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Eser F, Hasanoğlu İ, Kayaaslan B, Kaya Kalem A, Bilen Ş, Orhan G, Güner R. Iatrogenic botulism cases after gastric and axillary application of botulinum toxin and review of literature. J Infect Dev Ctries 2024; 18:480-487. [PMID: 38635607 DOI: 10.3855/jidc.18868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/02/2023] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION Iatrogenic botulism is a rare, serious disease that progresses with descending paralysis and develops after cosmetic or therapeutic botulinum toxin-A (BoNT-A) application. CASE PRESENTATIONS In this case series; six cases of iatrogenic botulism followed up in our center are presented. Four of these developed after gastric BoNT-A and two after axillary BoNT-A application. RESULTS The most important cause for the disease was the use of unlicensed products and high-dose toxin applications. The first symptoms were blurred vision, double vision, difficulty in swallowing, and hoarseness. Symptoms appeared within 4-10 days after the application of BoNT-A. Symptoms progressed in the course of descending paralysis in the following days with fatigue, weakness in extremities and respiratory distress. Diagnosis was based on patient history and clinical findings. The main principles of foodborne botulism therapy were applied in the treatment of iatrogenic botulism. If clinical worsening continued, regardless of the time elapsed after BoNT-A application, the use of botulinum antitoxin made a significant contribution to clinical improvement and was recommended. CONCLUSIONS Routine and new indications for BoNT-A usage are increasing and, as a result, cases of iatrogenic botulism will be encountered more frequently. Physicians should be alert for iatrogenic botulism in the follow-up after BoNT-A applications and in the differential diagnosis of neurological diseases that are presented with similar findings.
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Affiliation(s)
- Fatma Eser
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - İmran Hasanoğlu
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Bircan Kayaaslan
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
| | - Şule Bilen
- University of Health Sciences, Ankara City Hospital, Department of Neurology, Ankara, Turkey
| | - Gürdal Orhan
- University of Health Sciences, Ankara City Hospital, Department of Neurology, Ankara, Turkey
| | - Rahmet Güner
- Ankara Yildirim Beyazit University, Ankara City Hospital, Department of Infectious Disease and Clinical Microbiology, Ankara, Turkey
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Uzal FA, Henderson E, Asin J. Botulism in fish: a review. J Vet Diagn Invest 2024:10406387241236725. [PMID: 38465871 DOI: 10.1177/10406387241236725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
Published information about fish botulism is scant. We review here the current literature on fish botulism. Freshwater fish are susceptible to botulism. Only anecdotal evidence exists about possible botulism cases in saltwater fish. With only a few exceptions, the etiology of all cases of fish botulism reported is Clostridium botulinum type E, although fish are sensitive to, and may carry, various C. botulinum types. Clinical signs of botulism in fish include loss of equilibrium and motion, abducted opercula, open mouths, dark pigmentation, and head up/tail down orientation in which attempts to swim result in breaching the surface of the water. Dark pigmentation is thought to be associated with acetylcholine imbalance in botulinum neurotoxin (BoNT)-affected fish. Rarely, but similar to the situation in other animal species, fish can recover from botulism. Fish botulism can cause secondary outbreaks of the disease in birds, as botulism-affected fish stand out from normal fish, and are selectively preyed upon by fish-eating birds, which thus become intoxicated by the BoNT present in sick fish. The source of BoNT in fish has not been definitively confirmed. Fish may ingest C. botulinum spores that then germinate in their digestive tract, but the possibility that fish ingest preformed BoNT from the environment (e.g., dead fish, shellfish, insects) cannot be ruled out. The presumptive diagnosis of botulism in fish is established based on clinical signs, and as in other species, confirmation should be based on detection of BoNT in intestinal content, liver, and/or serum of affected fish.
