus infecting different hosts.
Collapse
|
9
|
Gazerani P. How Does Botulinum Toxin Inhibit Itch? Toxins (Basel) 2022; 14:701. [PMID: 36287970 PMCID: PMC9610088 DOI: 10.3390/toxins14100701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 12/04/2022] Open
Abstract
Two decades after reports of the anti-pruritic effects of botulinum neurotoxins (BoNTs), there is still no approved product for the anti-itch indication of BoNTs, and most clinical case reports still focus on the off-label use of BoNTs for various itchy conditions. Few randomized clinical trials have been conducted with controversial results, and the beneficial effects of BoNTs against itch are mainly based on case studies and case series. These studies are valuable in presenting the potential application of BoNTs in chronic pruritic conditions, but due to the nature of these studies, they are categorized as providing lower levels of evidence or lower grades of recommendation. To obtain approval for the anti-pruritic indication of BoNTs, higher levels of evidence are required, which can be achieved through conducting large-scale and well-designed studies with proper control groups and established careful and reliable primary and secondary outcomes. In addition to clinical evidence, presenting the mechanism-based antipruritic action of BoNTs can potentially strengthen, accelerate, and facilitate the current efforts towards further investments in accelerating the field towards the potential approval of BoNTs for itchy conditions. This review, therefore, aimed to provide the state-of-the-art mechanisms underlying the anti-itch effect of BoNTs from basic studies that resemble various clinical conditions with itch as a hallmark. Evidence of the neuronal, glial, and immune modulatory actions of BoNTs in reducing the transmission of itch are presented, and future potential directions are outlined.
Collapse
Affiliation(s)
- Parisa Gazerani
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, 0130 Oslo, Norway; or
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, 9220 Aalborg East, Denmark
| |
Collapse
|
10
|
Sheehan J, Sadlier C, O'Brien B. Bacterial endotoxins and exotoxins in intensive care medicine. BJA Educ 2022; 22:224-230. [DOI: 10.1016/j.bjae.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 11/28/2022] Open
|
11
|
OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy. J Clin Med 2021; 10:jcm10132898. [PMID: 34209849 PMCID: PMC8269087 DOI: 10.3390/jcm10132898] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.
Collapse
|
12
|
Abstract
For the general dentist, the use of BTA and dermal fillers confers the ability to exert control over the soft tissues surrounding the mouth to better create a harmonious smile. The injection of BTA and fillers into the facial musculature and dermis requires a level of finesse to achieve the desired outcomes. A sound understanding of the mechanisms of action and the ability to manage potential complications are also necessary, because the dentist administering BTA and dermal fillers must be competent to the same level as other providers who have traditionally been the gatekeepers of such agents.
Collapse
Affiliation(s)
- David Sheen
- Department of Oral & Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA.
| | - Earl Clarkson
- Department of Oral & Maxillofacial Surgery, Woodhull Medical Center, 760 Broadway, Brooklyn, NY 11206, USA
| |
Collapse
|
13
|
Pohanka M. Botulinum Toxin as a Biological Warfare Agent: Poisoning, Diagnosis and Countermeasures. Mini Rev Med Chem 2020; 20:865-874. [PMID: 32108007 DOI: 10.2174/1389557520666200228105312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 12/16/2022]
Abstract
Botulinum toxin is a neurotoxin produced by Clostridium botulinum and some other relative species. It causes a lethal disease called botulism. It can enter the body via infections by Clostridium (e.g. wound and children botulism) or by direct contact with the toxin or eating contaminated food (food-borne botulism). Botulinum toxin is also considered as a relevant biological warfare agent with an expected high number of causalities when misused for bioterrorist or military purposes. The current paper surveys the actual knowledge about botulinum toxin pathogenesis, the manifestation of poisoning, and current trends in diagnostics and therapeutics. Relevant and recent literature is summarized in this paper.
Collapse
Affiliation(s)
- Miroslav Pohanka
- Faculty of Military Health Sciences, University of Defense, Trebesska 1575, Hradec Kralove CZ-50001, Czech Republic
| |
Collapse
|
14
|
Cenciarelli O, Riley PW, Baka A. Biosecurity Threat Posed by Botulinum Toxin. Toxins (Basel) 2019; 11:toxins11120681. [PMID: 31757074 PMCID: PMC6950065 DOI: 10.3390/toxins11120681] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/03/2019] [Accepted: 11/13/2019] [Indexed: 12/28/2022] Open
Abstract
The deliberate release of biological agents with terrorist or criminal intent continues to pose concerns in the current geopolitical situation. Therefore, attention is still needed to ensure preparedness against the potential use of pathogens as unconventional weapons. Botulinum neurotoxin (BoNT) is one such biological threat, characterized by an extremely low lethal dose, high morbidity and mortality when appropriately disseminated, and the capacity to cause panic and social disruption. This paper addresses the risks of a potential release of the botulinum neurotoxin and summarizes the relevant aspects of the threat.
