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Bonny V, Gabarre P, Urbina T, Mazuet C, Missri L, Joffre J, Baudel JL, Ait Oufella H, Maury E. Never too late to neutralize botulinum neurotoxin. Minerva Anestesiol 2023; 89:950-951. [PMID: 37272271 DOI: 10.23736/s0375-9393.23.17401-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Vincent Bonny
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Paul Gabarre
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Tomas Urbina
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Christelle Mazuet
- CNR Bactéries Anaérobies et Botulisme, Pasteur Institute, Paris, France
| | - Louaï Missri
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Jérémie Joffre
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Jean-Luc Baudel
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Hafid Ait Oufella
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Sorbonne University, Paris, France
| | - Eric Maury
- Intensive Medicine Resuscitation Service, Hospital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France -
- Sorbonne University, Paris, France
- UMR S 1136, INSERM and Sorbonne University, Pierre and Marie Curie University - Paris6, Paris, France
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Harris RA, Tchao C, Prystajecky N, Weedmark K, Tcholakov Y, Lefebvre M, Austin JW. Foodborne Botulism, Canada, 2006-2021 1. Emerg Infect Dis 2023; 29. [PMID: 37610295 PMCID: PMC10461667 DOI: 10.3201/eid2909.230409] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023] Open
Abstract
During 2006-2021, Canada had 55 laboratory-confirmed outbreaks of foodborne botulism, involving 67 cases. The mean annual incidence was 0.01 case/100,000 population. Foodborne botulism in Indigenous communities accounted for 46% of all cases, which is down from 85% of all cases during 1990-2005. Among all cases, 52% were caused by botulinum neurotoxin type E, but types A (24%), B (16%), F (3%), and AB (1%) also occurred; 3% were caused by undetermined serotypes. Four outbreaks resulted from commercial products, including a 2006 international outbreak caused by carrot juice. Hospital data indicated that 78% of patients were transferred to special care units and 70% required mechanical ventilation; 7 deaths were reported. Botulinum neurotoxin type A was associated with much longer hospital stays and more time spent in special care than types B or E. Foodborne botulism often is misdiagnosed. Increased clinician awareness can improve diagnosis, which can aid epidemiologic investigations and patient treatment.
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3
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Peñuelas M, Guerrero-Vadillo M, Valdezate S, Zamora MJ, Leon-Gomez I, Flores-Cuéllar Á, Carrasco G, Díaz-García O, Varela C. Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997-2019. Toxins (Basel) 2022; 15:2. [PMID: 36668823 PMCID: PMC9863742 DOI: 10.3390/toxins15010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Botulism is a low incidence but potentially fatal infectious disease caused by neurotoxins produced mainly by Clostridium botulinum. There are different routes of acquisition, food-borne and infant/intestinal being the most frequent presentation, and antitoxin is the treatment of choice in all cases. In Spain, botulism is under surveillance, and case reporting is mandatory. METHODS This retrospective study attempts to provide a more complete picture of the epidemiology of botulism in Spain from 1997 to 2019 and an assessment of the treatment, including the relationship between a delay in antitoxin administration and the length of hospitalization using the Cox proportional hazards test and Kruskal-Wallis test, and an approach to the frequency of adverse events, issues for which no previous national data have been published. RESULTS Eight of the 44 outbreaks were associated with contaminated commercial foods involving ≤7 cases/outbreak; preserved vegetables were the main source of infection, followed by fish products; early antitoxin administration significantly reduces the hospital stay, and adverse reactions to the antitoxin affect around 3% of treated cases.
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Affiliation(s)
- Marina Peñuelas
- Escuela Internacional de Doctorado, Universidad Nacional de Educación a Distancia (UNED), Calle de Bravo Murillo, 38, 28015 Madrid, Spain
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - María Guerrero-Vadillo
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - Sylvia Valdezate
- Laboratorio de Referencia e Investigación en Taxonomía, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo-Majadahonda Km 2.2, 28220 Madrid, Spain
| | - María Jesús Zamora
- Servicio de Microbiología Alimentaria, Centro Nacional de Alimentación, Agencia Española de Seguridad Alimentaria y Nutrición, Ctra. Pozuelo a Majadahonda Km 5.1, 28220 Madrid, Spain
| | - Inmaculada Leon-Gomez
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Ángeles Flores-Cuéllar
- Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), C/Campezo 1, Edificio 8, 28022 Madrid, Spain
| | - Gema Carrasco
- Laboratorio de Referencia e Investigación en Taxonomía, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo-Majadahonda Km 2.2, 28220 Madrid, Spain
| | - Oliva Díaz-García
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - Carmen Varela
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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4
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Osawa EA, Maciel AT. Concurrent hospitalization of a married couple presenting with distinct symptoms but diagnosed with a life-threatening infectious disease. Rev Soc Bras Med Trop 2022; 55:e0134. [PMID: 35946627 PMCID: PMC9344940 DOI: 10.1590/0037-8682-0134-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/17/2022] [Indexed: 12/03/2022] Open
Abstract
We described the cases of a married couple hospitalized for distinct symptoms and developed a neuroparalytic syndrome with rapid progression. In Case 1, a 75-year-old woman was admitted for abdominal pain, diarrhea, and blurred vision. The patient developed acute respiratory failure, ptosis, and ophthalmoplegia. She died on day 15 because of an acute abdomen. In Case 2, her husband, a 71-year-old man, was admitted for diplopia. The patient developed abdominal distension and slurred speech. Later, he developed bilateral ptosis, ophthalmoparesis, and mydriasis. Botulism was suspected, and both patients received botulinum antitoxin. Our male patient survived but underwent prolonged rehabilitation.
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Affiliation(s)
- Eduardo Atsushi Osawa
- Imed Group, Departamento de Pesquisa, São Paulo, SP, Brasil.,Hospital São Camilo Unidade Pompéia, Unidade de Terapia Intensiva, São Paulo, SP, Brasil
| | - Alexandre Toledo Maciel
- Imed Group, Departamento de Pesquisa, São Paulo, SP, Brasil.,Hospital São Camilo Unidade Pompéia, Unidade de Terapia Intensiva, São Paulo, SP, Brasil
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5
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Wang J, Xu H, Zhang C, Chen J, Wang C, Li X, Zhang Y, Xie J. Serotype Features of 17 Suspected Cases of Foodborne Botulism in China 2019-2022 Revealed by a Multiplex Immuno-Endopep-MS Method. Front Microbiol 2022; 13:869874. [PMID: 35450283 PMCID: PMC9016322 DOI: 10.3389/fmicb.2022.869874] [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: 02/05/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
Diagnosis of botulism caused by multiple serotypes of botulinum neurotoxin (BoNT) is still a challenge due to the lack of a reliable detection method. The present study develops a feasible laboratorial method based on an isotope dilution Immuno-Endopep-MS to detect BoNTs and determine their serotypes and activities in clinical samples. Eleven positive foodborne botulism cases out of a total of 17 suspected cases in China, 2019–2022, were determined by the established method. Blood, urine, vomitus, gastric mucosa samples, and food samples were employed and evidenced to be suitable for the detection. Results showed that, although single type A-intoxication was still the first cause among these foodborne botulism cases, other causes involving type E, type B, and their mixed types were also determined, providing a glimpse to the serotype profile of botulism happened in recent years in China. Furthermore, in order to provide insights into in vivo profiles of toxin serotypes, a comprehensive analysis of clinical specimens collected from one family of four patients was performed during a clinically and therapeutically relevant time frame. Serotypes and concentrations of BoNT in specimens revealed a good correlation with symptoms and progresses of disease. Additionally, serum was proved to be more suitable for detection of BoNT/A with a detection window up to 12 days. A urine sample, although rarely reported for foodborne botulism diagnosis, was validated to be suitable for testing BoNTs, with a longer detection window up to 25 days. To the best of our knowledge, this is the first comprehensive analytical research on in vivo profiles of serotypes A, B, and E in different types of specimens from mixed botulism cases. Our method and findings facilitate the toxin detection and identification by clinical diagnostic laboratories.
