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Douillard FP, Derman Y, Jian C, Korpela K, Saxén H, Salonen A, de Vos WM, Korkeala H, Lindström M. Case report: Aberrant fecal microbiota composition of an infant diagnosed with prolonged intestinal botulism. Gut Pathog 2024; 16:20. [PMID: 38581020 PMCID: PMC10996148 DOI: 10.1186/s13099-024-00614-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/27/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Intestinal botulism is primarily reported in small babies as a condition known as infant botulism. The condition results from the ingestion of environmental or foodborne spores of botulinum neurotoxin (BoNT) producing Clostridia, usually Clostridium botulinum, and subsequent spore germination into active botulinum neurotoxinogenic cultures in the gut. It is generally considered that small babies are susceptible to C. botulinum colonization because of their immature gut microbiota. Yet, it is poorly understood which host factors contribute to the clinical outcome of intestinal botulism. We previously reported a case of infant botulism where the infant recovered clinically in six weeks but continued to secrete C. botulinum cells and/or BoNT in the feces for seven months. CASE PRESENTATION To further understand the microbial ecology behind this exceptionally long-lasting botulinum neurotoxinogenic colonization, we characterized the infant fecal microbiota using 16S rRNA gene amplicon sequencing over the course of disease and recovery. C. botulinum could be detected in the infant fecal samples at low levels through the acute phase of the disease and three months after recovery. Overall, we observed a temporal delay in the maturation of the infant fecal microbiota associated with a persistently high-level bifidobacterial population and a low level of Lachnospiraceae, Bacteroidaceae and Ruminococcaceae compared to healthy infants over time. CONCLUSION This study brings novel insights into the infant fecal composition associated with intestinal botulism and provides a basis for a more systematic analysis of the gut microbiota of infants diagnosed with botulism. A better understanding of the gut microbial ecology associated with infant botulism may support the development of prophylactic strategies against this life-threatening disease in small babies.
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Affiliation(s)
- François P Douillard
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Yağmur Derman
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ching Jian
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Katri Korpela
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Harri Saxén
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anne Salonen
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Willem M de Vos
- Human Microbiome Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Laboratory of Microbiology, Wageningen University & Research, Wageningen, The Netherlands
| | - Hannu Korkeala
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Miia Lindström
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland.
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2
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Rowe JA, Vedala K, Thomas C, Mukthapuram S. Newborn with Lethargy and Hypotonia. Neoreviews 2023; 24:e733-e736. [PMID: 37907399 DOI: 10.1542/neo.24-11-e733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Affiliation(s)
- James A Rowe
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Neonatology, Perinatal Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kishore Vedala
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Neurology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Cameron Thomas
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Neurology, Cincinnati Children's Hospital, Cincinnati, OH
| | - Shanmukha Mukthapuram
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- Division of Neonatology, Perinatal Institute Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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3
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Goldberg B, Danino D, Levinsky Y, Levy I, Straussberg R, Dabaja-Younis H, Guri A, Almagor Y, Tasher D, Elad D, Baider Z, Blum S, Scheuerman O. Infant Botulism, Israel, 2007-2021. Emerg Infect Dis 2023; 29:235-241. [PMID: 36692296 PMCID: PMC9881770 DOI: 10.3201/eid2902.220991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infant botulism (IB) is an intestinal toxemia that manifests as descending paralysis, constipation, and, in some cases, respiratory failure. Laboratory-confirmed IB cases are rare, and recent data in Israel are lacking. We conducted a national multicenter retrospective study of laboratory-confirmed IB cases reported in Israel during 2007-2021. A total of 8 cases were reported during the study period. During 2019-2021, incidence may have increased because of a cluster of 5 cases. Infant median age for diagnosis was 6.5 months, older than previously reported (3 months). Most cases occurred during March-July. Honey consumption was reported in 1 case, and possible environmental risk factors (living nearby rural or construction areas, dust exposure, and having a father who works as a farmer) were reported in 6 cases. Although IB is rare, its incidence in Israel may have increased over recent years, and its epidemiology and risk factors differ from cases reported previously in Israel.
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Corrado A, Yoshiba G, Buranosky M, Woods Z, Wohrley J, Romantseva L, Wolf A. A 43-Day-Old Male With Respiratory Distress and Acute-Onset Hypotonia. Pediatrics 2022; 150:189742. [PMID: 36254627 DOI: 10.1542/peds.2022-056744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/06/2022] Open
Abstract
A 43-day-old, full-term, previously healthy male presented with decreased activity and oral intake. He was found to be grunting and hypoxemic on examination, and a respiratory pathogen panel was positive for rhinovirus. He was diagnosed with presumed bronchiolitis. His neurologic exam on admission was normal. Because of respiratory failure, he was escalated from high-flow nasal cannula to bilevel positive airway pressure upon admission and he was started on ceftriaxone and vancomycin while awaiting culture data. On hospital day 6, he required escalation of respiratory support. His examination at that time was notable for new hypotonia of his bilateral upper and lower extremities, sluggish pupils, bilateral exotropia, intermittent vertical nystagmus, and an absent Moro reflex. He developed a focal seizure and a computed tomography of the brain demonstrated simple right otomastoiditis. The seizure was attributed to a serum sodium of 113 mmol/L in the setting of syndrome of inappropriate antidiuretic hormone secretion, thought to be secondary to viral bronchiolitis. However, as the patient's sodium was corrected to a normal range, he continued to have neurologic deficits on examination. Given his persistent hypotonia and respiratory failure, atypical for the expected course of viral bronchiolitis, the patient underwent an extensive neurologic and infectious workup, which ultimately revealed a surprising diagnosis.