Collapse
|
15
|
Affiliation(s)
- A. L. Johnson
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Philadelphia Pennsylvania USA
| |
Collapse
|
16
|
Cook PA, Mishler A, Quan D, Parrish-Garcia A. Wound botulism caused by Clostridium subterminale after a heroin injection. Infect Dis Rep 2018; 10:7654. [PMID: 30344967 PMCID: PMC6176474 DOI: 10.4081/idr.2018.7654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/04/2018] [Accepted: 06/14/2018] [Indexed: 11/23/2022] Open
Abstract
Botulism is caused by toxin production from many species of Clostridium, most commonly Clostridium botulinum as well as C. baratii and C. butyricum. Development of wound botulism is associated with injection drug users but has also been described in traumatic injuries with exposure to soil. A patient presented to the emergency department with a complaint of descending, progressive weakness. He recently reported skin popping with heroin injections. Heptavalent botulinum antitoxin was obtained from the [Center for Disease Control and Prevention (CDC)]. On hospital day seven, the anaerobic wound cultures resulted with growth of Clostridium subterminale.
Collapse
Affiliation(s)
| | | | - Dan Quan
- Department of Emergency Medicine, Maricopa Integrated Health System, University of Arizona, Phoenix, AZ, USA
| | - Ashley Parrish-Garcia
- Department of Emergency Medicine, Maricopa Integrated Health System, University of Arizona, Phoenix, AZ, USA
| |
Collapse
|
17
|
Ghosal KJ, Patel K, Singh BR, Hale ML. Role of critical elements in botulinum neurotoxin complex in toxin routing across intestinal and bronchial barriers. PLoS One 2018; 13:e0199524. [PMID: 29975725 PMCID: PMC6033393 DOI: 10.1371/journal.pone.0199524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/08/2018] [Indexed: 11/18/2022] Open
Abstract
The highly potent botulinum neurotoxin serotype A (BoNT/A) inhibits neurotransmitter release at neuromuscular junctions resulting in flaccid muscle paralysis, respiratory arrest and death. In order to reach their neuronal cell targets, BoNT/A must cross epithelial cell barriers lining the intestines and airways. The toxin is produced as a large protein complex comprised of the neurotoxin and non-toxic neurotoxin-associated proteins (NAPs). Although NAPs are known to protect the toxin from harsh environments, their role in the movement of BoNT/A across epithelial barriers has not been fully characterized. In the current study, movement of the toxin across epithelial cells was examined macroscopically using a sensitive near infrared fluorescence transcytosis assay and microscopically using fluorescently labeled toxin and confocal microscopy. The studies show that the BoNT/A complex internalizes more rapidly than the pure toxin. The studies also show that one NAP protein, hemaglutinin 33 (Hn33), enhanced both the binding and movement of a deactivated recombinant botulinum neurotoxin A (DrBoNT) across epithelial cell monolayers and that the toxin associates with Hn33 on the cell surface. Collectively, the data demonstrate that, in addition to their protective role, NAPs and Hn33 play an important role in BoNT/A intoxication.
Collapse
Affiliation(s)
- Koyel J. Ghosal
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, United States of America
| | - Kruti Patel
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, United States of America
| | - Bal Ram Singh
- Department of Chemistry and Biochemistry, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts, United States of America
| | - Martha L. Hale
- Molecular and Translational Sciences Division, United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| |
Collapse
|
18
|
Dual-route targeted vaccine protects efficiently against botulinum neurotoxin A complex. Vaccine 2017; 36:155-164. [PMID: 29180028 DOI: 10.1016/j.vaccine.2017.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/19/2017] [Accepted: 11/06/2017] [Indexed: 01/05/2023]
Abstract
Clostridium botulinum readily persists in the soil and secretes life-threatening botulinum neurotoxins (BoNTs) that are categorized into serotypes A to H, of which, serotype A (BoNT/A) is the most commonly occurring in nature. An efficacious vaccine with high longevity against BoNT intoxication is urgent. Herein, we developed a dual-route vaccine administered over four consecutive weeks by mucosal and parenteral routes, consisting of the heavy chain (Hc) of BoNT/A targeting dendritic cell peptide (DCpep) expressed by Lactobacillus acidophilus as a secretory immunogenic protein. The administered dual-route vaccine elicited robust and long-lasting memory B cell responses comprising germinal center (GC) B cells and follicular T cells (Tfh) that fully protected mice from lethal oral BoNT/A fatal intoxication. Additionally, passively transferring neutralizing antibodies against BoNT/A into naïve mice induced robust protection against BoNT/A lethal intoxication. Together, a targeted vaccine employing local and systemic administrative routes may represent a novel formulation eliciting protective B cell responses with remarkable longevity against threatening biologic agents such as BoNTs.