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Affiliation(s)
- Jiang Wang
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Hua Xu
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Cheng Zhang
- Yongding Road Outpatient Department, Jingnan Medical District of Chinese PLA General Hospital, Beijing, China
| | - Jia Chen
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Chunyan Wang
- Poisoning Treatment Department, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinying Li
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Yajiao Zhang
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
| | - Jianwei Xie
- Beijing Institute of Pharmacology and Toxicology, Beijing, China
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6
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Foodborne botulism survey in Northern Italy from 2013 to 2020: Emerging risk or stable situation? Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Wang J, Wu Y, Luo D, Zhuang C, Ning N, Zhang Y, He Z, Gao J, Hong Z, Xv X, Zhang W, Li T, Miao Z, Wang H. Discovery of a Potent Botulinum Neurotoxin A Inhibitor
ZM299
with Effective Protections in Botulism Mice. CHINESE J CHEM 2021. [DOI: 10.1002/cjoc.202100681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jianxin Wang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Yuelin Wu
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Deyan Luo
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Chunlin Zhuang
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Nianzhi Ning
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Yanming Zhang
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Zhili He
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Jie Gao
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Zhanying Hong
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Xiguo Xv
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Wannian Zhang
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Tao Li
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
| | - Zhenyuan Miao
- School of Pharmacy Second Military Medical University, 325 Guohe Road Shanghai 200433 China
| | - Hui Wang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology Beijing 100071 China
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8
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Current Developments in Diagnostic Assays for Laboratory Confirmation and Investigation of Botulism. J Clin Microbiol 2021; 60:e0013920. [PMID: 34586891 DOI: 10.1128/jcm.00139-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Detection of botulinum neurotoxin or isolation of the toxin producing organism is required for the laboratory confirmation of botulism in clinical specimens. In an effort to reduce animal testing required by the gold standard method of botulinum neurotoxin detection, the mouse bioassay, many technologies have been developed to detect and characterize the causative agent of botulism. Recent advancements in these technologies have led to improvements in technical performance of diagnostic assays; however, many emerging assays have not been validated for the detection of all serotypes in complex clinical and environmental matrices. Improvements to culture protocols, endopeptidase-based assays, and a variety of immunological and molecular methods have provided laboratories with a variety of testing options to evaluate and incorporate into their testing algorithms. While significant advances have been made to improve these assays, additional work is necessary to evaluate these methods in various clinical matrices and to establish standardized criteria for data analysis and interpretation.
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9
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A Novel Running Wheel Mouse Model for Botulism and Its Use for the Evaluation of Postsymptom Antitoxin Efficacy. Antimicrob Agents Chemother 2021; 65:e0042121. [PMID: 33972251 DOI: 10.1128/aac.00421-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Antitoxin is currently the only approved therapy for botulinum intoxications. The efficacy of antitoxin preparations is evaluated in animals. However, while in practice antitoxin is administered to patients only after symptom onset, in most animal studies, it is tested in relation to time postintoxication. This may be attributed to difficulties in quantitating early botulism symptoms in animals. In the current study, a novel system based on high-resolution monitoring of mouse activity on a running wheel was developed to allow evaluation of postsymptom antitoxin efficacy. The system enables automatic and remote monitoring of 48 mice simultaneously. Based on the nocturnal activity patterns of individual naive mice, two criteria were defined as the onset of symptoms. Postsymptom treatment with a human-normalized dose of antitoxin was fully protective in mice exposed to 4 50% lethal doses (LD50s) of botulinum neurotoxin serotype A (BoNT/A) and BoNT/B. Moreover, for the first time, a high protection rate was obtained in mice treated postsymptomatically, following a challenge with BoNT/E, the fastest-acting BoNT. The running wheel system was further modified to develop a mouse model for the evaluation of next-generation therapeutics for progressive botulism at time points where antitoxin is not effective. Exposure of mice to 0.3 LD50 of BoNT/A resulted in long-lasting paralysis and a reduction in running activity for 16 to 18 days. Antitoxin treatment was no longer effective when administered 72 h postintoxication, defining the time window to evaluate next-generation therapeutics. Altogether, the running wheel systems presented herein offer quantitative means to evaluate the efficacy of current and future antibotulinum drugs.
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10
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Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep 2021; 70:1-30. [PMID: 33956777 PMCID: PMC8112830 DOI: 10.15585/mmwr.rr7002a1] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.
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Affiliation(s)
- Agam K Rao
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jeremy Sobel
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Kevin Chatham-Stephens
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Carolina Luquez
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
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11
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Toxemia in Human Naturally Acquired Botulism. Toxins (Basel) 2020; 12:toxins12110716. [PMID: 33202855 PMCID: PMC7697460 DOI: 10.3390/toxins12110716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 12/18/2022] Open
Abstract
Human botulism is a severe disease characterized by flaccid paralysis and inhibition of certain gland secretions, notably salivary secretions, caused by inhibition of neurotransmitter release. Naturally acquired botulism occurs in three main forms: food-borne botulism by ingestion of preformed botulinum neurotoxin (BoNT) in food, botulism by intestinal colonization (infant botulism and intestinal toxemia botulism in infants above one year and adults), and wound botulism. A rapid laboratory confirmation of botulism is required for the appropriate management of patients. Detection of BoNT in the patient's sera is the most direct way to address the diagnosis of botulism. Based on previous published reports, botulinum toxemia was identified in about 70% of food-borne and wound botulism cases, and only in about 28% of infant botulism cases, in which the diagnosis is mainly confirmed from stool sample investigation. The presence of BoNT in serum depends on the BoNT amount ingested with contaminated food or produced locally in the intestine or wound, and the timeframe between serum sampling and disease onset. BoNT levels in patient's sera are most frequently low, requiring a highly sensitive method of detection. Mouse bioassay is still the most used method of botulism identification from serum samples. However, in vitro methods based on BoNT endopeptidase activity with detection by mass spectrometry or immunoassay have been developed and depending on BoNT type, are more sensitive than the mouse bioassay. These new assays show high specificity for individual BoNT types and allow more accurate differentiation between positive toxin sera from botulism and autoimmune neuropathy patients.
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12
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Lonati D, Schicchi A, Crevani M, Buscaglia E, Scaravaggi G, Maida F, Cirronis M, Petrolini VM, Locatelli CA. Foodborne Botulism: Clinical Diagnosis and Medical Treatment. Toxins (Basel) 2020; 12:toxins12080509. [PMID: 32784744 PMCID: PMC7472133 DOI: 10.3390/toxins12080509] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
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 conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.
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Affiliation(s)
- Davide Lonati
- Correspondence: ; Tel.: +39-0382-26261; Fax: +39-0382-24605
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13
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Rapidly Fatal Postlaparoscopic Liver Infection from the Rarely Isolated Species Clostridium butyricum. Case Rep Infect Dis 2020; 2020:1839456. [PMID: 32802529 PMCID: PMC7411483 DOI: 10.1155/2020/1839456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 11/20/2022] Open
Abstract
We report a case of a rapidly fatal postlaparoscopic cholecystectomy liver infection from the rarely isolated species Clostridium butyricum. Liver examination at autopsy showed cystic spaces, necrosis, and spore-forming Gram-positive rods. 16sRNA gene sequencing of the cystic liver tissue identified the organism as C. butyricum.
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14
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Wang Y, Schill KM, Fry HC, Duncan TV. A Quantum Dot Nanobiosensor for Rapid Detection of Botulinum Neurotoxin Serotype E. ACS Sens 2020; 5:2118-2127. [PMID: 32527082 DOI: 10.1021/acssensors.0c00738] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Botulinum neurotoxins (BoNTs) are potent toxins produced by Clostridium bacteria that are responsible for the illness botulism and are listed as bioterrorism agents. BoNT serotype E (BoNT/E) is one of four BoNT serotypes that cause human botulism and is the second most frequent cause of foodborne botulism. Rapid detection and discrimination of BoNT serotypes implicated in human disease are critical for ensuring timely treatment of patients and identifying sources of toxins, but there have been few reported detection methods for BoNT/E and even fewer methods usable for BoNT serotyping. We report a nanobiosensor based on Förster resonance energy transfer (FRET) between semiconductor nanocrystals (quantum dots, QDs) and dark quencher-labeled peptide probes to detect biologically active BoNT/E in aqueous media. The peptide probes contain a specific cleavage site for active BoNT/E. QD photoluminescence, which changes intensity due to FRET when the peptide probe is cleaved, was used to indicate toxin presence and quantity. The detection of a BoNT/E light chain (LcE) and holotoxin was observed within 3 h. The limits of detection were 0.02 and 2 ng/mL for LcE and holotoxin, respectively. The nanobiosensor shows good specificity toward the target in tests with nontarget BoNT serotypes. The high sensitivity, simple operation, short detection time, and ability to be used in parallel with probes developed for other BoNT serotypes indicate that the nanobiosensor will be useful for rapid BoNT/E detection and serotype discrimination in food analysis.