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Affiliation(s)
- Alisa Corrado
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Grace Yoshiba
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Megan Buranosky
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Zakary Woods
- Rush Medical College, Rush University Medical Center, Chicago, Illinois
| | - Julie Wohrley
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Lubov Romantseva
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
| | - Ashley Wolf
- Department of Pediatrics, Rush University Children's Hospital, Chicago, Illinois
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5
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Dilena R, Pozzato M, Baselli L, Chidini G, Barbieri S, Scalfaro C, Finazzi G, Lonati D, Locatelli CA, Cappellari A, Anniballi F. Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review. Toxins (Basel) 2021; 13:toxins13120860. [PMID: 34941698 PMCID: PMC8703831 DOI: 10.3390/toxins13120860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022] Open
Abstract
Infant botulism is a rare and underdiagnosed disease caused by BoNT-producing clostridia that can temporarily colonize the intestinal lumen of infants less than one year of age. The diagnosis may be challenging because of its rareness, especially in patients showing atypical presentations or concomitant coinfections. In this paper, we report the first infant botulism case associated with Cytomegalovirus coinfection and transient hypogammaglobulinemia and discuss the meaning of these associations in terms of risk factors. Intending to help physicians perform the diagnosis, we also propose a practical clinical and diagnostic criteria checklist based on the revision of the literature.
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Affiliation(s)
- Robertino Dilena
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
- Correspondence:
| | - Mattia Pozzato
- Neurology Unit & MS Centre, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Dino Ferrari Centre, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Lucia Baselli
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Sergio Barbieri
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
| | - Concetta Scalfaro
- National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.S.); (F.A.)
| | - Guido Finazzi
- Department of Food Control, Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia-Romagna, 25124 Brescia, Italy;
| | - Davide Lonati
- Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (D.L.); (C.A.L.)
| | - Carlo Alessandro Locatelli
- Toxicology Unit, Laboratory of Clinical and Experimental Toxicology, and Poison Control Centre and National Toxicology Information Centre, Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy; (D.L.); (C.A.L.)
| | - Alberto Cappellari
- Unità di Neurofiopatologia, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.B.); (A.C.)
| | - Fabrizio Anniballi
- National Reference Centre for Botulism, Nutrition and Veterinary Public Health, Department of Food Safety, Istituto Superiore di Sanità, 00161 Rome, Italy; (C.S.); (F.A.)
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Respiratory Syncytial Virus-Associated Neurologic Complications in Children: A Systematic Review and Aggregated Case Series. J Pediatr 2021; 239:39-49.e9. [PMID: 34181989 DOI: 10.1016/j.jpeds.2021.06.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/30/2021] [Accepted: 06/21/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To describe the features and frequency of respiratory syncytial virus (RSV)-associated severe acute neurologic disease in children. STUDY DESIGN We performed a systematic review of the literature to identify reports of severe acute neurologic complications associated with acute RSV infection in children aged <15 years (PROSPERO Registration CRD42019125722). Main outcomes included neurologic, clinical, and demographic features of cases and the frequency of disease. We aggregated available case data from the published literature and from the Australian Acute Childhood Encephalitis (ACE) study. RESULTS We identified 87 unique studies from 26 countries describing a spectrum of RSV-associated severe acute neurologic syndromes including proven encephalitis, acute encephalopathy, complex seizures, hyponatremic seizures, and immune-mediated disorders. The frequency of RSV infection in acute childhood encephalitis/encephalopathy was 1.2%-6.5%. We aggregated data from 155 individual cases with RSV-associated severe acute neurologic complications; median age was 11.0 months (IQR 2.0-21.5), most were previously healthy (71/104, 68%). Seizure was the most frequently reported neurologic feature (127/150, 85%). RSV was detected in the central nervous system of 12 cases. Most children recovered (81/122, 66%); however, some reports described partial recovery (33/122, 27%) and death (8/122, 7%). CONCLUSIONS RSV-associated neurologic complications have been widely reported, but there is substantial heterogeneity in the design and quality of existing studies. The findings from our study have implications for the investigation, management, and prevention of RSV-associated neurologic complications. Further, this systematic review can inform the design of future studies aiming to quantify the burden of childhood RSV-associated neurologic disease.
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7
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Antonucci L, Locci C, Schettini L, Clemente MG, Antonucci R. Infant botulism: an underestimated threat. Infect Dis (Lond) 2021; 53:647-660. [PMID: 33966588 DOI: 10.1080/23744235.2021.1919753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Infant botulism (IB) is defined as a potentially life-threatening neuroparalytic disorder affecting children younger than 12 months. It is caused by ingestion of food or dust contaminated by Clostridium botulinum spores, which germinate in the infant's large bowel and produce botulinum neurotoxin. Although the real impact of IB is likely underestimated worldwide, the USA has the highest number of cases. The limited reporting of IB in many countries is probably due to diagnostic difficulties and nonspecific presentation. The onset is usually heralded by constipation, followed by bulbar palsy, and then by a descending bilateral symmetric paralysis; ultimately, palsy can involve respiratory and diaphragmatic muscles, leading to respiratory failure. The treatment is based on supportive care and specific therapy with Human Botulism Immune Globulin Intravenous (BIG-IV), and should be started as early as possible. The search for new human-like antibody preparations that are both highly effective and well tolerated has led to the creation of a mixture of oligoclonal antibodies that are highly protective and can be produced in large quantities without the use of animals. Ongoing research for future treatment of IB involves the search for new molecular targets to produce a new generation of laboratory-produced antitoxins, and the development of new vaccines with safety and efficacy profiles that can be scaled up for clinical use. This narrative literature review aims to provide a readable synthesis of the best current literature on microbiological, epidemiological and clinical features of IB, and a practical guide for its treatment.