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Affiliation(s)
- Francisco A Uzal
- California Animal Health and Food Safety Laboratory System-San Bernardino Branch, School of Veterinary Medicine, University of California-Davis, CA, USA
| | - Eileen Henderson
- California Animal Health and Food Safety Laboratory System-San Bernardino Branch, School of Veterinary Medicine, University of California-Davis, CA, USA
| | - Javier Asin
- California Animal Health and Food Safety Laboratory System-San Bernardino Branch, School of Veterinary Medicine, University of California-Davis, CA, USA
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Karcioglu O, Akman C, Atnis I. Efficacy and Safety Analysis of Botox Application and Iatrogenic Botulism: Panacea or Peril? Curr Pharm Des 2024; 30:CPD-EPUB-138682. [PMID: 38409723 DOI: 10.2174/0113816128284720240212111926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/24/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024]
Abstract
Clostridium botulinum toxin-A (BoNT-A) creates temporary paralysis in the muscles by acting on the muscle-nerve junction. It is injected into the mimic muscles when a decrease in the movements of the mimic muscles is desired. Despite many favorable applications, the use of BoNT-A is not without drawbacks. Although there is no expected serious side effect on health in BoNT-A treatments, various problems can be encountered in patients treated for aesthetic purposes. Botulism is a rare but potentially life-threatening syndrome, which is caused by the toxin produced by the bacterium Clostridium botulinum, which acts on the nervous system, vegetative forms of C. botulinum can only survive in anaerobic conditions, while spore forms are common in nature and can withstand harsh conditions. Botulism can stem from bacterial spores which release toxin in the body; in the form of enteric botulism, and wound botulism. The cases that develop 'iatrogenic botulism' after such procedures are usually those receiving high-dose toxin for therapeutic purposes. The treatment of botulism mainly consists of anti-toxin therapy and, if necessary, intensive care to prevent organ failures, including respiratory support. This article aims to cover all these issues related to botulism and other adverse outcomes related to BoNT-A injection in light of the most recent literature.
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Affiliation(s)
- Ozgur Karcioglu
- Department of Emergency Medicine, Taksim Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Canan Akman
- Department of Emergency Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Ilknur Atnis
- Department of Emergency Medicine, Niğde Omer Halisdemir Education and Research Hospital, University of Health Sciences, Nigde, Turkey
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McGorum BC, Davey T, Dosi MCM, Keen JA, Morrison LR, Pirie RS, Shaw DJ, Harris JB. Equine grass sickness is associated with major abnormalities in the ultrastructure of skeletal neuromuscular junctions. Equine Vet J 2024. [PMID: 38301732 DOI: 10.1111/evj.14063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 01/04/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Equine grass sickness (EGS) is a frequently fatal multisystem neuropathy of equids. The aetiology is unknown; proposed causes include toxicoinfection with Clostridium botulinum and a mycotoxicosis. The effect of EGS on the organisation and structural integrity of the skeletal neuromuscular junction (NMJ), the target of botulinum neurotoxins (BoNTs), is unknown. OBJECTIVES To compare the organisation and structural integrity of skeletal NMJs from EGS horses, control horses and one horse with a presumptive diagnosis of botulism. STUDY DESIGN Blinded, retrospective case control. METHODS NMJs in samples of diaphragm or intercostal muscle from six EGS horses, three control horses and one equine botulism case were compared using electron microscopy, morphometry and confocal light microscopy. RESULTS A significantly higher percentage of EGS NMJs had abnormal morphology (EGS 72.2%, 95% CI 55.6-84.4; Controls 6.9%, 1.7-23.8; OR 35.1, 8.47-244.8; p < 0.001). EGS NMJs had a significantly lower mean volume fraction occupied by synaptic vesicles (SVs) (EGS 18.7%, 12.6-28.0; Controls 36.3%, 20.8-63.4; p = 0.024). EGS NMJs had evidence of accelerated SV exocytosis and SV depletion, accumulation of neurofilament-like material in terminal boutons and/or bouton degeneration. NMJs from the botulism horse had dense packing of SVs towards the presynaptic membrane active zone, consistent with BoNT intoxication, but had absence of the abnormalities identified in EGS NMJs. MAIN LIMITATIONS Group sizes were limited by difficulties obtaining suitably processed samples. Ages of control and EGS horses differed. Botulism was diagnosed based on clinical and post mortem findings. CONCLUSIONS EGS is associated with major changes in skeletal NMJ ultrastructure that are inconsistent with the effects of BoNTs. SV depletion may reflect increased exocytosis coupled with reduced repopulation of SVs via anterograde axonal transport and endocytosis, consistent with the action of an excitatory presynaptic toxin and/or neurotransmitter reuptake inhibitor. Skeletal NMJs represent a previously unrecognised target for the toxin that causes EGS.
