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Elrayes M, Al Bachari S, Macdonagh R, Peel A, Khurshid S, Hamzah J, Holzmann T, Chaouch A, Cummins G, McKee D, Richardson A, Kobylecki C. Delayed onset post-traumatic wound botulism. Pract Neurol 2024:pn-2023-004036. [PMID: 38290842 DOI: 10.1136/pn-2023-004036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
A 41-year-old man developed rapidly progressive cranial neuropathies and muscle weakness followed by respiratory failure, requiring ventilation support. On examination, there was marked bilateral ptosis and ophthalmoplegia with bulbar, neck and proximal upper limb weakness. He had a recent open left humeral fracture that eventually required amputation. Despite immunoglobulin therapy, his progressive weakness continued. Multiple investigation results were inconclusive. Eventually, botulinum type A toxin was found positive, by which time the therapeutic window for antitoxin had passed. He continued on supportive management and was treated for concomitant infections and nosocomial illnesses. He was subsequently weaned from respiratory support and has made a good neurological recovery.
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Affiliation(s)
- Mai Elrayes
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Sarah Al Bachari
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Ronan Macdonagh
- Neurophysiology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Alex Peel
- Microbiology Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Salman Khurshid
- Microbiology Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Juiliana Hamzah
- Critical Care Unit, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Tim Holzmann
- Critical Care Unit, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Amina Chaouch
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Gemma Cummins
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - David McKee
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Anna Richardson
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Christopher Kobylecki
- Neurology Department, Manchester Centre for Clinical Neuroscience, Northern Care Alliance NHS Foundation Trust, Salford, UK
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Rawson AM, Dempster AW, Humphreys CM, Minton NP. Pathogenicity and virulence of Clostridium botulinum. Virulence 2023; 14:2205251. [PMID: 37157163 PMCID: PMC10171130 DOI: 10.1080/21505594.2023.2205251] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Clostridium botulinum, a polyphyletic Gram-positive taxon of bacteria, is classified purely by their ability to produce botulinum neurotoxin (BoNT). BoNT is the primary virulence factor and the causative agent of botulism. A potentially fatal disease, botulism is classically characterized by a symmetrical descending flaccid paralysis, which is left untreated can lead to respiratory failure and death. Botulism cases are classified into three main forms dependent on the nature of intoxication; foodborne, wound and infant. The BoNT, regarded as the most potent biological substance known, is a zinc metalloprotease that specifically cleaves SNARE proteins at neuromuscular junctions, preventing exocytosis of neurotransmitters, leading to muscle paralysis. The BoNT is now used to treat numerous medical conditions caused by overactive or spastic muscles and is extensively used in the cosmetic industry due to its high specificity and the exceedingly small doses needed to exert long-lasting pharmacological effects. Additionally, the ability to form endospores is critical to the pathogenicity of the bacteria. Disease transmission is often facilitated via the metabolically dormant spores that are highly resistant to environment stresses, allowing persistence in the environment in unfavourable conditions. Infant and wound botulism infections are initiated upon germination of the spores into neurotoxin producing vegetative cells, whereas foodborne botulism is attributed to ingestion of preformed BoNT. C. botulinum is a saprophytic bacterium, thought to have evolved its potent neurotoxin to establish a source of nutrients by killing its host.
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Affiliation(s)
- Alexander M Rawson
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Andrew W Dempster
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Christopher M Humphreys
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
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Oliveira LM, Gonçalves DB, Cabral LDCR, Bernardino MRA, Feitoza PVS. Botulism in the Brazilian Amazon: a life-threatening disease in a neglected population. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:1227-1232. [PMID: 36580960 PMCID: PMC9800156 DOI: 10.1055/s-0042-1758651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Botulism is a rare and potentially fatal neuroparalytic syndrome caused by the gram-positive anaerobe spore-forming bacterium Clostridium botulinum. The microorganism produces a neurotoxin that inhibits the presynaptic release of acetylcholine at the neuromuscular junction, clinically leading to a myasthenic syndrome. OBJECTIVE To describe the recent outbreak of botulism cases and its demographic, clinical, and laboratory characteristics. METHODS We report 4 patients with botulism in the recent outbreak occurred between 2017 and 2019 in the state of Amazon. RESULTS Out of four patients with botulism, three contracted it from eating contaminated food and one had wound botulism. We emphasize the excellent clinical outcome of the different disease presentations in our case series. CONCLUSION The temporal proximity of these reports may suggest a new rise in the number of cases in the upcoming years. A possible hypothesis is that the rarity of the disease decreased the awareness regarding the primary prevention or even a diagnosis by an untrained physician.