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Affiliation(s)
- Yun Wang
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Bedford Park, Illinois 60501, United States
| | - Kristin M. Schill
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Bedford Park, Illinois 60501, United States
| | - H. Christopher Fry
- Center for Nanoscale Materials, Argonne National Laboratory, DuPage County, Illinois 60439, United States
| | - Timothy V. Duncan
- Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Bedford Park, Illinois 60501, United States
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15
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Abstract
Background: With the flourishing application of botulinum toxin cosmetically and therapeutically is the emergence of iatrogenic botulism, a new type of botulism in addition to the traditional ones. Objectives: We aim at a comprehensive review of the clinical characteristics of iatrogenic botulism. Methods: The available publications are retrieved and studied. Results: Botulinum toxin blocks cholinergic transmission in the neuromuscular junctions and autonomic ganglia. The blockade can spread from the site of tissue injection to adjacent or sometimes far off structures, resulting in inadvertent disabling or even lethal effects. On literature review, weakness and dysphagia are the commonest complications of iatrogenic botulism, whereas ophthalmological and oropharyngeal symptoms are more prevalent in the cosmetic group and dyspnea in the therapeutic group. Antitoxin therapy is required in about 20% of the patients. Diagnosis of iatrogenic botulism is primarily clinical and should not be confused with the neurological diagnoses possessing similar clinical manifestations. Vigilance to the drug formulation, dosage, and administration during botulinum toxin injection are part of the preventive measures in minimizing the occurrence of iatrogenic botulism. Conclusion: While overlapping with the traditional types of botulism, iatrogenic botulism carries its unique clinical characteristics.
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Affiliation(s)
- Hin Tat Fung
- Accident & Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
| | - Ka Man Chan
- Accident & Emergency Department, Tuen Mun Hospital, Tuen Mun, Hong Kong
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Hsu PC, Wu WT, Han DS, Chang KV. Comparative Effectiveness of Botulinum Toxin Injection for Chronic Shoulder Pain: A Meta-Analysis of Randomized Controlled Trials. Toxins (Basel) 2020; 12:toxins12040251. [PMID: 32290577 PMCID: PMC7232231 DOI: 10.3390/toxins12040251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
Botulinum toxin (BoNT) injection is regarded as a promising treatment for musculoskeletal pain. However, its efficacy for treating chronic shoulder pain remains unclear. We investigated the effectiveness of BoNT injections for chronic shoulder pain by conducting a systematic search of electronic databases up to March 2020 for randomized control trials (RCTs) that used BoNT injections for chronic shoulder pain treatment. The primary outcome was the between-group comparison of pain reduction, quantified by the standardized mean difference (SMD). Nine RCTs comprising 666 patients were included and divided into two groups: one group with shoulder joint pain (n = 182) and the other group with shoulder myofascial pain (n = 484). Regarding shoulder joint pain, the efficacy of BoNT injections was similar to that of the reference treatment (SMD: −0.605, 95% confidence level [CI]: −1.242 to 0.032 versus saline; SMD: −0.180, 95% CI: −0.514 to 0.153 versus corticosteroids) at one month post-intervention, and was superior (SMD: −0.648, 95% CI: −0.1071 to −0.225 versus corticosteroids) between one and three months. Likewise, in terms of shoulder myofascial pain, the effectiveness of BoNT injections did not differ from the reference treatment (SMD: −0.212, 95% CI: −0.551 to 0.127 versus saline; SMD: 0.665, 95% CI: −0.260 to 1.590 versus dry needling and SMD: 1.093; 95% CI: 0.128 to 2.058 versus lidocaine) at one month post- intervention, and appeared superior (SMD: −0.314, 95% CI: −0.516 to −0.111 versus saline) between one and three months. Our meta-analysis revealed that BoNT injections could be a safe and effective alternative for patients with chronic shoulder pain.
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Affiliation(s)
- Po-Cheng Hsu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan; (P.-C.H.); (W.-T.W.); (D.-S.H.)
- Department of Physical Medicine and Rehabilitation, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Correspondence: ; Tel.: +886-2-2371-7101
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Pons L, Vilain C, Volteau M, Picaut P. Safety and pharmacodynamics of a novel recombinant botulinum toxin E (rBoNT-E): Results of a phase 1 study in healthy male subjects compared with abobotulinumtoxinA (Dysport®). J Neurol Sci 2019; 407:116516. [PMID: 31655410 DOI: 10.1016/j.jns.2019.116516] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/30/2019] [Accepted: 09/30/2019] [Indexed: 12/26/2022]
Abstract
Naturally occurring botulinum toxin (BoNT) serotypes have different pharmacological features of therapeutic and aesthetic interest. This phase 1, double-blind, placebo-controlled study (EudraCT: 2016-002609-20) assessed safety, tolerability and pharmacodynamics (PD) of the first recombinant BoNT serotype E (rBoNT-E) versus abobotulinumtoxinA (Dysport®), administered to extensor digitorum brevis (EDB) of healthy males. Subjects were randomised 3:1 (n = 28) to single ascending rBoNT-E (0.04-3.6 ng) doses or placebo. A further 24 subjects received abobotulinumtoxinA (20, 40, or 70 U) or placebo. PD were assessed using compound muscle action potential (CMAP) amplitude. Demographics were similar between groups. All rBoNT-E doses were well tolerated (no severe treatment-emergent adverse events [TEAEs], serious adverse events, or treatment-related toxicities). Most TEAEs were mild/moderate and treatment-unrelated. rBoNT-E had a faster onset of action (days 1-2 post-injection), greater peak effect (>90% CMAP inhibition), and shorter duration of effect at highest tested doses versus abobotulinumtoxinA (onset of action ≤7 days post-injection; 70% maximal CMAP inhibition). rBoNT-E duration of effect was 2-7 weeks versus >26 weeks for abobotulinumtoxinA. Dose-dependent effects were observed for magnitude and duration of EDB CMAP inhibition, plateauing at 0.9 and 3.6 ng. rBoNT-E demonstrated a good safety profile and a PD profile that may address unmet therapeutic and aesthetic patient needs.
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Fleck-Derderian S, Shankar M, Rao AK, Chatham-Stephens K, Adjei S, Sobel J, Meltzer MI, Meaney-Delman D, Pillai SK. The Epidemiology of Foodborne Botulism Outbreaks: A Systematic Review. Clin Infect Dis 2019; 66:S73-S81. [PMID: 29293934 DOI: 10.1093/cid/cix846] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We performed a systematic review of foodborne botulism outbreaks to describe their clinical aspects and descriptive epidemiology in order to inform public health response strategies. Methods We searched seven databases for reports of foodborne botulism outbreaks published in English from database inception to May 2015. We summarized descriptive characteristics and analyzed differences in exposure and toxin types by geographic region. We performed logistic regression to assess correlations between exposure source, implicated food, and outbreak size. Results There were 197 outbreaks reported between 1920 and 2014. The median number of cases per outbreak was 3 (range 2-97). The majority of reported outbreaks (109; 55%) occurred in the United States. Toxin types A, B, E, and F were identified as the causative agent in 34%, 16%, 17%, and 1% of outbreaks, respectively. The median duration between exposure and symptom onset was approximately 1 day. The mean percentage of cases requiring mechanical ventilation per outbreak was 34%. Seventy percent of all outbreaks and 77% of small outbreaks (≤11 cases) originated from point source exposures, while commercial foods were significantly (odds ratio, 6.9; 95% confidence interval, 2.2-21.1) associated with large outbreaks (≥12 cases). Conclusions Toxin type A accounted for half of outbreaks, and these outbreaks had a higher proportion of patient ventilatory failure. Most outbreaks were due to point source exposures, while outbreaks due to commercial food were larger. For effective responses to foodborne botulism outbreaks, these findings demonstrate the need for timely outbreak investigation and hospital surge capacity.