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Affiliation(s)
- Luca Antonucci
- Academic Department of Pediatrics, Children's Hospital Bambino Gesù, University of Rome 'Tor Vergata', Rome, Italy
| | - Cristian Locci
- Pediatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Livia Schettini
- Academic Department of Pediatrics, Children's Hospital Bambino Gesù, University of Rome 'Tor Vergata', Rome, Italy
| | - Maria Grazia Clemente
- Pediatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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8
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Re: The dilemma of diagnosing wound botulism in an infant. Int J Infect Dis 2020; 104:181-182. [PMID: 33340665 DOI: 10.1016/j.ijid.2020.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/10/2020] [Indexed: 11/23/2022] Open
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9
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Säuglingsbotulismus – eine verkannte Rarität? Monatsschr Kinderheilkd 2020. [DOI: 10.1007/s00112-019-00818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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10
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Lyons-Warren AM, Risen SR, Clark G. Infant Botulism With Asymmetric Cranial Nerve Palsies. Pediatr Neurol 2019; 92:71-72. [PMID: 30639248 DOI: 10.1016/j.pediatrneurol.2018.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/20/2018] [Accepted: 11/23/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Ariel Maia Lyons-Warren
- Baylor College of Medicine, Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas.
| | - Sarah R Risen
- Baylor College of Medicine, Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas
| | - Gary Clark
- Baylor College of Medicine, Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas
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11
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Natural Compounds and Their Analogues as Potent Antidotes against the Most Poisonous Bacterial Toxin. Appl Environ Microbiol 2018; 84:AEM.01280-18. [PMID: 30389764 DOI: 10.1128/aem.01280-18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023] Open
Abstract
Botulinum neurotoxins (BoNTs), the most poisonous proteins known to humankind, are a family of seven (serotype A to G) immunologically distinct proteins synthesized primarily by different strains of the anaerobic bacterium Clostridium botulinum Being the causative agents of botulism, the toxins block neurotransmitter release by specifically cleaving one of the three soluble N-ethylmaleimide-sensitive factor attachment receptor (SNARE) proteins, thereby inducing flaccid paralysis. The development of countermeasures and therapeutics against BoNTs is a high-priority research area for public health because of their extreme toxicity and potential for use as biowarfare agents. Extensive research has focused on designing antagonists that block the catalytic activity of BoNTs. In this study, we screened 300 small natural compounds and their analogues extracted from Indian plants for their activity against BoNT serotype A (BoNT/A) as well as its light chain (LCA) using biochemical and cellular assays. One natural compound, a nitrophenyl psoralen (NPP), was identified to be a specific inhibitor of LCA with an in vitro 50% inhibitory concentration (IC50) value of 4.74 ± 0.03 µM. NPP was able to rescue endogenous synaptosome-associated protein 25 (SNAP-25) from cleavage by BoNT/A in human neuroblastoma cells with an IC50 of 12.2 ± 1.7 µM, as well as to prolong the time to the blocking of neutrally elicited twitch tensions in isolated mouse phrenic nerve-hemidiaphragm preparations.IMPORTANCE The long-lasting endopeptidase activity of BoNT is a critical biological activity inside the nerve cell, as it prompts proteolysis of the SNARE proteins, involved in the exocytosis of the neurotransmitter acetylcholine. Thus, the BoNT endopeptidase activity is an appropriate clinical target for designing new small-molecule antidotes against BoNT with the potential to reverse the paralysis syndrome of botulism. In principle, small-molecule inhibitors (SMIs) can gain entry into BoNT-intoxicated cells if they have a suitable octanol-water partition coefficient (log P) value and other favorable characteristics (P. Leeson, Nature 481:455-456, 2012, https://doi.org/10.1038/481455a). Several efforts have been made in the past to develop SMIs, but inhibitors effective under in vitro conditions have not in general been effective in vivo or in cellular models (L. M. Eubanks, M. S. Hixon, W. Jin, S. Hong, et al., Proc Natl Acad Sci U S A 104:2602-2607, 2007, https://doi.org/10.1073/pnas.0611213104). The difference between the in vitro and cellular efficacy presumably results from difficulties experienced by the compounds in crossing the cell membrane, in conjunction with poor bioavailability and high cytotoxicity. The screened nitrophenyl psoralen (NPP) effectively antagonized BoNT/A in both in vitro and ex vivo assays. Importantly, NPP inhibited the BoNT/A light chain but not other general zinc endopeptidases, such as thermolysin, suggesting high selectivity for its target. Small-molecule (nonpeptidic) inhibitors have better oral bioavailability, better stability, and better tissue and cell permeation than antitoxins or peptide inhibitors.