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Affiliation(s)
| | | | | | - Marília Rosa Abtibol Bernardino
- Universidade Federal do Amazonas, Faculdade de Medicina, Manaus AM, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus AM, Brazil.
| | - Pablo Vinícius Silveira Feitoza
- Universidade Federal do Amazonas, Faculdade de Medicina, Manaus AM, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus AM, Brazil.,Address for correspondence Pablo Vinícius Silveira Feitoza
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Raza N, Dhital S, Espinoza VE, Jariwal R, Chiu CW, Valdez M, Heidari A, Petersen G, Sabetian K. Wound Botulism in Black Tar Heroin Injecting Users: A Case Series. J Investig Med High Impact Case Rep 2021; 9:23247096211028078. [PMID: 34259080 PMCID: PMC8283217 DOI: 10.1177/23247096211028078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/23/2022] Open
Abstract
The incidence of wound botulism in injection drug users has increased since the introduction of black tar heroin. Many species of the Clostridium genus, most commonly Clostridium botulinum, Clostridium baratii, and Clostridium butyricum, have been associated with wound botulism. Patients often present with progressive bulbar weakness, including dysphagia, cranial nerve palsies, and loss of speech, in addition to symmetrical descending weakness of the upper extremities that may progress to the chest and lower extremities. In this article, we present 3 cases of wound botulism, in which the patients presented with bulbar weakness and were treated with botulism antitoxin heptavalent. The time to antitoxin administration and its effect on the patients' clinical courses is compared.
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Affiliation(s)
- Nadia Raza
- UCLA at Kern Medical Center, Bakersfield, CA, USA
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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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Awsare S, Chirikian D, Lui F. Wound Botulism Caused by Botulinum Neurotoxin Type A in a Chronic Parenteral Drug Abuser. Case Rep Neurol 2020; 12:422-427. [PMID: 33362521 PMCID: PMC7747075 DOI: 10.1159/000510846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022] Open
Abstract
Botulism is an acute paralytic disease caused by botulinum neurotoxin (BoNT)-mediated inhibition of neurosignaling at the neuromuscular junction. BoNTs are produced by gram positive, anaerobic, spore-forming bacteria from the genus <i>Clostridium,</i>most commonly<i> Clostridium botulinum</i>. Over the last decade, a previously uncommon form of botulism, wound botulism, has increased in prevalence possibly due to the rise in parenteral drug abuse. A 53-year-old patient with a history of drug abuse presents to a rural emergency department with rapidly progressing lower extremity weakness over the past few days. He reports a recent heroin injection into right buttock and diffuse skin-popping scarring was observed throughout. The patient was treated with heptavalent botulinum antitoxin obtained from the Center for Disease Control and Prevention (CDC). A right thigh abscess culture was positive for<i> Clostridium tertium</i>, a left hip abscess culture was positive for methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA), and blood culture confirmed multi-microbial bacteremia caused by <i>Staphylococcus epidermidis</i> and <i>Streptococcus mitis</i>. Serum analysis was positive for BoNT type A from a suspected concurrent<i> Clostridium botulinum</i> infection as <i>C. tertium</i> is not known to produce BoNT type A. This case report highlights the importance of early antitoxin treatment for patients with suspected wound botulism.
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Affiliation(s)
- Sohun Awsare
- *Sohun Awsare, California Northstate University College of Medicine, 9700 West Taron Drive, Elk Grove, CA, 95757 (USA),
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