Collapse
|
19
|
Lispi L, Leonardi L, Petrucci A. Longitudinal neurophysiological assessment of intramuscular type-A botulin toxin in healthy humans. Neurol Sci 2017; 39:329-332. [PMID: 29128986 DOI: 10.1007/s10072-017-3191-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study is to assess the neurophysiological abnormalities of type A botulin toxin-infiltrated human muscle, and their evolution over time. Seried cMAP measurements, 3 and 20 Hz repetitive nerve stimulation, EMG, SFEMG over 3 months from toxin injection. Our findings consist in lack of decrement with 3 Hz repetitive nerve stimulation and facilitation with 20 Hz repetitive nerve stimulation; progressive increasing of jitter; early appearance of fibrillations; small and short motor unit action potential in the first 3 weeks, followed by increasing of MUAP amplitude and duration, with polyphasic morphology. Although claimed as highly specific and sensible, neuromuscular junction facilitation is an inconstant finding in human botulism. Therefore, lack of neuromuscular junction facilitation cannot exclude a diagnosis of botulism. Our findings are compatible with a process of acute denervation followed by distal reinnervation, favored by terminal nerve sprouting.
Collapse
Affiliation(s)
- L Lispi
- Unit of Neurology and Neurophysiopathology, S. Camillo Forlanini Hospital, Rome, Italy
| | - L Leonardi
- Unit of Neurology and Neurophysiopathology, S. Camillo Forlanini Hospital, Rome, Italy.
| | - A Petrucci
- Unit of Neurology and Neurophysiopathology, S. Camillo Forlanini Hospital, Rome, Italy
| |
Collapse
|
20
|
Abstract
For the general dentist, the use of botulinum toxin type A (BTA) confers the ability to exert control over the soft tissues surrounding the mouth to better create a harmonious smile. The injection of BTA into the facial musculature requires a level of finesse to achieve the desired outcomes. A sound understanding of the toxin's mechanism of action and the ability to manage potential complications are also necessary, as the dentist administering BTA must be competent to the same level as other providers who have traditionally been the gatekeepers of such agents.
Collapse
|
21
|
Anti-botulism single-shot vaccine using chitosan for protein encapsulation by simple coacervation. Anaerobe 2016; 42:182-187. [DOI: 10.1016/j.anaerobe.2016.10.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/21/2022]
|
22
|
Frey C, Eifert A, Schütz H, Barth H, Mizaikoff B, Kranz C. Macroscopic and microscopic electrochemical investigation of Clostridium botulinum C2IIa embedded in supported lipid membranes. Electrochim Acta 2016. [DOI: 10.1016/j.electacta.2016.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
|
23
|
Affiliation(s)
- Maria A Carrillo-Marquez
- Department of Pediatrics, Pediatric Infectious Diseases Division, University of Tennessee Health Science Center, Memphis, TN
| |
Collapse
|
24
|
Ambrose EA. Botulinum Neurotoxin, Tetanus Toxin, and Anthrax Lethal Factor Countermeasures. TOPICS IN MEDICINAL CHEMISTRY 2016. [DOI: 10.1007/7355_2016_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
25
|
Proverbio MR, Lamba M, Rossi A, Siani P. Early diagnosis and treatment in a child with foodborne botulism. Anaerobe 2015; 39:189-92. [PMID: 26688278 DOI: 10.1016/j.anaerobe.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Foodborne botulism is a neuroparalytic disease caused by ingestion of food contaminated with botulinum toxins. Despite rare the mortality rate is high if untreated. Diagnosis of botulism is still a challenge for clinician, due to the variability of clinical manifestations and disease course. We report on a child with type B botulin intoxication who was early diagnosed and treated underlining that clinical suspicion is crucial to start prompt treatment. CASE PRESENTATION An 11-year-old boy presented with bilateral ptosis and mydriasis, dry mouth, difficulty in swallowing, dysphonia, urine retention and constipation. Clear sensorium and no fever were observed. Immediately the suspicion of botulism was risen and botulinum antitoxin was administered. 3 days later serum and rectal samples tested positive for Clostridium botulinum. The patient completely recovered when discharged from hospital. DISCUSSION Foodborne botulism is still possible in developed countries. The confirmation test of botulism requires some days. To avoid long delays between intoxication and diagnosis prompt clinical suspicion is thus crucial. The outcome depends on rapid implementation of appropriate management with intensive respiratory care and antitoxin administration.