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12
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Khouri JM, Payne JR, Arnon SS. More Clinical Mimics of Infant Botulism. J Pediatr 2018; 193:178-182. [PMID: 29229451 DOI: 10.1016/j.jpeds.2017.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/23/2017] [Accepted: 09/19/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To ascertain the actual diagnoses of 76 patients (2005-2015) whose clinical presentations so closely resembled infant botulism that the patients were treated with Human Botulism Immune Globulin Intravenous (BIG-IV; BabyBIG), but whose illnesses subsequently were not laboratory confirmed as infant botulism ("clinical mimics" of infant botulism). STUDY DESIGN The California Department of Public Health produces BIG-IV and distributes it nationwide as a public service (ie, not-for-profit) orphan drug to treat patients hospitalized with suspected infant botulism. During the study period, admission records and discharge summaries for all patients treated with BIG-IV but who lacked a laboratory-confirmed diagnosis of infant botulism were collected and abstracted. The patients' discharge diagnoses were identified, categorized, and compared with previously reported clinical mimics categories for 32 patients (1992-2005). RESULTS From 2005 to 2015, 76 clinical mimic illnesses were identified. These illnesses were distributed into the 5 categories previously reported of (1) probable infant botulism lacking confirmatory testing (26.3%); (2) spinal muscular atrophy (19.7%); (3) miscellaneous (15.8%); (4) metabolic disorders (11.8%); and (5) other infectious diseases (10.6%). Of the 76 clinical mimic illnesses, 15.8% had no alternate diagnosis established and were therefore categorized as undetermined. CONCLUSIONS Over the 23 years 1992-2015, patients presenting with illnesses so clinically similar to infant botulism that they were treated with BIG-IV had actual diagnoses that were distributed into 5 main categories. These categories and their individual components constitute a working bedside differential diagnosis of infant botulism.
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Affiliation(s)
- Jessica M Khouri
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratory Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA
| | - Jessica R Payne
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratory Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA
| | - Stephen S Arnon
- Infant Botulism Treatment and Prevention Program, Infectious Diseases Laboratory Branch, Division of Communicable Disease Control, Center for Infectious Diseases, California Department of Public Health, Richmond, CA.
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13
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Jackson L, Madan-Khetarpal S, Naik M, Michaels MG, Riley M. Infant Botulism in the Very Young Neonate: A Case Series. AJP Rep 2017; 7:e163-e166. [PMID: 28765793 PMCID: PMC5536996 DOI: 10.1055/s-0037-1604407] [Citation(s) in RCA: 2] [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: 04/24/2017] [Accepted: 06/14/2017] [Indexed: 11/01/2022] Open
Abstract
Background Though botulism is a rare disease overall, all infants younger than 1 year of age are at risk of contracting infant botulism, the most prevalent form reported in the United States. Nonetheless, infant botulism is frequently omitted from the differential diagnosis of the very young neonate exclusively due to age, and the diagnosis is often only considered secondarily after a costly and prolonged work up is undertaken. Delayed diagnosis can lead not only to unnecessary testing but also to prolonged hospital stay and increased morbidity. Case This case series highlights three critically ill neonates, all younger than 30 days, who presented to our neonatal intensive care unit and were eventually diagnosed with infant botulism. The initial diagnostic dilemma is described for each of these patients and highlights the importance of early recognition of the main symptoms, in addition to consideration of important potential coinciding conditions.
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Affiliation(s)
- Laura Jackson
- Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Suneeta Madan-Khetarpal
- Division of Medical Genetics, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Monica Naik
- Division of Neurology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Marian G Michaels
- Division of Infectious Disease, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Melissa Riley
- Division of Newborn Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
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14
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Torgeman A, Ozeri E, Ben David A, Diamant E, Rosen O, Schwartz A, Barnea A, Makovitzki A, Mimran A, Zichel R. Role of Homologous Fc Fragment in the Potency and Efficacy of Anti-Botulinum Antibody Preparations. Toxins (Basel) 2017; 9:toxins9060180. [PMID: 28555060 PMCID: PMC5488030 DOI: 10.3390/toxins9060180] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 05/24/2017] [Accepted: 05/27/2017] [Indexed: 12/12/2022] Open
Abstract
The only approved treatment for botulism relies on passive immunity which is mostly based on antibody preparations collected from hyper-immune horses. The IgG Fc fragment is commonly removed from these heterologous preparations to reduce the incidence of hyper-sensitivity reactions. New-generation therapies entering the pipeline are based on a combination of humanized monoclonal antibodies (MAbs), which exhibit improved safety and pharmacokinetics. In the current study, a systematic and quantitative approach was applied to measure the direct contribution of homologous Fc to the potency of monoclonal and polyclonal antitoxin preparations in mice. Homologous Fc increased the potency of three individual anti-botulinum toxin MAbs by up to one order of magnitude. Moreover, Fc fragment removal almost completely abolished the synergistic potency obtained from a combined preparation of these three MAbs. The MAb mixture neutralized a 400-mouse median lethal dose (MsLD50) of botulinum toxin, whereas the F(ab′)2 combination failed to neutralize 10 MsLD50 of botulinum toxin. Notably, increased avidity did not compensate for this phenomenon, as a polyclonal, hyper-immune, homologous preparation lost 90% of its potency as well upon Fc removal. Finally, the addition of homologous Fc arms to a heterologous pharmaceutical anti-botulinum toxin polyclonal horse F(ab′)2 preparation improved its efficacy when administered to intoxicated symptomatic mice. Our study extends the aspects by which switching from animal-based to human-based antitoxins will improve not only the safety but also the potency and efficacy of passive immunity against toxins.
