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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; 24:320-325. [PMID: 38290842 DOI: 10.1136/pn-2023-004036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [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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2
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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 2017; 66:S43-S56. [PMID: 29293927 PMCID: PMC5850555 DOI: 10.1093/cid/cix815] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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3
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Pathogens of Food Animals: Sources, Characteristics, Human Risk, and Methods of Detection. ADVANCES IN FOOD AND NUTRITION RESEARCH 2017; 82:277-365. [PMID: 28427535 DOI: 10.1016/bs.afnr.2016.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Pathogens associated with food production (livestock) animals come in many forms causing a multitude of disease for humans. For the purpose of this review, these infectious agents can be divided into three broad categories: those that are associated with bacterial disease, those that are associated with viruses, and those that are parasitic in nature. The goal of this chapter is to provide the reader with an overview of the most common pathogens that cause disease in humans through exposure via the food chain and the consequence of this exposure as well as risk and detection methods. We have also included a collection of unusual pathogens that although rare have still caused disease, and their recognition is warranted in light of emerging and reemerging diseases. These provide the reader an understanding of where the next big outbreak could occur. The influence of the global economy, the movement of people, and food makes understanding production animal-associated disease paramount to being able to address new diseases as they arise.
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4
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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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5
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Potulska-Chromik A, Zakrzewska-Pniewska B, Szmidt-Sałkowska E, Lewandowski J, Siński M, Przyjałkowski W, Kostera-Pruszczyk A. Long lasting dysautonomia due to botulinum toxin B poisoning: clinical-laboratory follow up and difficulties in initial diagnosis. BMC Res Notes 2013; 6:438. [PMID: 24172031 PMCID: PMC3816205 DOI: 10.1186/1756-0500-6-438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 10/03/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Botulism is an acute form of poisoning caused by one of four types (A, B, E, F) toxins produced by Clostridium botulinum, ananaerobic, spore forming bacillus. Usually diagnosis of botulism is considered in patients with predominant motor symptoms: muscle weakness with intact sensation and preserved mental function. CASE PRESENTATION We report a case of 56-year-old Caucasian female with a history of arterial hypertension, who presented with acute respiratory failure and bilateral ptosis misdiagnosed as brainstem ischemia. She had severe external and internal ophtalmoplegia, and autonomic dysfunction with neither motor nor sensory symptoms from upper and lower limbs. Diagnosis of botulinum toxin poisoning was made and confirmed by serum antibody testing in the mouse inoculation test. CONCLUSIONS Ophtalmoplegia, autonomic dysfunction and respiratory failure can be caused by botulism. Early treatment and intensive care is essential for survival and recovery. The electrophysiological tests are crucial to correct and rapid diagnosis. Botulism (especially type B) should be considered in any case of acute or predominant isolated autonomic dysfunction.
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Affiliation(s)
- Anna Potulska-Chromik
- Department of Neurology, Medical University of Warsaw, Banacha 1a Street, 02-097 Warsaw, Poland.
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Peck MW, Stringer SC, Carter AT. Clostridium botulinum in the post-genomic era. Food Microbiol 2010; 28:183-91. [PMID: 21315972 DOI: 10.1016/j.fm.2010.03.005] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 03/11/2010] [Accepted: 03/12/2010] [Indexed: 01/11/2023]
Abstract
Foodborne botulism is a severe neuroparalytic disease caused by consumption of botulinum neurotoxin formed by strains of proteolytic Clostridium botulinum and non-proteolytic C. botulinum during their growth in food. The botulinum neurotoxin is the most potent substance known, with as little as 30-100 ng potentially fatal, and consumption of just a few milligrams of neurotoxin-containing food is likely to be sufficient to cause illness and potentially death. In order to minimise the foodborne botulism hazard, it is necessary to extend understanding of the biology of these bacteria. This process has been recently advanced by genome sequencing and subsequent analysis. In addition to neurotoxin formation, endospore formation is also critical to the success of proteolytic C. botulinum and non-proteolytic C. botulinum as foodborne pathogens. The endospores are highly resistant, and enable survival of adverse treatments such as heating. To better control the botulinum neurotoxin-forming clostridia, it is important to understand spore resistance mechanisms, and the physiological processes involved in germination and lag phase during recovery from this dormant state.
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Affiliation(s)
- Michael W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, NR4 7UA, UK.
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7
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Affiliation(s)
- Michael W Peck
- Institute of Food Research, Norwich Research Park, Colney, Norwich, UK
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8
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Tseng CK, Tsai CH, Tseng CH, Tseng YC, Lee FY, Huang WS. An outbreak of foodborne botulism in Taiwan. Int J Hyg Environ Health 2009; 212:82-6. [DOI: 10.1016/j.ijheh.2008.01.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Revised: 01/02/2008] [Accepted: 01/23/2008] [Indexed: 11/25/2022]
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9
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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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10
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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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11
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Han SZ, Alfano MC, Psoter WJ, Rekow ED. Bioterrorism and catastrophe response: a quick-reference guide to resources. J Am Dent Assoc 2003; 134:745-52. [PMID: 12839411 DOI: 10.14219/jada.archive.2003.0261] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dentists' responses to catastrophe have been redefined by bioterrorism. Informed response requires accurate information about agents and diseases that have the potential to be used as weapons. METHODS The authors reviewed information about the most probable bioterrorist weapons (those from the Center for Disease Control and Prevention's Category A) from the World Wide Web and print journals and distilled it into a resource list that is current, relevant to dentistry and noncommercial. The Web sites cited include those sponsored by federal agencies, academic institutions and professional organizations. The articles cited include those published in English within the last six years in refereed journals that are available in most higher education institutions. RESULTS The authors present the information in a table that provides a quick-reference guide to resources describing agents and diseases with the greatest potential for use as weapons: anthrax, botulism, plague, smallpox, tularemia and viral hemorrhagic fevers. This article presents Web site and journal citations for background and patient-oriented information (fact sheets), signs and symptoms, and prophylactic measures and treatment for each of the agents and diseases. The table facilitates quick access to this information, especially in an emergency. This article also points out guidelines for response should a suspected attack occur. CONCLUSIONS Armed with information about biological weapons, dentists can provide faster diagnosis, inform their patients about risks, prophylaxis or treatment and rethink their own role in terrorism response. CLINICAL IMPLICATIONS Fast, accurate diagnosis limits the spread of exceptionally contagious diseases. Providing accurate information to patients minimizes misinformation and the associated public fear and panic that, unchecked, could overwhelm health care systems.
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Affiliation(s)
- Susan Z Han
- Harvard School of Dental Medicine, Boston, USA
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12
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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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