Collapse
Affiliation(s)
| | - Marta Lamba
- Department of Pediatrics, AORN "Santobono-Pausilipon", Naples, Italy.
| | - Alessandro Rossi
- Department of Translational Medical Sciences, Section of Pediatrics, "Federico II" University, Naples, Italy.
| | - Paolo Siani
- Department of Pediatrics, AORN "Santobono-Pausilipon", Naples, Italy.
| |
Collapse
|
26
|
Johnson AL, McAdams-Gallagher SC, Aceto H. Outcome of adult horses with botulism treated at a veterinary hospital: 92 cases (1989-2013). J Vet Intern Med 2014; 29:311-9. [PMID: 25408202 PMCID: PMC4858097 DOI: 10.1111/jvim.12502] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 08/26/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022] Open
Abstract
Background There are no studies evaluating a large population of adult horses treated for botulism. Reported survival rates in outbreak situations are low; however, many horses in outbreaks do not receive treatment. Hypothesis/Objectives That adult horses treated at a veterinary hospital would have improved survival compared to outbreak situations. Additional aims included identification of predictors of nonsurvival. Animals All horses greater than 6 months of age with a final diagnosis of botulism admitted to a veterinary teaching hospital between 1989 and 2013 were included. Methods Retrospective study. Historical, admission, and hospitalization data were retrieved from medical records and associations between variables and nonsurvival were identified using logistic regression. Two multivariable models were developed pertaining to (1) information available at admission and (2) clinical findings during hospitalization. Results Ninety‐two records met inclusion criteria. Retained variables for the two models indicated that higher rectal temperature (OR, 1.94; CI, 1.19–3.17) and dysphagia (OR, 4.04; CI, 1.01–16.17) observed at admission increased the odds of survival, as did treatment with antitoxin (OR, 121.30; CI, 9.94–1,480.65). Horses with abnormal respiratory effort or inability to stand had decreased odds of survival. Overall survival was 48% but was significantly higher (67%, P = .011) for horses that arrived standing, and even higher (95%, P < .001) for horses that remained able to stand throughout hospitalization. Complications occurred in 62% of horses but were not associated with nonsurvival. Conclusions and Clinical Importance Horses that lose the ability to stand have a poor chance of survival. Complications are common in treated horses but do not reduce survival.
Collapse
Affiliation(s)
- A L Johnson
- Botulism Reference Laboratory, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA; Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | | | | |
Collapse
|
27
|
Olsen JS, Scholz H, Fillo S, Ramisse V, Lista F, Trømborg AK, Aarskaug T, Thrane I, Blatny JM. Analysis of the genetic distribution among members of Clostridium botulinum group I using a novel multilocus sequence typing (MLST) assay. J Microbiol Methods 2013; 96:84-91. [PMID: 24246230 DOI: 10.1016/j.mimet.2013.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 11/01/2013] [Accepted: 11/05/2013] [Indexed: 10/26/2022]
Abstract
Clostridium botulinum is the etiological agent of botulism. Due to food-borne poisoning and the potential use of the extremely toxic botulinum neurotoxin (BoNT) from C. botulinum in bioterror or biocrime related actions, reliable high resolution typing methods for discriminating C. botulinum strains are needed. Partial sequencing of the adk, atpH, gyrB, proC, rpoD and spo0A genes from 51 various C. botulinum/sporogenes isolates was performed, resulting in 37 different sequence types (STs). Analysis of the sequence data revealed a genetic distribution in five larger clusters with a loose correlation to the BoNT serotypes. The developed MLST assay had a slightly lower resolution ability when compared to the MLVA (multilocus variable number of tandem repeat analysis), but the two methods resulted in similar subclusters of the strains possessing the BoNT serotypes A, B and F. The current work presents the development of a novel MLST assay useful for genotyping C. botulinum related to basic phylogenetic research and trace-back analysis in microbial forensic studies.
Collapse
Affiliation(s)
- Jaran S Olsen
- Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway.
| | - Holger Scholz
- German Armed Forces, Institute of Microbiology, Munich, Germany
| | - Silvia Fillo
- Army Medical and Veterinary Research Center, Via Santo Stefano Rotondo 4, I-00184 Rome, Italy
| | - Vincent Ramisse
- Division of Analytical Microbiology, DGA CBRN Defence, BP3, 91710 Vert le Petit, France
| | - Florigio Lista
- Army Medical and Veterinary Research Center, Via Santo Stefano Rotondo 4, I-00184 Rome, Italy
| | - Anette K Trømborg
- Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway
| | - Tone Aarskaug
- Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway
| | - Ingjerd Thrane
- Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway
| | - Janet M Blatny
- Norwegian Defence Research Establishment, P.O. Box 25, N-2027 Kjeller, Norway
| |
Collapse
|
28
|