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Affiliation(s)
- Shannon Fleck-Derderian
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, CDC Fellowship Program, Tennessee
| | - Manjunath Shankar
- Scientific Programs Services Branch, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Agam K Rao
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin Chatham-Stephens
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stacey Adjei
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy Sobel
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Martin I Meltzer
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Dana Meaney-Delman
- Office of the Director, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Satish K Pillai
- Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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19
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Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clinical Characteristics and Ancillary Test Results Among Patients With Botulism-United States, 2002-2015. Clin Infect Dis 2019; 66:S4-S10. [PMID: 29293936 DOI: 10.1093/cid/cix935] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Botulism is classically described as a bilateral, symmetric, descending flaccid paralysis in an afebrile and alert patient without sensory findings. We describe the reported spectrum of clinical findings among persons >12 months of age in the United States during 2002-2015. Methods The Centers for Disease Control and Prevention collects clinical findings reported by physicians treating suspected cases of botulism nationwide. We analyzed symptoms and signs, and neuroimaging and cerebrospinal fluid (CSF) results. A case was defined as illness compatible with botulism with laboratory confirmation or epidemiologic link to a confirmed case, and presence or absence of at least 1 sign or symptom recorded. Physicians' differential diagnoses were evaluated. Results Clinical information was evaluated for 332 botulism cases; data quality and completeness were variable. Most had no fever (99%), descending paralysis (93%), no mental status change (91%), at least 1 ocular weakness finding (84%), and neuroimaging without acute changes (82%). Some had paresthesias (17%), elevated CSF protein level (13%), and other features sometimes considered indicative of alternative diagnoses. Five of 71 (7%) cases with sufficient information were reported to have atypical findings (eg, at least 1 cranial nerve finding that was unilateral or ascending paralysis). Illnesses on the physician differential included Guillain-Barré syndrome (99 cases) and myasthenia gravis (76 cases) and, rarely, gastrointestinal-related illness (5 cases), multiple sclerosis (3 cases), sepsis (3 cases), and Lyme disease (2 cases). Conclusions Our analysis illustrates that classic symptoms and signs were common among patients with botulism but that features considered atypical were reported by some physicians. Diagnosis can be challenging, as illustrated by the broad range of illnesses on physician differentials.
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Affiliation(s)
- Agam K Rao
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Neal H Lin
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly A Jackson
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rajal K Mody
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Patricia M Griffin
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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20
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Chatham-Stephens K, Fleck-Derderian S, Johnson SD, Sobel J, Rao AK, Meaney-Delman D. Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932-2015. Clin Infect Dis 2019; 66:S11-S16. [PMID: 29293923 DOI: 10.1093/cid/cix811] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Botulism is a rare, potentially fatal paralytic illness caused by neurotoxins. To inform the evaluation of patients with suspected botulism, we conducted a systematic review to describe the clinical features of botulism. Methods We searched Medline Ovid, Embase Dialog, Embase Ovid, Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO, Global Health Ovid, Cochrane Library, Scopus, and ClinicalTrials.gov for English language articles through May 2015. Information abstracted included demographics, signs and symptoms, laboratory results, and clinical outcome for foodborne and wound botulism patients confirmed by laboratory testing, epidemiologic link, or association with an outbreak. The review followed PRISMA guidelines and was registered with PROSPERO (CRD42015024784). Results We identified 402 patients from 233 articles published in English between 1932 and 2015. Most cases (n = 346 [86%]) were foodborne botulism and most (n = 263 [65%]) were associated with an outbreak. The median incubation period was 1 day, and the median time from illness onset to hospital admission was 2 days. Shortness of breath, dyspnea, or respiratory distress or failure at hospital admission was reported in 169 (42%) patients; 71 (42%) reported respiratory involvement without report of extremity weakness. Among 154 patients for whom the hospital day of intubation was reported, 134 (87%) were intubated on the first or second hospital day. Conclusions Botulism patients can experience a range of signs and symptoms. Respiratory involvement may occur early in the illness and can occur without preceding extremity weakness. Clinicians and public health departments preparing for and responding to botulism events should use this information to guide the evaluation of suspected botulism patients.
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Affiliation(s)
- Kevin Chatham-Stephens
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Shannon Fleck-Derderian
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.,Oak Ridge Institute for Science and Education, CDC Fellowship Program, Oak Ridge, Tennessee
| | - Shacara D Johnson
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jeremy Sobel
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Agam K Rao
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Dana Meaney-Delman
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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21
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Food-borne Botulism Caused by Clay Cheese: A Case Report. ADVANCED JOURNAL OF EMERGENCY MEDICINE 2019; 3:e44. [PMID: 31633099 PMCID: PMC6789077 DOI: 10.22114/ajem.v0i0.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Recently, the use of metal and plastic containers instead of clay containers in producing this type of cheese has provided the anaerobic condition for growing the bacterium and producing the botulinum toxin. In this case report was to introduce "clay cheese dug in the ground" as a source of botulinum toxin for the first time. Case Report A 34-year-old man with dizziness, asthma, and inability to swallow for four days referred to the hospital emergency department. He had diplopia and ptosis for two days. During admission to the emergency, the patient was conscious without fever, but with dysarthria and bilateral ptosis, an impaired gag reflex, slow right papillary reaction to light, a decreased eye movement, and a decreased power of facial muscles and limbs. The patient reported the use of clay cheese in a week before referring to the emergency. Hematological, biochemical, electrocardiogram, magnetic resonance imaging, and chest X-ray assays were normal. According to the Centers for Disease Control and Prevention classification, these symptoms were related to botulism. The evaluation of serum samples, emission, and gastric juice confirmed botulism by type A toxin. Conclusion Considering the clinical results of this case study, clay cheese, which is produced in the west of Iran, can be introduced as a new source of the botulinum toxin.
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23
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Torgeman A, Schwartz A, Diamant E, Baruchi T, Dor E, Ben David A, Pass A, Barnea A, Tal A, Rosner A, Rosen O, Zichel R. Studying the differential efficacy of postsymptom antitoxin treatment in type A versus type B botulism using a rabbit spirometry model. Dis Model Mech 2018; 11:dmm.035089. [PMID: 30115749 PMCID: PMC6177009 DOI: 10.1242/dmm.035089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/30/2018] [Indexed: 11/20/2022] Open
Abstract
Botulinum neurotoxin (BoNT) serotypes A, B and E are responsible for most cases of human botulism. The only approved therapy for botulism is antitoxin treatment administered to patients after symptom onset. However, a recent meta-analysis of antitoxin efficacy in human botulism cases over the past century concluded that a statistically significant reduction in mortality is associated with the use of type E and type A antitoxin, but not with type B antitoxin. Animal models could be highly valuable in studying postsymptom antitoxin efficacy (PSAE). However, the few attempts to evaluate PSAE in animals relied on subjective observations and showed ∼50% protection. Recently, we developed a novel spirometry model for the quantitative evaluation of PSAE in rabbits and used it to demonstrate full protection against BoNT/E. In the current study, a comparative evaluation of PSAE in botulism types A and B was conducted using this quantitative respiratory model. A lethal dose of each toxin induced a comparable course of disease both in terms of time to symptoms (TTS, 41.9±1.3 and 40.6±1.1 h, respectively) and of time to death (TTD, 71.3±3.1 and 66.3±1.7 h, respectively). However, in accordance with the differential serotypic PSAE observed in humans, postsymptom antitoxin treatment was fully effective only in BoNT/A-intoxicated rabbits. This serotypic divergence was reflected by a positive and statistically significant correlation between TTS and TTD in BoNT/A-intoxicated rabbits (r=0.91, P=0.0006), but not in those intoxicated with BoNT/B (r=0.06, P=0.88). The rabbit spirometry system might be useful in the evaluation toolkit of botulism therapeutics, including those under development and intended to act when antitoxin is no longer effective. Summary: Here, we used a quantitative rabbit respiratory model to study the human-related, differential antitoxin efficacy observed in type A and type B botulism.
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Affiliation(s)
- Amram Torgeman
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Arieh Schwartz
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Eran Diamant
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Tzadok Baruchi
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Eyal Dor
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Alon Ben David
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Avi Pass
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Ada Barnea
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Arnon Tal
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Amir Rosner
- The Veterinary Center for Pre-clinical Research, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Osnat Rosen
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
| | - Ran Zichel
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel
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24
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Thirunavukkarasu N, Johnson E, Pillai S, Hodge D, Stanker L, Wentz T, Singh B, Venkateswaran K, McNutt P, Adler M, Brown E, Hammack T, Burr D, Sharma S. Botulinum Neurotoxin Detection Methods for Public Health Response and Surveillance. Front Bioeng Biotechnol 2018; 6:80. [PMID: 29988463 PMCID: PMC6024544 DOI: 10.3389/fbioe.2018.00080] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/30/2018] [Indexed: 01/06/2023] Open
Abstract
Botulism outbreak due to consumption of food contaminated with botulinum neurotoxins (BoNTs) is a public health emergency. The threat of bioterrorism through deliberate distribution in food sources and/or aerosolization of BoNTs raises global public health and security concerns due to the potential for high mortality and morbidity. Rapid and reliable detection methods are necessary to support clinical diagnosis and surveillance for identifying the source of contamination, performing epidemiological analysis of the outbreak, preventing and responding to botulism outbreaks. This review considers the applicability of various BoNT detection methods and examines their fitness-for-purpose in safeguarding the public health and security goals.