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Affiliation(s)
- Bruce C McGorum
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - Tracey Davey
- Electron Microscopy Research Services, Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
| | - Miranda C M Dosi
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - John A Keen
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - Linda R Morrison
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - R Scott Pirie
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - Darren J Shaw
- Royal (Dick) School of Veterinary Studies and The Roslin Institute, University of Edinburgh, Roslin, UK
| | - John B Harris
- Medical Toxicology Centre and Institute of Neuroscience, Newcastle University, Faculty of Medical Sciences, Newcastle upon Tyne, UK
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Richardson J, Viviano S. From Beauty to Botulism: A Case Report Highlighting the Rare Risk of Botox Administration. Cureus 2024; 16:e54090. [PMID: 38487143 PMCID: PMC10937334 DOI: 10.7759/cureus.54090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
Botox (onabotulinumtoxinA) is a pharmaceutical approved by the Food and Drug Administration (FDA) for use in both cosmetic and therapeutic applications. Despite its increasing use worldwide, Botox carries a rare but potentially life-threatening risk of iatrogenic botulism. This condition, although treatable with antitoxin if promptly recognized, presents a diagnostic challenge to healthcare providers due to its rarity, lack of awareness, and diverse clinical presentations. Here, we present a case of iatrogenic botulism from Botox injections administered in Istanbul, Turkey, in a healthy 47-year-old female. Prompt administration of antitoxin led to remarkable clinical improvement. This case underscores the importance of vigilance among healthcare providers in recognizing and promptly treating iatrogenic botulism, particularly in patients with recent Botox use. Given that the majority of reported cases of iatrogenic botulism occur outside the United States, this case raises concerns about the need for stricter regulations and oversight of Botox administration worldwide.
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Affiliation(s)
- Jordan Richardson
- Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, USA
| | - Shannon Viviano
- Emergency Medicine, Corewell Health Beaumont Troy Hospital, Troy, USA
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Gao L, Jin R. NTNH protein: more than a bodyguard for botulinum neurotoxins. FEBS J 2024; 291:672-675. [PMID: 38009421 PMCID: PMC10922118 DOI: 10.1111/febs.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
As one of the most fatal substances, botulinum neurotoxins (BoNTs) have never acted solo to accomplish their formidable missions. Most notably, nontoxic nonhemagglutinin (NTNH), a protein co-secreted with BoNT by bacteria, plays critical roles to stabilize and protect BoNT by tightly associating with it to form the minimal progenitor toxin complex (M-PTC). A new cryo-EM structure of the M-PTC of a BoNT-like toxin from Weissella oryzae (BoNT/Wo) reveals similar assembly modes between M-PTC/Wo and that of other BoNTs, yet also reveals some unique structural features of NTNH/Wo. These findings shed new light on the potential versatile roles of NTNH during BoNT intoxication.