Balali-Mood M, Moshiri M, Etemad L. Medical aspects of bio-terrorism. Toxicon 2013; 69:131-42. [PMID: 23339855 DOI: 10.1016/j.toxicon.2013.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 01/02/2013] [Accepted: 01/09/2013] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Bioterrorism is a terrorist action involving the intentional release or dissemination of a biological warfare agent (BWA), which includes some bacteria, viruses, rickettsiae, fungi or biological toxins. BWA is a naturally occurring or human-modified form that may kill or incapacitate humans, animals or plants as an act of war or terrorism. BWA is a weapon of choice for mass destruction and terrorism, because of the incubation period, less effective amount than chemical warfare agents, easily distribution, odorless, colorless, difficult to detect, no need of specialized equipment for production and naturally distribution which can easily be obtained. BWA may be disseminating as an aerosol, spray, explosive device, and by food or water. CLASSIFICATION Based on the risk for human health, BWAs have been prioritized into three categories of A, B and C. Category A includes microorganisms or toxins that easily spread, leading to intoxication with high death rates such as Anthrax, Botulism, Plague, Smallpox, Tularemia and Viral hemorrhagic fevers. Category B has lower toxicity with wider range, including Staphylococcal Entrotoxin type B (SEB), Epsilon toxin of Clostridium perfringens, Ricin, Saxotoxins, Abrin and Trichothecene mycotoxins. The C category includes emerging pathogens that could also be engineered for mass spread such as Hanta viruses, multidrug-resistant tuberculosis, Nipah virus, the tick-borne encephalitis viruses, hemorrhagic fever viruses and yellow fever. CLINICAL MANIFESTATIONS OF BIOTOXINS IN HUMAN: Clinical features and severity of intoxication depend on the agent and exposed dose, route of entry, individual variation and environmental factors. Onset of symptoms varies from 2-24 h in Ricin to 24-96 h in Botulism. Clinical manifestations also vary from irritation of the eyes, skin and mucus membranes in T2 toxin to an acute flaccid paralysis of bilateral cranial nerve impairment of descending manner in botulism. Most of the pyrogenic toxins such as SEB produce the same signs and symptoms as toxic shock syndrome including a rapid drop in blood pressure, elevated temperature, and multiple organ failure. MANAGEMENT There is no specific antidote or effective treatment for most of the biotoxins. The clinical management is thus more supportive and symptomatic. Fortunately vaccines are now available for most of BWA. Therefore, immunization of personnel at risk of exposure is recommended. CONCLUSION Biotoxins are very wide and bioterrorism is a heath and security threat that may induce national and international problems. Therefore, the security authorities, health professional and even public should be aware of bioterrorism.
Collapse
Affiliation(s)
- Mahdi Balali-Mood
- Medical Toxicology Research Centre, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 91735-348, Islamic Republic of Iran.
| | | | | |
Collapse
|
29
|
Vasa M, Baudendistel TE, Ohikhuare CE, Grace EM, Yan W, Josephson SA, Tierney LM. Clinical problem-solving. The eyes have it. N Engl J Med 2012; 367:938-43. [PMID: 22931263 DOI: 10.1056/nejmcps1105394] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Miten Vasa
- Department of Medicine, University of California, Irvine, Orange, CA 92868, USA.
| | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
Bioterrorism is defined as the intentional use of biological, chemical, nuclear, or radiological agents to cause disease, death, or environmental damage. Early recognition of a bioterrorist attack is of utmost importance to minimize casualties and initiate appropriate therapy. The range of agents that could potentially be used as weapons is wide, however, only a few of these agents have all the characteristics making them ideal for that purpose. Many of the chemical and biological weapons can cause neurological symptoms and damage the nervous system in varying degrees. Therefore, preparedness among neurologists is important. The main challenge is to be cognizant of the clinical syndromes and to be able to differentiate diseases caused by bioterrorism from naturally occurring disorders. This review provides an overview of the biological and chemical warfare agents, with a focus on neurological manifestation and an approach to treatment from a perspective of neurological critical care.
Collapse
Affiliation(s)
- Katharina M Busl
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA.
| | | |
Collapse
|
31
|
In vitro detection and quantification of botulinum neurotoxin type e activity in avian blood. Appl Environ Microbiol 2011; 77:7815-22. [PMID: 21908624 DOI: 10.1128/aem.06165-11] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Botulinum neurotoxin serotype E (BoNT/E) outbreaks in the Great Lakes region cause large annual avian mortality events, with an estimated 17,000 bird deaths reported in 2007 alone. During an outbreak investigation, blood collected from bird carcasses is tested for the presence of BoNT/E using the mouse lethality assay. While sensitive, this method is labor-intensive and low throughput and can take up to 7 days to complete. We developed a rapid and sensitive in vitro assay, the BoTest Matrix E assay, that combines immunoprecipitation with high-affinity endopeptidase activity detection by Förster resonance energy transfer (FRET) to rapidly quantify BoNT/E activity in avian blood with detection limits comparable to those of the mouse lethality assay. On the basis of the analysis of archived blood samples (n = 87) collected from bird carcasses during avian mortality investigations, BoTest Matrix E detected picomolar quantities of BoNT/E following a 2-h incubation and femtomolar quantities of BoNT/E following extended incubation (24 h) with 100% diagnostic specificity and 91% diagnostic sensitivity.