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Affiliation(s)
- Amram Torgeman
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel.
| | - Eyal Ozeri
- 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.
| | - Eran Diamant
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel.
| | - Osnat Rosen
- 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.
| | - Ada Barnea
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel.
| | - Arik Makovitzki
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel.
| | - Avishai Mimran
- 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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Campbell AJ, Knight G, Walsh P, Bowen AC. Effective treatment of infant botulism on day 13 after symptom onset with human botulism antitoxin. J Paediatr Child Health 2017; 53:416-418. [PMID: 28306178 DOI: 10.1111/jpc.13496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/16/2016] [Accepted: 12/03/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Anita J Campbell
- Department of Infectious Diseases, Princess Margaret Hospital, Perth, Western Australia, Australia.,Pathwest Microbiology Department, QE11 Medical Centre, Perth, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Geoff Knight
- Department of Paediatric Intensive Care, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Peter Walsh
- Department of Neurology, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Asha C Bowen
- Department of Infectious Diseases, Princess Margaret Hospital, Perth, Western Australia, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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16
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Affiliation(s)
- Maria A Carrillo-Marquez
- Department of Pediatrics, Pediatric Infectious Diseases Division, University of Tennessee Health Science Center, Memphis, TN
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17
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Rosow LK, Strober JB. Infant botulism: review and clinical update. Pediatr Neurol 2015; 52:487-92. [PMID: 25882077 DOI: 10.1016/j.pediatrneurol.2015.01.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/10/2015] [Accepted: 01/13/2015] [Indexed: 12/24/2022]
Abstract
Botulism is a rare neuromuscular condition, and multiple clinical forms are recognized. Infant botulism was first identified in the 1970s, and it typically occurs in infants younger than 1 year of age who ingest Clostridium botulinum spores. A specific treatment for infant botulism, intravenous botulism immunoglobulin (BIG-IV or BabyBIG®), was developed in 2003, and this treatment has substantially decreased both morbidity and hospital costs associated with this illness. This article will review the pathogenesis of infant botulism as well as the epidemiology, clinical manifestations, diagnosis, and treatment of this condition.
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Affiliation(s)
- Laura K Rosow
- Department of Neurology, University of California San Francisco, San Francisco, California.
| | - Jonathan B Strober
- Department of Pediatric Neurology, University of California San Francisco, San Francisco, California
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18
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Cagan E, Peker E, Dogan M, Caksen H. Infant botulism. Eurasian J Med 2015; 42:92-4. [PMID: 25610131 DOI: 10.5152/eajm.2010.25] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 04/11/2010] [Indexed: 11/22/2022] Open
Abstract
Infant botulism is a rare condition caused by intestinal colonization with Clostridium botulinum. The enteric toxin causes intestinal immobility and progressive descending paralysis due to the effect on acetylcholine release at the neuromuscular junction and other cholinergic nerve terminals, particularly in the gut. Herein, we report an infant with infantile botulism because of rare clinically entity, with early diagnosis and appropriate treatment recover no squeal.
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Affiliation(s)
- Eren Cagan
- Yuzuncu Yil University, Medical Faculty, Department of Pediatrics, Van, Turkey
| | - Erdal Peker
- Yuzuncu Yil University, Medical Faculty, Department of Pediatrics, Van, Turkey
| | - Murat Dogan
- Yuzuncu Yil University, Medical Faculty, Department of Pediatrics, Van, Turkey
| | - Huseyin Caksen
- Yuzuncu Yil University, Medical Faculty, Department of Pediatrics, Van, Turkey
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19
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López-Laso E, Roncero-Sánchez-Cano I, Arce-Portillo E, Ley-Martos M, Aguirre-Rodríguez J, García-Ron A, Mora-Navarro D, Méndez-García M, Camino-León R. Infant botulism in Andalusia (Southern Spain). Eur J Paediatr Neurol 2014; 18:321-6. [PMID: 24468429 DOI: 10.1016/j.ejpn.2013.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 12/21/2013] [Accepted: 12/30/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Infant botulism (IB) is caused by the intestinal colonization by Clostridium botulinum in the first year of life and its subsequent production of neurotoxins. Traditionally, IB has been associated to honey consumption. IB cases tend to cluster in geographic regions. In Europe, IB is a rare disorder. From 1976 through 2006, 65 cases were identified in 13 European countries. In Spain, in the last 15 years, most of the cases have been reported in one region, Andalusia (Southern Spain). A specific treatment for IB type A and type B (BabyBIG) is available outside of the United States since 2005. METHODS and aims: We performed a retrospective review of IB cases detected in Andalusia since 1997 and compare them with the cases of IB reported in Europe. RESULTS We identified 11 confirmed cases of IB in Andalusia since 1997, and 14 cases in Spain. Nine out of 11 cases were detected since 2007; none of these infants had been exposed to honey consumption. One case in 1997 and another in 2000 were associated to honey. Two cases were treated with BabyBIG in 2007. In the period 2006-2012 the cases of IB reported in Europe were 54. CONCLUSIONS We identified a considerable increase in the incidence of IB since 2006. A tendency to a reduction in the number of cases of IB linked to honey consumption has also been identified. An increase in the exposure to these bacteria from the environment could be presumed. Clinicians should maintain a high index of suspicion for this treatable disorder.