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Affiliation(s)
- Nagarajan Thirunavukkarasu
- Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Eric Johnson
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI, United States
| | - Segaran Pillai
- U.S. Food and Drug Administration Office of Laboratory Science and Safety, Silver Spring, MD, United States
| | - David Hodge
- Chemical and Biological Defense Division, Science and Technology Directorate, U.S. Department of Homeland Security, Washington, DC, United States
| | - Larry Stanker
- U.S. Department of Agriculture, Agriculture Research Service Albany, Albany, CA, United States
| | - Travis Wentz
- Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - BalRam Singh
- Institute of Advanced Sciences, Botulinum Research Center, Dartmouth, MA, United States
| | | | - Patrick McNutt
- United States Army Medical Research Institute of Chemical Defense, Aberdeen, MD, United States
| | - Michael Adler
- United States Army Medical Research Institute of Chemical Defense, Aberdeen, MD, United States
| | - Eric Brown
- Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Thomas Hammack
- Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
| | - Donald Burr
- Office of Regulatory Affairs, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, Silver Spring, MD, United States
| | - Shashi Sharma
- Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, MD, United States
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A Novel Rabbit Spirometry Model of Type E Botulism and Its Use for the Evaluation of Postsymptom Antitoxin Efficacy. Antimicrob Agents Chemother 2018; 62:AAC.02379-17. [PMID: 29437616 DOI: 10.1128/aac.02379-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/26/2018] [Indexed: 01/16/2023] Open
Abstract
Botulinum neurotoxins (BoNTs), the most poisonous substances known in nature, pose significant concern to health authorities. The only approved therapeutic for botulism is antitoxin. While administered to patients only after symptom onset, antitoxin efficacy is evaluated in animals mostly in relation to time postintoxication regardless of symptoms. This is most likely due to the difficulty in measuring early symptoms of botulism in animals. In this study, a rabbit spirometry model was developed to quantify early respiratory symptoms of type E botulism that were further used as a trigger for treatment. Impaired respiration, in the form of a reduced minute volume, was detected as early as 18.1 ± 2.9 h after intramuscular exposure to 2 rabbit 50% lethal doses (LD50) of BoNT serotype E (BoNT/E), preceding any visible symptoms. All rabbits treated with antitoxin immediately following symptom onset survived. Postsymptom antitoxin efficacy was further evaluated in relation to toxin and antitoxin dosages as well as delayed antitoxin administration. Our system enabled us to demonstrate, for the first time, full antitoxin protection of animals treated with antitoxin after the onset of objective and quantitative type E botulism symptoms. This model may be utilized to evaluate the efficacy of antitoxins for additional serotypes of BoNT as well as that of next-generation anti-BoNT drugs that enter affected cells and act when antitoxin is no longer effective.
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26
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Hellmich D, Wartenberg KE, Zierz S, Mueller TJ. Foodborne botulism due to ingestion of home-canned green beans: two case reports. J Med Case Rep 2018; 12:1. [PMID: 29301587 PMCID: PMC5755244 DOI: 10.1186/s13256-017-1523-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/21/2017] [Indexed: 11/17/2022] Open
Abstract
Background Foodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The only specific treatment is the administration of botulism antitoxin. According to the German guidelines administration of antitoxin is recommended only in the first 24 hours after oral ingestion of the toxin. Case presentation A 47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans. The disease was complicated by autonomic changes like hypertension, febrile temperatures, and a paralytic ileus. The diagnosis was confirmed by identification of botulinum neurotoxin type A in the serum of the woman. In accordance with the German guidelines, antitoxin was not given due to the prolonged time interval at diagnosis. Both patients had a long intensive care unit course requiring ventilation for approximately 5 months. Finally they recovered completely. Conclusions A full recovery from foodborne botulism is possible even in patients with intensive care lasting several months. There are only case reports indicating that administration of antitoxin may shorten the course of the disease, even if given later than 24 hours after intoxication. Due to the rarity of the disease and its rapid course there are no randomized controlled trials. Thus, evidence of the superiority of this treatment is lacking. However, the prevailing view according to the German guidelines to administer antitoxin only within 24 hours after ingestion of the toxin should be questioned in the case of progression of the disease with proof of remaining toxin in the blood.
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Affiliation(s)
- Dorothea Hellmich
- Neurointensive Care Unit, Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Strasse 40, D-06097, Halle (Saale), Germany.
| | - Katja E Wartenberg
- Neurointensive Care Unit, Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Strasse 40, D-06097, Halle (Saale), Germany
| | - Stephan Zierz
- Neurointensive Care Unit, Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Strasse 40, D-06097, Halle (Saale), Germany
| | - Tobias J Mueller
- Neurointensive Care Unit, Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Strasse 40, D-06097, Halle (Saale), Germany
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27
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Kodihalli S, Emanuel A, Takla T, Hua Y, Hobbs C, LeClaire R, O’Donnell DC. Therapeutic efficacy of equine botulism antitoxin in Rhesus macaques. PLoS One 2017; 12:e0186892. [PMID: 29166654 PMCID: PMC5699824 DOI: 10.1371/journal.pone.0186892] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022] Open
Abstract
Background There are currently no licensed vaccines available for prevention of botulism in humans. The vaccination is not desirable due to expanding therapeutic indications of botulinum toxins. The only available specific treatment for botulism is antitoxin to remove circulating toxin, thus, preventing further neuronal damage. BAT® (Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G)—(Equine)) has been developed and its therapeutic efficacy evaluated against botulinum neurotoxin serotype A (BoNT/A) in Rhesus macaques. Methods and findings In a post-exposure prophylaxis (PEP) study, animals were exposed to 4x LD50/kg of BoNT/A and administered intravenously with either BAT (1x or 0.1x scaled human dose), or placebo at 4 hours post-exposure. The animals were monitored for 14 days. For the therapeutic intervention studies, animals were exposed to a 1.7x LD50/kg of BoNT/A and treated intravenously with either placebo or BAT at a 1x scaled human dose at the onset of clinical signs. Animals were monitored on an hourly basis for 14 or 21 days. In the PEP study, all animals tolerated equine based antitoxin without any adverse clinical signs. A 100% survival was observed in groups treated with the BAT compared to 0% survival in those treated with the placebo (p<0.001, Fisher’s exact test). BAT antitoxin prevented the development of signs of neurotoxicity of botulinum toxin. In a therapeutic study, treatment with the BAT at scaled 1x human dose after the onset of clinical signs significantly enhanced survival compared to the placebo (46.6% vs. 0%, p<0.0001, Fisher’s exact test). Additionally, treatment with the BAT delayed the progression of signs (muscular weakness, respiratory distress, oral/nasal discharge) of toxin intoxication and reduced the severity of the disease. Conclusions A single dose of BAT, when administered to symptomatic monkeys, resulted in a statistically significant survival benefit compared to the placebo. Additionally, BAT completely protected monkeys from the clinical signs of intoxication and subsequent death when administered as PEP treatment. These data in part supported the licensure of BAT under the Animal Rule in the United States by the Food and Drug Administration.
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Affiliation(s)
- Shantha Kodihalli
- Research and Development, Emergent BioSolution, Winnipeg, Manitoba, Canada
- * E-mail:
| | - Andrew Emanuel
- Research and Development, Emergent BioSolution, Winnipeg, Manitoba, Canada
| | - Teresa Takla
- Research and Development, Emergent BioSolution, Winnipeg, Manitoba, Canada
| | - Yi Hua
- Clinical Research, Emergent BioSolutions, Winnipeg, Manitoba, Canada
| | - Charles Hobbs
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
| | - Ross LeClaire
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
| | - Denise C. O’Donnell
- Lovelace Respiratory Research Institute, Albuquerque, New Mexico, United States of America
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Tonomura S, Kakehi Y, Sato M, Naito Y, Shimizu H, Goto Y, Takahashi N. Takotsubo-like Myocardial Dysfunction in a Patient with Botulism. Intern Med 2017; 56:2925-2927. [PMID: 28924131 PMCID: PMC5709640 DOI: 10.2169/internalmedicine.8968-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Botulinum toxin A (BTXA) can disrupt the neuromuscular and autonomic functions. We herein report a case of autonomic system dysfunction that manifested as Takotsubo-like myocardial dysfunction in a patient with botulism. Takotsubo syndrome results in acute cardiac insufficiency, another fatal complication of botulism in addition to respiratory muscle paralysis, particularly in patients with cardiovascular disease.