Collapse
|
32
|
Reynolds KA, Young DR, Bariola JR, Rudnicki SA, Gruenwald JM. Bilateral Open Femoral Fracture Complicated by Wound Botulism: A Case Report. JBJS Case Connect 2011; 1:e3. [PMID: 34428871 DOI: 10.2106/jbjs.cc.k.00048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Kirk A Reynolds
- Department of Orthopaedic Surgery (K.A.R. and J.M.G.); Infectious Disease Division, Department of Internal Medicine (D.R.Y. and J.R.B.); and Departments of Neurology, Neurobiology and Developmental Science (S.A.R.), University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205.
| | | | | | | | | |
Collapse
|
33
|
|
34
|
Kakati BR, Dang SM, Heif MM, Aduli F. Rare case of dysphagia. Dysphagia 2010; 26:337-9. [PMID: 20809173 DOI: 10.1007/s00455-010-9300-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 08/07/2010] [Indexed: 11/28/2022]
Abstract
Wound botulism is exceedingly rare and occurs almost exclusively among injection drug users. In 2008 there was a case of wound botulism in a noninjecting drug user reported to the Centers for Disease Control and Prevention (CDC). We report a case of a Caucasian male developing dysphagia due to wound botulism after having a motorcycle accident that left him with open fractures. The CDC was contacted and the patient was transferred to medical intensive care unit to be emergently started on hepatavalent Clostridium botulinum antitoxin. Early suspicion of wound botulism is essential for effective therapy with antitoxin in this life-threatening disease. If not suspected, this patient would likely have died. Nevertheless, the delay in diagnosis and treatment resulted in the patient's suffering dysphagia and neurological deficits. The patient required a percutaneous endoscopic gastrostomy tube and months of dysphagia therapy, supportive care, and rehabilitation. Our aim is to increase the awareness for wound botulism when a patient presents with dysphagia and diplopia after suffering open wounds. If suspected early, the morbidity and mortality from this disease can be prevented.
Collapse
Affiliation(s)
- Bobby R Kakati
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Slot#634, Little Rock, AR 72205, USA.
| | | | | | | |
Collapse
|
35
|
Clapp B, Golden S, Maddaloni M, Staats HF, Pascual DW. Adenovirus F protein as a delivery vehicle for botulinum B. BMC Immunol 2010; 11:36. [PMID: 20609248 PMCID: PMC2912244 DOI: 10.1186/1471-2172-11-36] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Accepted: 07/07/2010] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Immunization with recombinant carboxyl-terminal domain of the heavy chain (Hc domain) of botulinum neurotoxin (BoNT) stimulates protective immunity against native BoNT challenge. Most studies developing a botulism vaccine have focused on the whole Hc; however, since the principal protective epitopes are located within beta-trefoil domain (Hcbetatre), we hypothesize that immunization with the Hcbetatre domain is sufficient to confer protective immunity. In addition, enhancing its uptake subsequent to nasal delivery prompted development of an alternative vaccine strategy, and we hypothesize that the addition of targeting moiety adenovirus 2 fiber protein (Ad2F) may enhance such uptake during vaccination. RESULTS The Hcbetatre serotype B immunogen was genetically fused to Ad2F (Hcbetatre/B-Ad2F), and its immunogenicity was tested in mice. In combination with the mucosal adjuvant, cholera toxin (CT), enhanced mucosal IgA and serum IgG Ab titers were induced by nasal Hcbetatre-Ad2F relative to Hcbetatre alone; however, similar Ab titers were obtained upon intramuscular immunization. These BoNT/B-specific Abs induced by nasal immunization were generally supported in large part by Th2 cells, as opposed to Hcbetatre-immunized mice that showed more mixed Th1 and Th2 cells. Using a mouse neutralization assay, sera from animals immunized with Hcbetatre and Hcbetatre-Ad2F protected mice against 2.0 LD50. CONCLUSION These results demonstrate that Hcbetatre-based immunogens are highly immunogenic, especially when genetically fused to Ad2F, and Ad2F can be exploited as a vaccine delivery platform to the mucosa.
Collapse
Affiliation(s)
- Beata Clapp
- Veterinary Molecular Biology, Montana State University, Bozeman, MT 59717-3610, USA
| | - Sarah Golden
- Veterinary Molecular Biology, Montana State University, Bozeman, MT 59717-3610, USA
| | - Massimo Maddaloni
- Veterinary Molecular Biology, Montana State University, Bozeman, MT 59717-3610, USA
| | - Herman F Staats
- Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA
| | - David W Pascual
- Veterinary Molecular Biology, Montana State University, Bozeman, MT 59717-3610, USA
| |
Collapse
|
36
|
Johnson AL, McAdams SC, Whitlock RH. Type A botulism in horses in the United States: a review of the past ten years (1998-2008). J Vet Diagn Invest 2010; 22:165-73. [PMID: 20224073 DOI: 10.1177/104063871002200201] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of the current retrospective study was to describe naturally occurring type A botulism in horses in the United States. In the past 10 years, the Botulism Laboratory at the University of Pennsylvania's School of Veterinary Medicine has identified 3 isolated cases and 8 outbreaks of type A botulism in horses via samples positive for Clostridium botulinum type A toxin or spores using the mouse bioassay test. Additional information was obtained by review of submission forms and by telephone or email interviews. Almost all type A cases and outbreaks occurred in the western United States, with Oregon and Idaho overrepresented. Type A toxin was identified in only 1 outbreak; all other identified cases and outbreaks were positive for spores but not preformed toxin. Reported clinical signs included progressive muscle weakness, recumbency, decreased tail and/or tongue tone, dysphagia, respiratory distress, and death. Isolated cases involved foals < or =1 month of age; outbreaks involved horses > or =11 months. One hundred and nineteen horses were potentially exposed to the toxin source; 54 out of 119 showed signs of botulism, and 49 out of 54 affected horses were confirmed dead. The number of horses affected per outbreak ranged from 2 to 24. The source of infection was confirmed to be hay or silage in 6 out of 8 outbreaks and was unknown in 2 out of 8 outbreaks. The present report is the first description of outbreaks of type A botulism in horses and has important implications for prevention and treatment. Based on these findings, type A botulism should be considered in suspect cases of equine botulism in the western United States.