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Affiliation(s)
- Eduardo López-Laso
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, Córdoba, Spain; Maimónides Institute for Biomedical Research of Córdoba, Córdoba, Spain.
| | | | - Elena Arce-Portillo
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Virgen del Rocío, Sevilla, Spain
| | - Myriam Ley-Martos
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Puerta del Mar, Cádiz, Spain
| | - Javier Aguirre-Rodríguez
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Torre Cárdenas, Almería, Spain
| | - Adrián García-Ron
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - David Mora-Navarro
- Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Mario Méndez-García
- Department of Neurophysiology, University Hospital Reina Sofía, Córdoba, Spain
| | - Rafael Camino-León
- Pediatric Neurology Unit, Department of Pediatrics, University Hospital Reina Sofía, Córdoba, Spain
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20
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Patel K, Cai S, Singh BR. Current strategies for designing antidotes against botulinum neurotoxins. Expert Opin Drug Discov 2014; 9:319-33. [DOI: 10.1517/17460441.2014.884066] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Kruti Patel
- University of Massachusetts Dartmouth, Department of Chemistry and Biochemistry, North Dartmouth, MA 02747, USA
| | - Shuowei Cai
- University of Massachusetts Dartmouth, Department of Chemistry and Biochemistry, North Dartmouth, MA 02747, USA
| | - Bal Ram Singh
- University of Massachusetts Dartmouth, Department of Chemistry and Biochemistry, North Dartmouth, MA 02747, USA
- Institute of Advanced Sciences and Prime Bio, Inc., Botulinum Research Center, 166 Chase Road, North Dartmouth, MA 02747, USA
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21
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Abstract
Infant botulism is caused by the ingestion of Clostridium botulinum spores and leads to a life-threatening descending motor weakness and flaccid paralysis in infant children. This disease presents with symptoms such as constipation, weakness, and hypotonia and can lead to respiratory failure. Botulism immune globulin (BIG) was created to treat this deadly disease and functions by neutralizing all systemically circulating botulism toxins. It is indicated in children with clinically diagnosed infant botulism, before diagnostic confirmation, and has been shown to lead to a significant reduction in intensive care unit and hospital stay for these patients. This review article discusses the epidemiology, clinical presentation, history of BIG, and indications for administration of BIG.
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22
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Zhang P, Ray R, Singh BR, Ray P. Mastoparan-7 rescues botulinum toxin-A poisoned neurons in a mouse spinal cord cell culture model. Toxicon 2013; 76:37-43. [DOI: 10.1016/j.toxicon.2013.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 08/29/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
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23
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Brown N, Desai S. Infantile botulism: a case report and review. J Emerg Med 2013; 45:842-5. [PMID: 23871478 DOI: 10.1016/j.jemermed.2013.05.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 12/11/2012] [Accepted: 05/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infantile botulism is the result of ingestion of Clostridium botulinum spores, and is the most common form of infection with botulism in the United States. Ninety percent of cases occur in infants <6 months old. The infants typically present with vague symptoms such as hypotonia and poor feeding. This article reports an infant with confirmed infantile botulism that presented to the Emergency Department (ED) with complaints of decreased feeding and absence of bowel movements for >1 week. OBJECTIVES Review a case of infantile botulism, its diagnosis, and treatment. CASE REPORT A 4-month-old healthy Caucasian male presented to the ED with a 6-day history of decreased feeding after referral from the pediatrician. He had not had a bowel movement for 9 days, and his parents were also concerned about increasing weakness, as he was no longer able to hold his head up on his own. In the ED, he was minimally interactive. His vital signs were within normal limits, and he had hypoactive bowel sounds and decreased tone throughout. He was admitted to the Children's Hospital and eventually transferred to the Pediatric Intensive Care Unit requiring intubation and mechanical ventilation. The botulism immunoglobulin was administered, and a diagnosis was confirmed with positive botulinum toxin in the stool samples. Full recovery was made by the infant. CONCLUSION Awareness of the symptoms of botulism and a high degree of clinical suspicion is needed to make a prompt diagnosis.
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Affiliation(s)
- Nicole Brown
- Department of Pediatrics, University of Louisville, Louisville, Kentucky
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24
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Schwartz KL, Austin JW, Science M. Constipation and poor feeding in an infant with botulism. CMAJ 2012; 184:1919-22. [PMID: 22988147 DOI: 10.1503/cmaj.120340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Kevin L Schwartz
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ont.