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Affiliation(s)
- Linfeng Gao
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697, USA
| | - Rongsheng Jin
- Department of Physiology and Biophysics, University of California, Irvine, Irvine, CA 92697, USA
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Harris RA, Flint A, Blondin Brosseau M, Weedmark K, Austin JW. Complete genomes of Clostridium botulinum type B(F) isolates associated with a 1995 foodborne botulism outbreak from commercial pâté reveals a recombination event disrupting the ntnh gene. Microb Genom 2024; 10:001169. [PMID: 38175697 PMCID: PMC10868621 DOI: 10.1099/mgen.0.001169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
Foodborne botulism is a neuroparalytic disease caused by ingestion of foods contaminated with botulinum neurotoxin (BoNT), produced by Clostridium botulinum. In 1995 a husband and wife from Québec, Canada, were hospitalized for several months with prolonged muscle paralysis after ingesting a commercial pâté de campagne. Examination of faecal samples from both patients and the pâté produced viable Group I (proteolytic) C. botulinum type B from each of the three samples. Whole genome sequencing revealed that all three isolates contain identical bont/B5 and bont/F2 genes encoded on a plasmid. Both faecal isolate genomes were identical in chromosome and plasmid length, as well as gene content. The genome of the pâté isolate was nearly identical to that of the faecal isolates with the notable difference of a missing 13-gene insertion on the bont/B5 cluster disrupting the ntnh gene. Examination of the insertion revealed several mobile genetic elements that participate in recombination.
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Affiliation(s)
| | - Annika Flint
- Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada
| | | | - Kelly Weedmark
- Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada
| | - John W. Austin
- Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada
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Silva Campos JJ, Abels E, Rinder HM, Tormey CA, Jacobs JW. Botulism mimicking Guillain-Barre syndrome: The question of plasma exchange in an unusual case of acute paralysis. J Clin Apher 2023; 38:760-763. [PMID: 37519071 DOI: 10.1002/jca.22081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/01/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy and the most common cause of acute flaccid paralysis worldwide. GBS classically presents with acute, progressive, ascending weakness, reduced to absent reflexes, and albuminocytological dissociation on cerebrospinal fluid (CSF) analysis. Botulism is a neurotoxin-mediated acute descending flaccid paralysis with cranial nerve palsies and dysautonomia. Botulism in adults is caused by ingestion/inhalation of botulinum toxin or wound infection with Clostridium botulinum. Both GBS and botulism can rapidly precipitate respiratory failure; thus, prompt diagnosis and treatment are crucial to mitigate poor outcomes. Herein, we describe a case of botulism initially diagnosed as GBS given classic laboratory features, and describe the importance of careful consideration of the most appropriate therapeutic modalities in cases of acute flaccid paralysis, particularly regarding empiric administration of botulinum antitoxin and use of intravenous immune globulin in lieu of plasma exchange for potential GBS to prevent removal of antitoxin.
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Affiliation(s)
- Juan J Silva Campos
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth Abels
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Henry M Rinder
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Internal Medicine (Hematology), Yale School of Medicine, New Haven, Connecticut, USA
| | - Christopher A Tormey
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Jeremy W Jacobs
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, Connecticut, USA
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Abstract
Clostridium botulinum, a polyphyletic Gram-positive taxon of bacteria, is classified purely by their ability to produce botulinum neurotoxin (BoNT). BoNT is the primary virulence factor and the causative agent of botulism. A potentially fatal disease, botulism is classically characterized by a symmetrical descending flaccid paralysis, which is left untreated can lead to respiratory failure and death. Botulism cases are classified into three main forms dependent on the nature of intoxication; foodborne, wound and infant. The BoNT, regarded as the most potent biological substance known, is a zinc metalloprotease that specifically cleaves SNARE proteins at neuromuscular junctions, preventing exocytosis of neurotransmitters, leading to muscle paralysis. The BoNT is now used to treat numerous medical conditions caused by overactive or spastic muscles and is extensively used in the cosmetic industry due to its high specificity and the exceedingly small doses needed to exert long-lasting pharmacological effects. Additionally, the ability to form endospores is critical to the pathogenicity of the bacteria. Disease transmission is often facilitated via the metabolically dormant spores that are highly resistant to environment stresses, allowing persistence in the environment in unfavourable conditions. Infant and wound botulism infections are initiated upon germination of the spores into neurotoxin producing vegetative cells, whereas foodborne botulism is attributed to ingestion of preformed BoNT. C. botulinum is a saprophytic bacterium, thought to have evolved its potent neurotoxin to establish a source of nutrients by killing its host.