Collapse
Affiliation(s)
- Amy L Johnson
- Section of Medicine, New Bolton Center, 382 West Street Road, Kennett Square, PA 19348, USA.
| | | | | |
Collapse
|
37
|
Hakami RM, Ruthel G, Stahl AM, Bavari S. Gaining ground: assays for therapeutics against botulinum neurotoxin. Trends Microbiol 2010; 18:164-72. [DOI: 10.1016/j.tim.2010.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 01/20/2010] [Accepted: 02/01/2010] [Indexed: 11/15/2022]
|
38
|
Witoonpanich R, Vichayanrat E, Tantisiriwit K, Wongtanate M, Sucharitchan N, Oranrigsupak P, Chuesuwan A, Nakarawat W, Tima A, Suwatcharangkoon S, Ingsathit A, Rattanasiri S, Wananukul W. Survival analysis for respiratory failure in patients with food-borne botulism. Clin Toxicol (Phila) 2010; 48:177-83. [DOI: 10.3109/15563651003596113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
39
|
Burkholder-Allen K, Rega P, Bork C, Budd C. Botulism Questionnaire: A tactical tool for community use in a mass casualty incident. Nurs Health Sci 2009; 11:374-7. [DOI: 10.1111/j.1442-2018.2009.00489.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
40
|
Brin MF, Boodhoo TI, Pogoda JM, James LM, Demos G, Terashima Y, Gu J, Eadie N, Bowen BL. Safety and tolerability of onabotulinumtoxinA in the treatment of facial lines: A meta-analysis of individual patient data from global clinical registration studies in 1678 participants. J Am Acad Dermatol 2009; 61:961-70.e1-11. [DOI: 10.1016/j.jaad.2009.06.040] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2009] [Revised: 05/28/2009] [Accepted: 06/08/2009] [Indexed: 10/20/2022]
|
41
|
Affiliation(s)
- Ban Al-Sayyed
- Memorial Hospital for Children, 1400 East Boulder Street, Colorado Springs, CO 80909, USA
| |
Collapse
|
42
|
Witoonpanich R, Vichayanrat E, Tantisiriwit K, Rattanasiri S, Ingsathit A. Electrodiagnosis of botulism and clinico-electrophysiological correlation. Clin Neurophysiol 2009; 120:1135-8. [DOI: 10.1016/j.clinph.2009.01.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Revised: 01/16/2009] [Accepted: 01/20/2009] [Indexed: 11/16/2022]
|
43
|
Stahl AM, Adler M, Millard CB, Gilfillan L. Accelerating botulism therapeutic product development in the Department of Defense. Drug Dev Res 2009. [DOI: 10.1002/ddr.20308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
44
|
Infantile Botulism: Clinical Manifestations, Treatment, and the Role of the Nurse Practitioner. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
45
|
Trott DL, Yang M, Gonzalez J, Larson AE, Tepp WH, Johnson EA, Cook ME. Egg yolk antibodies for detection and neutralization of Clostridium botulinum type A neurotoxin. J Food Prot 2009; 72:1005-11. [PMID: 19517727 DOI: 10.4315/0362-028x-72.5.1005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The objective of this research project was to determine the usefulness of an egg antibody platform for producing materials for the detection and neutralization of botulinum type A neurotoxin. Yield estimates for detection and neutralizing antibodies produced using methods described were calculated. Antibody specific to botulinum toxoid A (aToxoid) and toxin A (aBoNT/A) was produced by immunizing hens with botulinum toxoid A (toxoid) followed by increasing amounts of botulinum neurotoxin A (BoNT/A) in Freund incomplete adjuvant. Egg yolks were extracted with polyethylene glycol (PEG) for antibody detection and neutralization experiments. A model aToxoid/toxoid immunoassay using only egg yolk antibody was developed and had a detection limit of 1 pg/ml of toxoid. In an indirect enzyme-linked immunosorbent assay of BoNT/A-specific antibody, the aBoNT/A contained more BoNT/A-specific antibody than did the aToxoid, and aBoNT/A was as effective as commercial rabbit antibody. The aToxoid provided no protection against BoNT/A in a standard mouse neutralization assay; however, 1 mg of PEG-extracted aBoNT/A neutralized 4,000 lethal doses of BoNT/A injected intraperitoneally. Based on these results, we calculated that in 1 month one hen could produce more than 100 liters of antibody detection reagents or enough antibody to neutralize approximately 11.6 million mouse lethal doses of botulinum toxin. Utilization of an egg antibody platform is potentially rapid (28 to 70 days) and scalable to kilogram quantities using current egg production facilities with as few as 1,000 hens.