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25
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Formes graves de botulisme du nouveau-né et du nourrisson : trois observations récentes et algorithme de prise en charge. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-012-0464-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Langevin M, Zuijdwijk C, Alam M. Case 2: The clues were in the stools. Paediatr Child Health 2011; 16:333-5. [DOI: 10.1093/pch/16.6.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2010] [Indexed: 11/14/2022] Open
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27
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28
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May MLA, Corkeron MA, Stretton M. Infant botulism in Australia: availability of human botulinum antitoxin for treatment. Med J Aust 2010; 193:614-5. [DOI: 10.5694/j.1326-5377.2010.tb04073.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 08/18/2010] [Indexed: 11/17/2022]
Affiliation(s)
- Meryta L A May
- Paediatric Infection Management Service, Mater Children's Hospital, Brisbane, QLD
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29
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Iqbal SF, Agrawal D. The Floppy Little Baby. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2009. [DOI: 10.1016/j.cpem.2009.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Eberly MD, Uber I, Kieling CR, Birdsong RH. Infant Botulism and Raised Intraocular Pressure. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19873952 DOI: 10.3928/01913913-20091019-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2009] [Accepted: 06/12/2009] [Indexed: 11/20/2022]
Abstract
Infant botulism is an exceedingly rare disease. Because confirmatory laboratory testing is not available for several days after time of presentation, infant botulism remains a clinical diagnosis. The authors demonstrate how raised intraocular pressure may provide an additional clinical clue to making the diagnosis.
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31
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O'Reilly EB, Montenegro B, Arnold J, Tomita S. Infant botulism mimicking Hirschprung's disease. J Pediatr Surg 2009; 44:e5-7. [PMID: 19853738 DOI: 10.1016/j.jpedsurg.2009.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Revised: 06/13/2009] [Accepted: 06/15/2009] [Indexed: 11/26/2022]
Abstract
We report a case of infant botulism presenting as primary colonic ileus--mimicking Hirschprung's megacolon. Infant botulism should be considered in any infant with constipation and neurologic abnormalities.
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Affiliation(s)
- Eamon B O'Reilly
- Division of Pediatric Surgery, Department of General Surgery, Naval Medical Center San Diego, CA 92134-1005, USA
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32
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Abstract
Hypotonia is characterized by reduced resistance to passive range of motion in joints versus weakness, which is a reduction in the maximum muscle power that can be generated. (Dubowitz, 1985; Crawford, 1992; Martin, 2005) Based on strong research evidence, central hypotonia accounts for 60% to 80% of cases of hypotonia, whereas peripheral hypotonia is the cause in about 15% to 30% of cases. Disorders causing hypotonia often are associated with a depressed level of consciousness, predominantly axial weakness, normal strength accompanying the hypotonia, and hyperactive or normal reflexes. (Martin, 2005; Igarashi, 2004; Richer, 2001; Miller, 1992; Crawford, 1992; Bergen, 1985; Dubowitz, 1985) Based on some research evidence, 50% of patients who have hypotonia are diagnosed by history and physical examination alone. (Paro-Panjan, 2004) Based on some research evidence, an appropriate medical and genetic evaluation of hypotonia in infants includes a karyotype, DNA-based diagnostic tests, and cranial imaging. (Battaglia, 2008; Laugel, 2008; Birdi, 2005; Paro-Panjan, 2004; Prasad, 2003; Richer, 2001; Dimario, 1989) Based on strong research evidence, infant botulism should be suspected in an acute or subacute presentation of hypotonia in an infant younger than 6 months of age who has signs and symptoms such as constipation, listlessness, poor feeding, weak cry, and a decreased gag reflex. (Francisco, 2007; Muensterer, 2000)
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33
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Infantile Botulism: Clinical Manifestations, Treatment, and the Role of the Nurse Practitioner. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Infant botulism is a cause for significant pediatric morbidity in the United States, though early recognition and supportive care can greatly improve clinical outcomes. Since the approval of human botulism immune globulin by the United States Food and Drug Administration (FDA) for the treatment of infant botulism in 2003, the importance of prompt initiation of therapy has been emphasized, with clinical suspicion remaining the mainstay of diagnosis. In this report, 2 cases of infant botulism are described. Each presented to the Pediatric Neurology service at our institution in Upstate New York in the spring and summer months of 2007 and were felt to be related to markedly dusty environmental conditions and the probable ingestion of C. botulinum organisms present in soil. Following this, a comprehensive review of the literature regarding infant botulism in the United States is presented, wherein the pathophysiology, clinical features, epidemiology, and treatment are discussed.
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Affiliation(s)
- Rose M Domingo
- Department of Neurology, Albany Medical Center Hospital, Albany, New York 12208, USA.
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35
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Fathalla WM, Mohammed KA, Ahmed E. Infant botulism type Ba: first culture-confirmed case in the United Arab Emirates. Pediatr Neurol 2008; 39:204-6. [PMID: 18725068 DOI: 10.1016/j.pediatrneurol.2008.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 05/08/2008] [Accepted: 05/14/2008] [Indexed: 11/15/2022]
Abstract
We report on a 3-month-old girl with culture-confirmed infant botulism caused by a rare double toxin-producing Clostridium botulinum type Ba. This case was not related to honey-feeding. The clinical course was prolonged, with minimal spontaneous improvement at onset, and a period of fluctuating motor weakness and nasogastric feeding dependence afterward. Neurophysiologic studies produced normal results. Human botulism immune globulin was administered empirically on day 23 of presentation, with rapid full recovery. This case highlights the importance of pursuing diagnoses of infant botulism despite normal results of neurophysiologic testing and no history of honey-feeding. Our case also demonstrates a favorable response to human botulism immune globulin, despite the relatively late treatment.