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Affiliation(s)
| | | | - Masatoshi Sato
- Department of Infectious Disease, Nara City Hospital, Japan
| | - Yuki Naito
- Department of Neurology, Nara City Hospital, Japan
| | | | - Yasunobu Goto
- Department of Intensive Care Unit, Nara City Hospital, Japan
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Bhardwaj T, Somvanshi P. Pan-genome analysis of Clostridium botulinum reveals unique targets for drug development. Gene 2017; 623:48-62. [DOI: 10.1016/j.gene.2017.04.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/29/2017] [Accepted: 04/12/2017] [Indexed: 10/19/2022]
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Connan C, Voillequin M, Chavez CV, Mazuet C, Leveque C, Vitry S, Vandewalle A, Popoff MR. Botulinum neurotoxin type B uses a distinct entry pathway mediated by CDC42 into intestinal cells versus neuronal cells. Cell Microbiol 2017; 19. [PMID: 28296078 DOI: 10.1111/cmi.12738] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/07/2017] [Accepted: 03/08/2017] [Indexed: 12/15/2022]
Abstract
Botulinum neurotoxins (BoNTs) are responsible for severe flaccid paralysis by inhibiting the release of acetylcholine at the neuromuscular junctions. BoNT type B (BoNT/B) most often induces mild forms of botulism with predominant dysautonomic symptoms. In food borne botulism and botulism by intestinal colonisation such as infant botulism, which are the most frequent naturally acquired forms of botulism, the digestive tract is the main entry route of BoNTs into the organism. We previously showed that BoNT/B translocates through mouse intestinal barrier by an endocytosis-dependent mechanism and subsequently targets neuronal cells, mainly cholinergic neurons, in the intestinal mucosa and musculosa. Here, we investigated the entry pathway of BoNT/B using fluorescent C-terminal domain of the heavy chain (HcB), which is involved in the binding to specific receptor(s) and entry process into target cells. While the combination of gangliosides GD1a /GD1b /GT1b and synaptotagmin I and to a greater extent synaptotagmin II constitutes the functional HcB receptor on NG108-15 neuronal cells, HcB only uses the gangliosides GD1a /GD1b /GT1b to efficiently bind to m-ICcl2 intestinal cells. HcB enters both cell types by a dynamin-dependent endocytosis, which is efficiently prevented by Dynasore, a dynamin inhibitor, and reaches a common early endosomal compartment labeled by early endosome antigen (EEA1). In contrast to neuronal cells, HcB uses a Cdc42-dependent pathway to enter intestinal cells. Then, HcB is transported to late endosomes in neuronal cells, whereas it exploits a nonacidified pathway from apical to basal lateral side of m-ICcl2 cells supporting a transcytotic route in epithelial intestinal cells.
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Affiliation(s)
- Chloé Connan
- Bactéries anaérobies et Toxines, Institut Pasteur, Paris, France
| | - Marie Voillequin
- Bactéries anaérobies et Toxines, Institut Pasteur, Paris, France
| | | | | | - Christian Leveque
- INSERM, UMR_S 1072 (UNIS), Faculté de Médecine -Secteur Nord, Aix Marseille Université, Marseille, France
| | - Sandrine Vitry
- Neuro-Immunologie Virale, Institut Pasteur, Paris, France
| | | | - Michel R Popoff
- Bactéries anaérobies et Toxines, Institut Pasteur, Paris, France
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32
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Ramachandran P, Chan E, Poon M, Tu HTH, Davis JM, Eisen D, Marriott M. Adult food borne botulism in Australia: The only 2 cases from the last 15years. J Clin Neurosci 2017; 41:86-87. [PMID: 28347683 DOI: 10.1016/j.jocn.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Prashanth Ramachandran
- Royal Melbourne Hospital, Department of Medicine and Neurology, Melbourne Brain Centre, Melbourne, VIC, Australia.
| | - Eddie Chan
- Royal Melbourne Hospital, Victorian Infectious Diseases Services, Melbourne, VIC, Australia
| | - Michael Poon
- Western Health, Neurology Department, Melbourne, VIC, Australia
| | - Hans T H Tu
- Royal Melbourne Hospital, University of Melbourne, Melbourne Brain Centre @ RMH, Department of Nursing, Parkville, VIC, Australia
| | - Jennifer M Davis
- Microbiological Diagnostic Unit Public Health Laboratory (MDU PHL), The Peter Doherty Institute for Infection and Immunity, The University of Melbourne, VIC, Australia
| | - Damon Eisen
- James Cook University, College of Medicine and Dentistry, Centre for Biosecurity and Tropical Infectious Diseases, Townsville, QLD, Australia
| | - Mark Marriott
- Royal Melbourne Hospital, Department of Medicine and Neurology, Melbourne Brain Centre, Melbourne, VIC, Australia.
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Bremer PT, Adler M, Phung CH, Singh AK, Janda KD. Newly Designed Quinolinol Inhibitors Mitigate the Effects of Botulinum Neurotoxin A in Enzymatic, Cell-Based, and ex Vivo Assays. J Med Chem 2017; 60:338-348. [PMID: 27966961 DOI: 10.1021/acs.jmedchem.6b01393] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Botulinum neurotoxin A (BoNT/A) is one of the most deadly toxins and is the etiological agent of the potentially fatal condition, botulism. Herein, we investigated 8-hydroxyquinoline (quinolin-8-ol) as a potential inhibitor scaffold for preventing the deadly neurochemical effects of the toxin. Quinolinols are known chelators that can disrupt the BoNT/A metalloprotease zinc-containing active site, thus impeding its proteolysis of the endogenous protein substrate, synaptosomal-associated protein 25 (SNAP-25). By use of this information, the structure-activity relationship (SAR) of the quinolinol-5-sulfonamide scaffold was explored through preparation of a crude sulfonamide library and evaluation of the library in a BoNT/A LC enzymatic assay. Potency optimization of the sulfonamide hit compounds was undertaken as informed by docking studies, granting a lead compound with a submicromolar Ki. These quinolinol analogues demonstrated inhibitory activity in a cell-based model for SNAP-25 cleavage and an ex vivo assay for BoNT/A-mediated muscle paralysis.
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Affiliation(s)
- Paul T Bremer
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), The Scripps Research Institute , 10550 North Torrey Pines Road, La Jolla, California 92037, United States
| | - Michael Adler
- Neurobehavioral Toxicology Branch, Analytical Toxicology Division, U.S. Army Medical Research Institute of Chemical Defense , 2900 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010-5400, United States
| | - Cecilia H Phung
- Neurobehavioral Toxicology Branch, Analytical Toxicology Division, U.S. Army Medical Research Institute of Chemical Defense , 2900 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010-5400, United States
| | - Ajay K Singh
- Neurobehavioral Toxicology Branch, Analytical Toxicology Division, U.S. Army Medical Research Institute of Chemical Defense , 2900 Ricketts Point Road, Aberdeen Proving Ground, Maryland 21010-5400, United States
| | - Kim D Janda
- Departments of Chemistry and Immunology, The Skaggs Institute for Chemical Biology, Worm Institute of Research and Medicine (WIRM), The Scripps Research Institute , 10550 North Torrey Pines Road, La Jolla, California 92037, United States
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34
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Hodowanec AC, Bleck TP. Tetanus and Botulism. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bremer PT, Xue S, Janda KD. Picolinic acids as β-exosite inhibitors of botulinum neurotoxin A light chain. Chem Commun (Camb) 2016; 52:12521-12524. [PMID: 27722252 PMCID: PMC5085802 DOI: 10.1039/c6cc06749b] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
In developing small-molecule inhibitors of botulinum neurotoxin serotype A light chain (BoNT/A LC), substituted picolinic acids were identified. Extensive investigation into the SAR of the picolinic acid scaffold revealed 5-(1-butyl-4-chloro-1H-indol-2-yl)picolinic acid (CBIP), which possessed low micromolar activity against BoNT/A. Kinetic and docking studies demonstrated binding of CBIP to the β-exosite: a largely unexplored site on the LC that holds therapeutic relevance for botulism treatment.
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Affiliation(s)
- Paul T Bremer
- Departments of Chemistry, Immunology and Microbial Sciences, Worm Institute for Research and Medicine (WIRM), The Scripps Research Institute, 10550 N. Torrey Pines Rd, La Jolla, CA 92037, USA.
| | - Song Xue
- Departments of Chemistry, Immunology and Microbial Sciences, Worm Institute for Research and Medicine (WIRM), The Scripps Research Institute, 10550 N. Torrey Pines Rd, La Jolla, CA 92037, USA.
| | - Kim D Janda
- Departments of Chemistry, Immunology and Microbial Sciences, Worm Institute for Research and Medicine (WIRM), The Scripps Research Institute, 10550 N. Torrey Pines Rd, La Jolla, CA 92037, USA.
