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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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Peck MW, Webb MD, Goodburn KE. Assessment of the risk of botulism from chilled, vacuum/modified atmosphere packed fresh beef, lamb and pork held at 3 °C-8 °C. Food Microbiol 2020; 91:103544. [PMID: 32539958 DOI: 10.1016/j.fm.2020.103544] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 04/12/2020] [Accepted: 05/03/2020] [Indexed: 02/06/2023]
Abstract
The safety of current UK industry practice (including shelf-life) for chilled, vacuum/modified atmosphere-packed fresh red meat (beef, lamb and pork) held at 3°C-8°C has been evaluated with respect to non-proteolytic Clostridium botulinum. UK industry typically applies a retail pack shelf-life at 3°C-8°C to 13 days for fresh red meat, with a maximum of 23 days for beef, 27 days for lamb, and 18 days for pork. An exposure assessment established that current commercial practice for fresh red meat provided strong protection with more than 1010 person servings marketed in the UK without association with foodborne botulism. A challenge test demonstrated that spores of non-proteolytic C. botulinum inoculated on chilled vacuum-packed fresh red meat did not lead to detectable neurotoxin at day 50 for beef, day 35 for lamb, or day 25 for pork (i.e. <40 pg type B toxin and type E toxin g-1 of meat). The products were visually spoiled many days before these end points. The exposure assessment and challenge test demonstrated the safety of current UK industry practices for the shelf-life of fresh, vacuum-packed beef, lamb and pork held at 3°C-8°C with respect to C. botulinum, and that botulinum neurotoxin was not detected within their organoleptic shelf-life.
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Affiliation(s)
- Michael W Peck
- QIB Extra, Quadram Institute, Norwich Research Park, Norwich, NR4 7UQ, UK.
| | - Martin D Webb
- QIB Extra, Quadram Institute, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Karin E Goodburn
- Chilled Food Associates, C/o 3 Weekley Wood Close, Kettering, NN14 1UQ, UK
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O'Horo JC, Harper EP, El Rafei A, Ali R, DeSimone DC, Sakusic A, Abu Saleh OM, Marcelin JR, Tan EM, Rao AK, Sobel J, Tosh PK. Efficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016. Clin Infect Dis 2019; 66:S43-S56. [PMID: 29293927 DOI: 10.1093/cid/cix815] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Botulism is a rare, potentially severe illness, often fatal if not appropriately treated. Data on treatment are sparse. We systematically evaluated the literature on botulinum antitoxin and other treatments. Methods We conducted a systematic literature review of published articles in PubMed via Medline, Web of Science, Embase, Ovid, and Cumulative Index to Nursing and Allied Health Literature, and included all studies that reported on the clinical course and treatment for foodborne botulism. Articles were reviewed by 2 independent reviewers and independently abstracted for treatment type and toxin exposure. We conducted a meta-analysis on the effect of timing of antitoxin administration, antitoxin type, and toxin exposure type. Results We identified 235 articles that met the inclusion criteria, published between 1923 and 2016. Study quality was variable. Few (27%) case series reported sufficient data for inclusion in meta-analysis. Reduced mortality was associated with any antitoxin treatment (odds ratio [OR], 0.16; 95% confidence interval [CI], .09-.30) and antitoxin treatment within 48 hours of illness onset (OR, 0.12; 95% CI, .03-.41). Data did not allow assessment of critical care impact, including ventilator support, on survival. Therapeutic agents other than antitoxin offered no clear benefit. Patient characteristics did not predict poor outcomes. We did not identify an interval beyond which antitoxin was not beneficial. Conclusions Published studies on botulism treatment are relatively sparse and of low quality. Timely administration of antitoxin reduces mortality; despite appropriate treatment with antitoxin, some patients suffer respiratory failure. Prompt antitoxin administration and meticulous intensive care are essential for optimal outcome.