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Affiliation(s)
- Waseem M Fathalla
- Division of Child Neurology, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
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36
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López Laso E, Pérez Navero J, Rumbao Aguirre J, Mateos González M, Méndez García M, Cárdenas Aranzana M, Ibarra de la Rosa I. Botulismo del lactante. An Pediatr (Barc) 2008; 68:499-502. [DOI: 10.1157/13120050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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37
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Kostrzewa RM, Segura-Aguilar J. Botulinum neurotoxin: evolution from poison, to research tool--onto medicinal therapeutic and future pharmaceutical panacea. Neurotox Res 2008; 12:275-90. [PMID: 18201955 DOI: 10.1007/bf03033911] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Botulinum neurotoxin (BoNT), for more than a hundred years, has been a recognized poisonous principle in spoiled food. As its chemical structure became unraveled, and as more knowledge was gained over its mechanism of toxicity, it became clear that BoNT had the potential to act therapeutically as a targeted toxin that could inactivate specific nerve populations, and thus achieve a therapeutic goal. BoNT has evolved over the past 25 years into a viable therapeutic, now being a first line treatment for dystonia, overtly altering the course of progression of this disorder. BoNT is used for hyperhidrosis and gustatory sweating syndrome, alleviation of pain, as a treatment for overactive bladder, achalasia and anal fissure; and it has gained popularity as a cosmetic aid. Many other possible uses are being explored. The greatest potential for BoNT may lie in its being a molecular Trojan Horse - able to carry a specific enzyme or specific drug to the inside of a cancer or other type of cell while bypassing other cells and thereby having little or no ill effect. BoNT's pharmaceutical potential is boundless.
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Affiliation(s)
- Richard M Kostrzewa
- Department of Pharmacology, Quillen College of Medicine, East Tennessee State University, Johnson City, TN 37614, USA.
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38
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Affiliation(s)
- Eric A Johnson
- Department of Bacteriology, Food Research Institute, University of Wisconsin, Madison, WI, USA.
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39
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Abstract
Admissions from January 1, 1985, to December 31, 2005, with the diagnosis of infant botulism were reviewed to describe the clinical presentation, course, outcome, and changes related to the availability of botulism immune globulin treatment. Botulism diagnoses were confirmed by the finding of toxin or Clostridium botulinum organisms in stool samples (type A, 14; type B, 25; type not noted, 5). Twenty-four patients were admitted from 1985-1994 and 20 from 1995-2004. Infants in the two decades were similar in age, demographics, and presenting features. Ventilator support was needed in 13 of 24 (54%) in 1985-1994 and in 15 of 20 (75%) in 1995-2005; 43 required nasogastric feeding. Seventeen patients were treated with botulism immune globulin. Length of stay was shorter in infants treated with botulism immune globulin (13.5 vs 23 days, P = .009), with a trend toward reduced need for nasogastric feeding and in shorter duration of tracheal intubation. All patients recovered fully. Even with the availability of botulism immune globulin, meticulous supportive care remained essential for recovery.
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Affiliation(s)
- Linda Tseng-Ong
- Neurology Division, Childrens Hospital Los Angeles, California 90027, USA
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40
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Underwood K, Rubin S, Deakers T, Newth C. Infant botulism: a 30-year experience spanning the introduction of botulism immune globulin intravenous in the intensive care unit at Childrens Hospital Los Angeles. Pediatrics 2007; 120:e1380-5. [PMID: 18055655 DOI: 10.1542/peds.2006-3276] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To report a tertiary care hospital's 30-year experience with the diagnosis, treatment, and outcome of infant botulism in the PICU before and after the availability of Botulism Immune Globulin Intravenous. METHODS This was a retrospective medical chart review of the 67 patients who had received a diagnosis of infant botulism and were admitted to the ICU from 1976 to 2005. The ages on presentation, length of hospital stay, length of ICU stay, length of mechanical ventilation, and type of botulism toxin were recorded and compared for patients who had received Botulism Immune Globulin Intravenous and those who had not. On the basis of our results, conclusions were drawn regarding the effect of Botulism Immune Globulin Intravenous on the morbidity of infant botulism. RESULTS Sixty-seven patients' charts were reviewed; 23 male and 29 female patients did not receive Botulism Immune Globulin Intravenous. Of patients who did not receive Botulism Immune Globulin Intravenous, the median age at presentation was 71 days, median length of hospital stay was 35 days, ICU stay was 24 days, and duration of mechanical ventilation was 17 days. A total of 40% had type A toxin, and 60% had type B toxin. There was a significant difference between patients with toxin types A and B in length of hospital stay but not length of ICU stay or mechanical ventilation. Patients with type A toxin were significantly older than patients with type B toxin. Fifteen children received Botulism Immune Globulin Intravenous. There were statistically significant differences in length of hospital stay, length of ICU stay, and length of mechanical ventilation between patients who received Botulism Immune Globulin Intravenous and those who did not. CONCLUSIONS The use of Botulism Immune Globulin Intravenous significantly decreased the length of ICU stay, length of mechanical ventilation, and overall hospital stay in children with infant botulism.
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Affiliation(s)
- Karen Underwood
- Division of Critical Care, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California 90027, USA
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41
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Cárdenas Aranzana M, Isla Tejera B, Gil Navarro M, López Laso E. Botulismo infantil tratado con inmunoglobulina botulínica humana. FARMACIA HOSPITALARIA 2007; 31:384-5. [DOI: 10.1016/s1130-6343(07)75414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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