Collapse
Affiliation(s)
- D L Trott
- Department of Nutritional Science, University of Wisconsin, Madison, Wisconsin 53706, USA
| | | | | | | | | | | | | |
Collapse
|
46
|
Abstract
Following the introduction of black tar heroin mainly from Mexico in the 1980s, cases of wound botulism dramatically increased in the western United States. Contamination with spores of Clostridium botulinum of black tar heroin occurs along the distribution line. The heating of heroin powder to solubilize it for subcutaneous injection ("skin popping") does not kill the spores. The spores germinate in an anaerobic tissue environment and release botulinum toxin type A or B. Unless skin abscesses are found in the patient, the clinical diagnosis is often challenging. Facilitation of the compound muscle action potential by repetitive nerve stimulation at 20 to 50 Hz is an important and rapid diagnostic test. Definite diagnosis is made by detection of botulinum toxin in serum or isolation of C botulinum from the abscess. Early treatment with equine ABE botulinum antitoxin obtained from the Centers for Disease Control and Prevention often shortens the time on a ventilator.
Collapse
Affiliation(s)
- Larry E Davis
- Neurology Service (127), New Mexico VA Health Care System, Albuquerque, NM 87108, USA.
| | | |
Collapse
|
47
|
Bilusic M, Pattathil J, Brescia M, McHugh W, Zaboski M, Schanzer B. Recurrent Bulbar Paralysis Caused by Botulinum Toxin Type B. Clin Infect Dis 2008; 46:e72-4. [DOI: 10.1086/533470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
48
|
Berkes A, Szegedi I, Szikszay E, Gulyás M, Oláh E. [Botulism in infancy - survey of literature based on a case report]. Orv Hetil 2007; 148:1117-25. [PMID: 17561481 DOI: 10.1556/oh.2007.27977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors have drawn attention to a rare disease called infant botulism, which raises some difficulties with regard to differential diagnosis. In the case of the six-month-old infant portrayed, infant botulism and food-born botulism appeared together. As a result of the severity of the disease and due to its rapid course observed in the presented case as well, the diagnosis has to be raised relying on the accurate patient's history and on the clinical examination, then it should be confirmed by appropriate examinations. In relation to presenting a case, the authors examine the microbiological background of the disease, its symptomatology, its epidemiological characteristics, the appropriate methods of electrophysiological examination and laboratory analysis as recommended in current literature, together with the difficulties that arise in differential diagnosis and also the possibilities of treatment. They pay special attention to the particular characteristics of the infant form of the disease, to the difficulties of making a diagnosis due to the characteristics of the age group and also to the questions in relation to the guiding principles of therapy. The rapid and fatal process observed in the presented case warns us that serious complications can occur even when up-to-date therapy is used. Therefore, despite the improvement in prognosis we have to strive to prevent the disease by spreading the proper regulations of nutritional hygiene.
Collapse
Affiliation(s)
- Andrea Berkes
- Debreceni Egyetem, Orvos- és Egészségtudományi Centrum, Gyermekgyógyászati Klinika, Debrecen.
| | | | | | | | | |
Collapse
|
49
|
Abstract
There is well-founded concern that a chemical or radioactive agent will at some point be used as a weapon of terror. There are several antidotes that, if used correctly in a timely fashion, can help lessen the harm caused by these agents. This article is meant to introduce the clinician to several such agents, along with the antidotes useful in the management of exposure to these. It covers the indications, administration, and precautions for using these antidotes.
Collapse
Affiliation(s)
- David T Lawrence
- Blue Ridge Poison Center, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0774, USA.
| | | |
Collapse
|
50
|
Abstract
Food poisoning is encountered throughout the world. Many of the toxins responsible for specific food poisoning syndromes are no longer limited to isolated geographic locations. With increased travel and the ease of transporting food products, it is likely that a patient may present to any emergency department with the clinical effects of food poisoning. Recognizing specific food poisoning syndromes allows emergency health care providers not only to initiate appropriate treatment rapidly but also to notify health departments early and thereby prevent further poisoning cases. This article reviews several potential food-borne poisons and describes each agent's mechanism of toxicity, expected clinical presentation, and currently accepted treatment.
Collapse
Affiliation(s)
- David T Lawrence
- Blue Ridge Poison Center, Division of Medical Toxicology, Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908-0774, USA
| | | | | | | |
Collapse
|