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Abstract
Botulism had mortality rates >60% before the 1950s. We reviewed confirmed botulism cases in the USA during 1975-2009 including infant, foodborne, wound, and other/unknown acquisition categories, and calculated mortality ratios. We created a multivariate logistic regression model for non-infant cases (foodborne, wound, and other/unknown). Overall mortality was 3.0% with 109 botulism-related deaths among 3,618 botulism cases [18 (<1%) deaths among 2,352 infant botulism cases, 61 (7.1%) deaths among 854 foodborne botulism cases, 18 (5.0%) deaths among 359 wound botulism cases, and 12 (22.6%) deaths among 53 other/unknown botulism cases]. Mortality among all cases increased with age; it was lowest among infants (0.8%) and highest among persons ≥80 years old (34.4%). Toxin type F had higher mortality (13.8%) than types A, B, or E (range, 1.4% to 4.1%). Efforts to reduce botulism mortality should target non-infant transmission categories and older adults.
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Affiliation(s)
- Kelly A Jackson
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D63, Atlanta, GA 30333, USA
| | - Barbara E Mahon
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D63, Atlanta, GA 30333, USA
| | - John Copeland
- Biostatistics and Information Management Office, Centers for Disease Control and Prevention, 2500 Century Boulevard, MS E33, Atlanta, GA 30345, USA
| | - Ryan P Fagan
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS D63, Atlanta, GA 30333, USA
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Cengiz M, Yilmaz M, Dosemeci L, Ramazanoglu A. A botulism outbreak from roasted canned mushrooms. Hum Exp Toxicol 2016; 25:273-8. [PMID: 16758770 DOI: 10.1191/0960327106ht614oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Food-borne botulism is a rare disease that results from ingestion of the toxins produced by Clostridium botulinum. The most common cause of the disease is the consumption of home-canned foods prepared under inappropriate conditions, especially in rural environments. In this report, a food-borne botulism outbreak potentially caused by roasted home-canned mushrooms is evaluated and the major reasons for delayed diagnosis are emphasized. The clinical features, symptoms and prognosis of the five botulism patients involved in this outbreak are presented. The clinical progressions, treatments, durations of mechanical ventilation, intensive care unit stays and hospital stays of the three patients admitted to Akdeniz University Hospital are reported.
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Affiliation(s)
- Melike Cengiz
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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38
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Johnson AL, McAdams-Gallagher SC, Aceto H. Accuracy of a Mouse Bioassay for the Diagnosis of Botulism in Horses. J Vet Intern Med 2016; 30:1293-9. [PMID: 27108763 PMCID: PMC5074318 DOI: 10.1111/jvim.13950] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/11/2016] [Accepted: 03/31/2016] [Indexed: 12/18/2022] Open
Abstract
Background The laboratory diagnosis of botulism in horses traditionally has relied upon the mouse bioassay (MBA). The accuracy of this test for the diagnosis of botulism in horses is unknown. Hypothesis/Objectives Our goal was to determine the sensitivity, specificity, positive predictive value, and negative predictive value of the MBA on laboratory‐processed fecal and gastrointestinal samples for foals and adult horses. Animals Cases included all horses with a final clinical diagnosis of botulism that were admitted between 1986 and 2011 and had MBA testing performed. Controls included horses without botulism that were admitted during the same time period and had MBA testing performed. Methods Retrospective study. Horses suspected of having botulism had fecal or (less commonly) gastrointestinal content samples tested using MBA. For every hospitalized botulism suspect, control samples were obtained from ≥1 additional hospitalized horses not suspected to have botulism. Results One hundred and twenty‐nine adult horses and 253 adult controls were identified. Overall sensitivity of the MBA was only 32% but specificity was 97%. Forty‐three foal cases and 21 foal controls were evaluated; sensitivity of the MBA was 53% and specificity was 100%. Positive predictive value was substantially higher (100% for foals and 89% for adults) than negative predictive value (51% for foals and 67% for adults). Conclusions and Clinical Importance Mouse bioassay has low sensitivity but high specificity for the diagnosis of botulism in horses. Positive results are highly suggestive of botulism but negative results do not exclude the diagnosis. Unaffected horses and foals rarely shed C. botulinum in their feces.
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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
| | - S C McAdams-Gallagher
- Botulism Reference Laboratory, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - H Aceto
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
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Feng L, Chen X, Liu S, Zhou Z, Yang R. Two-family outbreak of botulism associated with the consumption of smoked ribs in Sichuan Province, China. Int J Infect Dis 2014; 30:74-7. [PMID: 25448333 DOI: 10.1016/j.ijid.2014.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 10/01/2014] [Accepted: 10/25/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND On September 22, 2013, two patients from Sichuan Province, China presented with symptoms of food-borne botulism, a rare but fatal illness caused by the consumption of foods containing Clostridium botulinum neurotoxins. METHODS Investigators reviewed the medical charts and food consumption histories, and interviewed patients and family members. Food samples and clinical specimens were tested for botulinum toxin and neurotoxin-producing Clostridium species by standard methods. RESULTS The first two index cases presented with cranial neuropathies and flaccid paralysis, and required mechanical ventilation. There were 12 confirmed outbreak-associated cases. Botulinum toxin type A was identified in the smoked ribs, and all of the patients had consumed the smoked ribs from the same local restaurant. The smoked ribs contained no added salt, sugar, or preservative. Botulinum toxin production likely resulted from the cold-smoking preparation method and inappropriate refrigeration. CONCLUSIONS Smoked ribs produced by a local restaurant, contaminated with type A botulism, was the contributor to this outbreak. The supervision of food safety should be strengthened to prevent future outbreaks in China.
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Affiliation(s)
- Ling Feng
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Xueping Chen
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Shujie Liu
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Zengrong Zhou
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, Sichuan 610041, China.
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Abstract
Botulism is a severe neuroparalytic disease caused by the toxins produced from several Clostridium species. Botulinum neurotoxins (BoNTs) cause flaccid paralysis by inducing a blockade at voluntary motor and autonomic cholinergic junctions that, if not treated, can be fatal. Vaccination to elicit protective circulating antibodies that bind, neutralize and clear toxins before they can be internalized and affect cholinergic neurons remains the most effective form of protection against BoNT. A pentavalent BoNT toxoid vaccine administered in the USA under an Investigational New Drug protocol to at-risk workers was discontinued by the CDC in 2011 due to diminished potency and reactogenic effects. Subsequent research efforts have primarily focused on recombinant protein antigens. This review focuses on the development of a recombinant bivalent vaccine (rBV A/B) composed of purified recombinant BoNT/A and BoNT/B receptor-binding domain proteins, as well as presenting a summary of progress and issues associated with alternative vaccines currently being developed against botulism.
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Affiliation(s)
- Robert P Webb
- US Army Medical Research Institute for Infectious Diseases, Frederick, MD 21702, USA
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41
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Jones RGA, Marks JD. Use of a new functional dual coating (FDC) assay to measure low toxin levels in serum and food samples following an outbreak of human botulism. J Med Microbiol 2013; 62:828-835. [DOI: 10.1099/jmm.0.053124-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Clostridium
botulinum type A toxin is the most prevalent cause of naturally occurring outbreaks of human botulism in the world. The active dichain neurotoxin molecule is composed of a heavy chain (H-chain) of ~100 kDa with the carboxy-terminal end consisting of a receptor-binding (HC) domain, while the amino-terminal (HN) domain is linked by a critical disulfide bond to a light chain (L-chain) of ~50 kDa. Although the mouse bioassay (MBA) is traditionally used to confirm the presence of toxin in serum or food, its sensitivity is insufficient to detect low toxin levels in approximately 30 to 60 % of botulism patients. A novel FDC (functional dual coating) microtitre plate immuno-biochemical assay, which quantifies botulinum toxicity by measuring the HC domain linked with L-chain endopeptidase activity, was modified to allow human serum (lysed or unlysed) to be tested without interference from the matrix, with toxin detection down to 0.03 mouse LD50 per ml serum or 0.13 pg ml–1 using just 100 µl of clinical samples. The assay was specific for type A toxin and could additionally be applied to whole blood and food samples. Low levels of 1 to 2 mouse LD50 per ml serum of type A toxin were quantified for the first time using the modified FDC assay in two severely intoxicated UK patients who required mechanical ventilation and antitoxin. Toxin levels in recovered food sample extracts were also detected and one MBA-negative sample was found to contain 0.32 LD50 per ml extract. The FDC assay provides a real alternative for public health laboratories to unambiguously confirm all cases of type A botulism and, due to its sensitivity, a promising new tool in toxin pharmacokinetic studies.