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Affiliation(s)
- John C O'Horo
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota.,Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine Group, Mayo Clinic, Rochester, Minnesota.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Abdelghani El Rafei
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Rashid Ali
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine Group, Mayo Clinic, Rochester, Minnesota.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Daniel C DeSimone
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Amra Sakusic
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine Group, Mayo Clinic, Rochester, Minnesota.,Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota
| | - Omar M Abu Saleh
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Jasmine R Marcelin
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eugene M Tan
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Agam K Rao
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases (DFWED), Atlanta, Georgia
| | - Jeremy Sobel
- DFWED, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pritish K Tosh
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
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Scalfaro C, Auricchio B, De Medici D, Anniballi F. Foodborne botulism: an evolving public health challenge. Infect Dis (Lond) 2018; 51:97-101. [DOI: 10.1080/23744235.2018.1524584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Concetta Scalfaro
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Bruna Auricchio
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Dario De Medici
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fabrizio Anniballi
- Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, Rome, Italy
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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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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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Juliao PC, Maslanka S, Dykes J, Gaul L, Bagdure S, Granzow-Kibiger L, Salehi E, Zink D, Neligan RP, Barton-Behravesh C, Lúquez C, Biggerstaff M, Lynch M, Olson C, Williams I, Barzilay EJ. National outbreak of type a foodborne botulism associated with a widely distributed commercially canned hot dog chili sauce. Clin Infect Dis 2012; 56:376-82. [PMID: 23097586 DOI: 10.1093/cid/cis901] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND On 7 and 11 July 2007, health officials in Texas and Indiana, respectively, reported 4 possible cases of type A foodborne botulism to the US Centers for Disease Control and Prevention. Foodborne botulism is a rare and sometimes fatal illness caused by consuming foods containing botulinum neurotoxin. METHODS Investigators reviewed patients' medical charts and food histories. Clinical specimens and food samples were tested for botulinum toxin and neurotoxin-producing Clostridium species. Investigators conducted inspections of the cannery that produced the implicated product. RESULTS Eight confirmed outbreak associated cases were identified from Indiana (n = 2), Texas (n = 3), and Ohio (n = 3). Botulinum toxin type A was identified in leftover chili sauce consumed by the Indiana patients and 1 of the Ohio patients. Cannery inspectors found violations of federal canned-food regulations that could have led to survival of Clostridium botulinum spores during sterilization. The company recalled 39 million cans of chili. Following the outbreak, the US Food and Drug Administration inspected other canneries with similar canning systems and issued warnings to the industry about the danger of C. botulinum and the importance of compliance with canned food manufacturing regulations. CONCLUSIONS Commercially produced hot dog chili sauce caused these cases of type A botulism. This is the first US foodborne botulism outbreak involving a commercial cannery in >30 years. Sharing of epidemiologic and laboratory findings allowed for the rapid identification of implicated food items and swift removal of potentially deadly products from the market by US food regulatory authorities.
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Affiliation(s)
- Patricia C Juliao
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Wright AP, Gould LH, Mahon B, Sotir MJ, Tauxe RV. Overview of the impact of epidemic-assistance investigations of foodborne and other enteric disease outbreaks, 1946-2005. Am J Epidemiol 2011; 174:S23-35. [PMID: 22135391 DOI: 10.1093/aje/kwr308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Epidemic-assistance investigations (Epi-Aids) in response to outbreaks of foodborne and other enteric pathogens have identified novel pathogens, clinical syndromes, and sequelae; described new reservoirs and vehicles of transmission; evaluated existing prevention strategies; and identified deficiencies in the food safety systems on local, national, and international levels. Since the first Epi-Aid was issued in 1946, approximately 23% (1,023 of 4,484 for which investigations were initiated) of all Epi-Aids have been related to foodborne or other enteric diseases. Epi-Aid results have yielded valuable insights into the epidemiology of these pathogens and have molded prevention strategies for detecting, responding to, and preventing future outbreaks. New challenges, brought about in part by centralization and globalization of the food supply, will continue to emerge. The need for Epi-Aids of such outbreaks undoubtedly will persist as an integral part of future public health response efforts, prevention strategies, and training programs.
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Affiliation(s)
- Ashton P Wright
- Atlanta Research and Education Foundation, 723 Cramer Avenue, Lexington, KY 40502, USA.
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Witoonpanich R, Vichayanrat E, Tantisiriwit K, Wongtanate M, Sucharitchan N, Oranrigsupak P, Chuesuwan A, Nakarawat W, Tima A, Suwatcharangkoon S, Ingsathit A, Rattanasiri S, Wananukul W. Survival analysis for respiratory failure in patients with food-borne botulism. Clin Toxicol (Phila) 2010; 48:177-83. [DOI: 10.3109/15563651003596113] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Affiliation(s)
- Michael W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK
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Lundin JI, Dargatz DA, Wagner BA, Lombard JE, Hill AE, Ladely SR, Fedorka-Cray PJ. Antimicrobial Drug Resistance of Fecal Escherichia coli and Salmonella spp. Isolates from United States Dairy Cows. Foodborne Pathog Dis 2008; 5:7-19. [DOI: 10.1089/fpd.2007.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jessica I. Lundin
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - David A. Dargatz
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Bruce A. Wagner
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Jason E. Lombard
- Centers for Epidemiology and Animal Health, Animal and Plant Health Inspection Service, United States Department of Agriculture, Fort Collins, Colorado
| | - Ashley E. Hill
- Animal Population Health Institute, Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Scott R. Ladely
- Bacterial Epidemiology and Antimicrobial Resistance Unit, Agriculture Research Service, United States Department of Agriculture, Athens, Georgia
| | - Paula J. Fedorka-Cray
- Bacterial Epidemiology and Antimicrobial Resistance Unit, Agriculture Research Service, United States Department of Agriculture, Athens, Georgia
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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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Abstract
Foodborne botulism is caused by consumption of preformed botulinum neurotoxin, with as little as 30 ng of neurotoxin being potentially lethal. Consumption of minute quantities of neurotoxin-containing food can result in botulism. In view of the severity of foodborne botulism, it is essential that new foods be developed safely without an increase in incidence of this disease. Minimally heated, chilled foods are a relatively new type of food, sales of which are currently increasing by about 10% per annum. These products meet consumer demand for high-quality foods that require little preparation time. Their safety and quality depends on mild heat treatment, chilled storage, restricted shelf life and sometimes on intrinsic properties of the foods. The principal microbiological hazard is nonproteolytic Clostridium botulinum, and there is a concern that this may become an emerging issue. A considerable amount of research and development over the last 15 years has underpinned the safe production of commercial, minimally heated, chilled foods with respect to foodborne botulism, and it is essential that safe food continues to be developed. In particular, the desire to use lighter heat processes and a longer shelf life presents a challenge that will only be met by significant developments in quantitative microbiological food safety.