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Affiliation(s)
- Alexander M Rawson
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Andrew W Dempster
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
| | - Christopher M Humphreys
- Clostridia Research Group, BBSRC/EPSRC Synthetic Biology Research Centre (SBRC), School of Life Sciences, The Biodiscovery Institute, The University of Nottingham, Nottingham, UK
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Hennen C, Demir S, Dafsari HS, Wunderlich G, Böll B, Hüser C, Barbe MT, Fink GR, Rueger MA. Botulism after intragastric botulinum toxin injections for weight reduction. Eur J Neurol 2023; 30:3979-3981. [PMID: 37584071 DOI: 10.1111/ene.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
Although-considering the risk-benefit ratio-botulinum neurotoxin A (BoNT/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT/A had not yet been reported, prompting some European countries to endorse its (off-label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT/A injections. These cases demonstrate the risks of BoNT/A injections if they are not applied within the limits of evidence-based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.
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Affiliation(s)
- Christina Hennen
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Seda Demir
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Hüser
- Department of Internal Medicine II, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
| | - Maria Adele Rueger
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
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Bamumin A, Bamumin S, Ahmadini HA, Alhindi Y, Alsanosi S, Alqashqari H, Esheb G, Ayoub N, Falemban A. Knowledge, attitude and practice among mothers on the relationship between honey and botulism in Saudi Arabian infants: a cross-section study. Ann Med 2023; 55:2279746. [PMID: 37943711 PMCID: PMC10653683 DOI: 10.1080/07853890.2023.2279746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Botulism is a rare disease, and infant botulism (IB) even rarer, especially when steering the condition to honey consumption. IB is considered a life-threatening disease as it leads to severe neurological symptoms. Exploring the knowledge, attitude, and practice (KAP) among mothers on the relationship between honey and IB will help public health professionals implement appropriate maternal health education materials targeting infant health and increase the awareness of the paediatric primary care providers, physicians, and nurse practitioners about the risk of IB among their patients. OBJECTIVES To determine the knowledge of mothers from Hail city in Saudi Arabia (SA) regarding IB and assess their attitude and practice towards feeding honey to their infants before 12 months of age. METHODS Using a comparative cross-sectional study, in February 2022, we broadcasted an online questionnaire through social networking and evaluated the KAP of 385 mothers. RESULTS Less than half (48%) of the mothers have heard about IB, 40% of them knew the relation between honey ingestion and IB and only 6.5% acknowledged that they knew the causative agent for IB. The prevalence of feeding honey to infants before 12 months was 52%. Mothers from Hail city were less likely to provide honey to their infants (p = 0.002). CONCLUSION The study revealed that mothers from Hail city have relatively low knowledge of IB and that they hold favourable perceptions of using honey as a food supplement and feeding honey to their infants before 12 months. Considering the high prevalence of honey feeding with the known low incidence of IB in SA, Medical professionals should consider IB in their differential diagnosis particularly in the presence of neurological symptoms.