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Affiliation(s)
- Russell G. A. Jones
- Division of Bacteriology, National Institute for Biological Standards and Control, Health Protection Agency, South Mimms, Hertfordshire, UK
| | - James D. Marks
- Department of Anesthesia, University of California, San Francisco, USA
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Leclair D, Fung J, Isaac-Renton JL, Proulx JF, May-Hadford J, Ellis A, Ashton E, Bekal S, Farber JM, Blanchfield B, Austin JW. Foodborne botulism in Canada, 1985-2005. Emerg Infect Dis 2013; 19:961-8. [PMID: 23735780 PMCID: PMC3713816 DOI: 10.3201/eid1906.120873] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During 1985-2005, a total of 91 laboratory-confirmed outbreaks of foodborne botulism occurred in Canada; these outbreaks involved 205 cases and 11 deaths. Of the outbreaks, 75 (86.2%) were caused by Clostridium botulinum type E, followed by types A (7, 8.1%) and B (5, 5.7%). Approximately 85% of the outbreaks occurred in Alaska Native communities, particularly the Inuit of Nunavik in northern Quebec and the First Nations population of the Pacific coast of British Columbia. These populations were predominantly exposed to type E botulinum toxin through the consumption of traditionally prepared marine mammal and fish products. Two botulism outbreaks were attributed to commercial ready-to-eat meat products and 3 to foods served in restaurants; several cases were attributed to non-Native home-prepared foods. Three affected pregnant women delivered healthy infants. Improvements in botulism case identification and early treatment have resulted in a reduction in the case-fatality rate in Canada.
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Development of a Cell-Based Functional Assay for the Detection of Clostridium botulinum Neurotoxin Types A and E. Int J Microbiol 2013; 2013:593219. [PMID: 23533420 PMCID: PMC3606727 DOI: 10.1155/2013/593219] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 01/22/2013] [Accepted: 01/30/2013] [Indexed: 11/17/2022] Open
Abstract
The standard procedure for definitive detection of BoNT-producing Clostridia is a culture method combined with neurotoxin detection using a standard mouse bioassay (MBA). The mouse bioassay is highly sensitive and specific, but it is expensive and time-consuming, and there are ethical concerns due to use of laboratory animals. Cell-based assays provide an alternative to the MBA in screening for BoNT-producing Clostridia. Here, we describe a cell-based assay utilizing a fluorescence reporter construct expressed in a neuronal cell model to study toxin activity in situ. Our data indicates that the assay can detect as little as 100 pM BoNT/A activity within living cells, and the assay is currently being evaluated for the analysis of BoNT in food matrices. Among available in vitro assays, we believe that cell-based assays are widely applicable in high-throughput screenings and have the potential to at least reduce and refine animal assays if not replace it.
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Acute neuromuscular weakness in a boy with a facial abscess contaminated with Clostridium botulinum. Pediatr Infect Dis J 2012; 31:1307-9. [PMID: 22935869 DOI: 10.1097/inf.0b013e3182700e34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Wound botulism arising from skin and soft tissue infection is rare in children, most cases being reported in adult intravenous drug users. Cranial nerve palsies are the primary presenting sign, followed by descending neuromuscular weakness. Diagnosis relies on isolation of either toxigenic Clostridium botulinum species or toxin from wound or blood samples. We present an unusual case of wound botulism in a pediatric patient with the intent to inform the reader and improve the time to diagnosis in such cases.
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Sun S, Tepp WH, Johnson EA, Chapman ER. Botulinum neurotoxins B and E translocate at different rates and exhibit divergent responses to GT1b and low pH. Biochemistry 2012; 51:5655-62. [PMID: 22720883 PMCID: PMC3398548 DOI: 10.1021/bi3004928] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
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Botulinum neurotoxins (BoNTs, serotypes A–G) are
the most
deadly substances known. Here, we investigated how BoNT/E, a serotype
that causes human botulism, translocates into the cytosol of neurons.
Analogous to BoNT/B, BoNT/E required binding of the coreceptor, GT1b,
to undergo significant secondary structural changes and transform
into a hydrophobic protein at low pH. These data indicate that both
serotypes act as coincidence detectors for both GT1b and low pH, to
undergo translocation. However, BoNT/E translocated much more rapidly
than BoNT/B. Also, BoNT/E required only GT1b, and not low pH, to oligomerize,
whereas BoNT/B required both. In further contrast to the case of BoNT/B,
low pH alone altered the secondary structure of BoNT/E to some degree
and resulted in its premature inactivation. Hence, comparison of two
BoNT serotypes revealed that these agents exhibit both convergent
and divergent responses to receptor interactions, and pH, in the translocation
pathway.
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Positive ice pack test in a case of food-borne botulism: a clinical note. J Neurol 2012; 259:2486-7. [PMID: 22752064 DOI: 10.1007/s00415-012-6591-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/12/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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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.
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Affiliation(s)
- Katharina M Busl
- Department of Neurological Sciences, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA.
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Nystrom SC, Wells EV, Pokharna HS, Johnson LE, Najjar MA, Mamou FM, Rudrik JT, Miller CE, Boulton ML. Botulism Toxemia Following Laparoscopic Appendectomy. Clin Infect Dis 2011; 54:e32-4. [DOI: 10.1093/cid/cir855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rowlands REG, Ristori CA, Lopes GISL, Paula AMRD, Sakuma H, Grigaliunas R, Lopreato Filho R, Gelli DS, Eduardo MBDP, Jakabi M. Botulism in Brazil, 2000-2008: epidemiology, clinical findings and laboratorial diagnosis. Rev Inst Med Trop Sao Paulo 2011; 52:183-6. [PMID: 21748224 DOI: 10.1590/s0036-46652010000400003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2009] [Accepted: 06/24/2010] [Indexed: 11/22/2022] Open
Abstract
Botulism is a rare and potentially lethal illness caused by Clostridium botulinum neurotoxin. We describe the findings of a laboratorial investigation of 117 suspected cases of botulism reported to the surveillance system in Brazil from January 2000 to October 2008. Data on the number and type of samples analyzed, type of toxins identified, reporting of the number of botulism cases and transmission sources are discussed. A total of 193 clinical samples and 81 food samples were analyzed for detection and identification of the botulism neurotoxin. Among the clinical samples, 22 (11.4%) presented the toxin (nine type A, five type AB and eight with an unidentified type); in food samples, eight (9.9%) were positive for the toxin (five type A, one type AB and two with an unidentified type). Of the 38 cases of suspected botulism in Brazil, 27 were confirmed by a mouse bioassay. Laboratorial botulism diagnosis is an important procedure to elucidate cases, especially food-borne botulism, to confirm clinical diagnosis and to identify toxins in food, helping sanitary control measures.
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Lonati D, Locatelli CA, Fenicia L, Anniballi F, Landri P, Giampreti A, Petrolini VM, Vecchio S, Manzo L. Fatal course of foodborne botulism in an eight-month old infant. Pediatr Rep 2011; 3:e31. [PMID: 22355516 PMCID: PMC3283199 DOI: 10.4081/pr.2011.e31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 10/13/2011] [Indexed: 11/23/2022] Open
Abstract
An 8-month old girl, weighing 9 kg, was brought by her parents at 8.15 am to the Emergency Department (ED) for a progressive worsening of weakness and acute respiratory failure. On admission, the baby presented with poor oral intake, a weak cry and extremely weak muscular body control. Poor gag and suck, unreactive mydriasis, hypotonia, lethargy and absence of peristalsis were noted. Laboratory data showed severe respiratory acidosis. Chest X-ray, electroencephalography, encephalic CT scan and MRI were all normal, as were cerebrospinal fluid analysis and viral tests. Orotracheal intubation and continuous mechanical ventilation were applied. The patient received fluids, corticosteroids, aerosol therapy, large-spectrum antibiotics and enteral-nutrition. Further investigation revealed ingestion of an improperly prepared home-canned homogenized turkey meal. Type A botulinum neurotoxin was identified. Trivalent botulinum antitoxin, prostigmine and oral activated charcoal were administered. Generalized flaccid paralysis, areflexic bilateral mydriasis, gastric stasis and deep coma persisted for the duration of the hospital stay, and the patient died of severe respiratory failure and cardiac arrest 12 days after ED admission. Botulism poisoning should be suspected in any infant presenting with feeding difficulties, constipation, descendent paralysis or acute respiratory failure. Supportive treatment and antidotal therapy should be performed as soon as a clinical diagnosis is made. We describe a case of foodborne botulism in an 8-month old infant caused by ingestion of an improperly prepared home-canned homogenized turkey meal, representing the youngest fatal case reported in medical literature.
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Affiliation(s)
- Davide Lonati
- Pavia Poison Center and National Toxicology Information Centre -Toxicology Unit IRCCS Maugeri Foundation and University of Pavia
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