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Affiliation(s)
- M W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK.
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Villar RG, Elliott SP, Davenport KM. Botulism: the many faces of botulinum toxin and its potential for bioterrorism. Infect Dis Clin North Am 2006; 20:313-27, ix. [PMID: 16762741 DOI: 10.1016/j.idc.2006.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rodrigo G Villar
- Department of Pediatrics and Steele Children's Research Center, University of Arizona Health Sciences Center, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
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Nafissi S, Pourmand R. Current concepts in botulism: clinical and electrophysiological aspects. J Clin Neuromuscul Dis 2003; 4:139-149. [PMID: 19078706 DOI: 10.1097/00131402-200303000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Shahriar Nafissi
- Salt Lake City, UT From the *Department of Neurology, Tehran University of Medical Sciences, Tehran; and the daggerDepartment of Neurology, State University of New York, Stony Brook, New York
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Abstract
OBJECTIVE To provide a concise review of the presentation and treatment of botulism. DATA SOURCES Searches of MEDLINE (1966-November 2001), tertiary references, and public and government Internet sites were conducted. STUDY SELECTION All articles and additional references from those articles were thoroughly evaluated. DATA SYNTHESIS Clostridium botulinum toxin blocks acetylcholine release in a dose-dependent fashion, resulting in acute symmetric diplopia, dysarthria, dysphonia, dysphagia, and possible neurologic sequelae despite the route of exposure (i.e., food-borne, wound, intestinal, inhalation). Disease secondary to genetically engineered C. botulinum may differ from that of inadvertent exposure. Present treatment is primarily supportive care, respiratory support, rapid decontamination, and antitoxin administration (i.e., trivalent, pentavalent, heptavalent antitoxin). Early initiation of antitoxin limits the extent of paralysis, but does not reverse it. CONCLUSIONS Supportive care and the use of antitoxin have been effective in the treatment of botulism from food-borne, intestinal, and wound exposure. However, the effectiveness of antitoxin in the treatment of inhaled C. botulinum has not been proven.
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Affiliation(s)
- Renee F Robinson
- Pediatric Pharmacotherapy, College of Pharmacy, Ohio State University, Columbus, OH 43210-1291, USA
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Caya JG. Clostridium botulinum and the ophthalmologist: a review of botulism, including biological warfare ramifications of botulinum toxin. Surv Ophthalmol 2001; 46:25-34. [PMID: 11525787 DOI: 10.1016/s0039-6257(01)00227-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The anaerobic bacterium Clostridium botulinum causes disease by elaborating an extremely potent neurotoxin that inhibits release of acetylcholine at presynaptic nerve endings, thereby resulting in a descending flaccid paralysis and autonomic nervous system dysfunction. Possible ophthalmological effects of this neurotoxin are many and typically constitute the earliest manifestations of botulism. This review summarizes the medical literature on botulism with regard to historical perspective, epidemiology, clinical manifestations, and treatment. Ophthalmological findings of botulism are tabulated and their frequencies are provided. Finally, the bioterrorism/biologic warfare ramifications of botulinum toxin are briefly discussed.
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Affiliation(s)
- J G Caya
- Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital, Madison, WI 53792, USA
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Böni R, Kreyden OP, Burg G. Revival of the use of botulinum toxin: application in dermatology. Dermatology 2000; 200:287-91. [PMID: 10894957 DOI: 10.1159/000018389] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Botulinum toxins (BTXs) comprise a family of neurotoxins designated as types A-G, which are produced by the anerobic bacterium Clostridium botulinum. BTX-A blocks the cholinergic transmission resulting in flaccid paralysis and autonomous nerve dysfunction. It has become a powerful therapeutic tool in a variety of conditions over the last decades. Primarily used in the treatment of strabismus, blepharospasm and hemifacial spasms, BTX has only recently been recognized in dermatology. The use of BTX in dermatology includes the treatment of focal hyperhidrosis, hyperfunctional facial lines as well as paralysis of the anal sphincter in the therapy of anal fissures. The mechanism of action is described and the current literature is reviewed.
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Affiliation(s)
- R Böni
- Department of Dermatology, University Hospital, Zürich, Switzerland
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