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Affiliation(s)
- Asma Bamumin
- King Salman Specialist Hospital, Hail, Saudi Arabia
| | | | | | - Yosra Alhindi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Safaa Alsanosi
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hamsah Alqashqari
- Department of Community Medicine, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ghada Esheb
- Department of Pathology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Nahla Ayoub
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Alaa Falemban
- Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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Meurice L, Filleul L, Fischer A, Burbaud A, Delvallez G, Diancourt L, Belichon S, Clouzeau B, Malvy D, Oliva-Labadie M, Bragança C, Wilking H, Franca R, Martin G, Godbole G, Tourdjman M, Jourdan-Da Silva N. Foodborne botulism outbreak involving different nationalities during the Rugby World Cup: critical role of credit card data and rapid international cooperation, France, September 2023. Euro Surveill 2023; 28:2300624. [PMID: 37997664 PMCID: PMC10668258 DOI: 10.2807/1560-7917.es.2023.28.47.2300624] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/23/2023] [Indexed: 11/25/2023] Open
Abstract
In September 2023, a severe outbreak of type B botulism with fifteen cases was linked to consumption of canned sardines at a restaurant in Bordeaux, France, during the Rugby World Cup. The cases were from seven countries. One death was recorded. Outbreak investigation using credit card data, rapid communication between health authorities of the affected countries and broad media communication allowed identification of cases and exposed persons and prevented further severe outcomes.
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Affiliation(s)
- Laure Meurice
- Santé publique France, Regional office in Nouvelle-Aquitaine, Bordeaux, France
| | - Laurent Filleul
- Santé publique France, Regional office in Nouvelle-Aquitaine, Bordeaux, France
| | - Aurélie Fischer
- Regional health agency Nouvelle-Aquitaine (ARS Nouvelle-Aquitaine), Bordeaux, France
| | - Annie Burbaud
- Regional health agency Nouvelle-Aquitaine (ARS Nouvelle-Aquitaine), Bordeaux, France
| | - Gauthier Delvallez
- National Reference Center for Anaerobic Bacteria and Botulism, Institut Pasteur, Université Paris Cité, Paris, France
| | - Laure Diancourt
- National Reference Center for Anaerobic Bacteria and Botulism, Institut Pasteur, Université Paris Cité, Paris, France
| | | | | | | | | | - Coralie Bragança
- Poison control center, Bordeaux Hospital Center, Bordeaux, France
| | - Hendrik Wilking
- Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
| | - Rafaela Franca
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Greg Martin
- Health Service Executive - Health Protection Surveillance Centre, Dublin, Ireland
| | - Gauri Godbole
- United Kingdom Health Security Agency, Gastrointestinal Pathogens and Food Safety (One Health) Division, London, United Kingdom
| | - Mathieu Tourdjman
- Santé publique France, Department of Infectious Disease, Saint-Maurice, France
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13
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Kılboz BB, Ervatan Z, Dumlu R, Akan O. Iatrogenic systemic botulism after intragastric botulinum neurotoxin injection: Case report. Eur J Neurol 2023; 30:3394-3396. [PMID: 37505930 DOI: 10.1111/ene.16005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND AND PURPOSE The recent off-label use of botulinum neurotoxin (BoNT) for intragastric obesity treatment has led to 67 cases of systemic botulism in Türkiye, Germany, Austria and Switzerland. This case report highlights the potential risks and adverse effects associated with this treatment. CASE REPORT A 36-year-old female presented to the emergency room with shortness of breath, fatigue, difficulty in eating and holding her head, constipation and double vision after receiving intragastric BoNT injection for obesity treatment. She had bilateral orbicularis oculi weakness, facial diplegia, weak tongue, masseter, neck and extremity muscles. Electromyography showed a presynaptic type neuromuscular junction disorder. The patient was admitted to the intensive care unit and administered botulinum heptavalent equine-derived antitoxin, but the medication had to be stopped due to a reaction. The patient was started on pyridostigmine for symptomatic treatment and was transferred to an inpatient clinic after minimal improvement. She was discharged after 7 days of follow-up. CONCLUSION Clinicians should be cautious of the potential risks of intragastric BoNT injection for obesity treatment and consider systemic botulism as a potential adverse effect. Antitoxin treatment should be considered in clinically progressing patients despite negative botulinum toxin testing.
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Affiliation(s)
- Bekir Burak Kılboz
- Department of Neurology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Zekeriya Ervatan
- Department of Anesthesiology and Reanimation, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Rıdvan Dumlu
- Department of Infectious Diseases, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
| | - Onur Akan
- Department of Neurology, Prof. Dr. Cemil Tascioglu City Hospital, University of Health Sciences, Istanbul, Turkey
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14
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Valdezate S, Carrasco G, Medina MJ, Garrido N, del Pino S, Valiente M, Pallarés MP, Villalon P. Exploring the genetic background of the botulism neurotoxin BoNT/B2 in Spain. Microbiol Spectr 2023; 11:e0238023. [PMID: 37750689 PMCID: PMC10581064 DOI: 10.1128/spectrum.02380-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/13/2023] [Indexed: 09/27/2023] Open
Abstract
To determine whether the neurotoxin BoNT/B2 causing botulism in Spain is clonal, the genetic diversity and phylogenetic relationships of Clostridium botulinum from food-borne episodes and infant cases of the condition were explored. The botulinum toxin gene (bont) subtype, the variable region of the flagellin gene (flaVR), and a seven-gene multi-locus sequence type were examined by sequencing 37 BoNT-positive cultures obtained over the period 2010 to 2022. Out of 37 botulism events, 16 food-borne episodes and 16 infant cases were associated with bont/b2. Eight bont/b2 alleles were detected [nucleotide distance range 0.0259-0.415%, Hunter and Gaston discrimination index (HGDI) 0.71]. The most common bont/b2 allele corresponded to that of strain Prevot 25 NCASE and its single and double locus variations (87.5%). Four known flaVR types were identified (HGDI 0.79), along with one previously unknown (flaVR-15). Sixteen sequence types (STs) (HGDI 0.89) were recorded including seven new STs (ST164-ST170; 10 new alleles) and five new STs (ST171-ST175; with new allele combinations) were also noted. Correlations among some STs and flaVR types were seen. Overall, the present results show that the combined analysis of bont/b2-flaVR-ST at the nucleotide level could be used to track botulism events in Spain. The neurotoxin BoNT/B2 has largely been responsible for human botulism in Spain. The polymorphism analysis of bont/b2, flaVR typing, and sequence type determinations, revealed a wide variety of clones to be responsible for human botulism, ruling out a common source of acquisition. IMPORTANCE Botulism, a potentially fatal disease, is classically characterized by a symmetrical descending flaccid paralysis, which if left untreated can lead to respiratory failure and death. Botulinum neurotoxin (BoNT), produced by certain species of Clostridium, is the most potent biological toxin known, and the direct cause of botulism. This study characterizes the acquisition in Spain of two forms of botulism, i.e., food-borne and infant botulism, which are largely caused by the main neurotoxin BoNT/B2. Polymorphism analysis of the bont/b2 gene, typing of the flagellin variable region sequence (flaVR), and multilocus sequence typing, were used to explore the genetic background of Clostridium botulinum group I. To our knowledge, this is the first phylogenetic and typing study of botulism undertaken in Spain.
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Affiliation(s)
- Sylvia Valdezate
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Gema Carrasco
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María J. Medina
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Noelia Garrido
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Silvia del Pino
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Monica Valiente
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María P. Pallarés
- Veterinary Unit, Animal Department, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Pilar Villalon
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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15
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Harmsen MM, Cornelissen JC, van der Wal FJ, Bergervoet JHW, Koene M. Single-Domain Antibody Multimers for Detection of Botulinum Neurotoxin Serotypes C, D, and Their Mosaics in Endopep-MS. Toxins (Basel) 2023; 15:573. [PMID: 37755999 PMCID: PMC10535107 DOI: 10.3390/toxins15090573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
Botulinum neurotoxins (BoNTs) are highly toxic proteins that require high-affinity immunocapture reagents for use in endopeptidase-based assays. Here, 30 novel and 2 earlier published llama single-domain antibodies (VHHs) against the veterinary-relevant BoNT serotypes C and D were yeast-produced. These VHHs recognized 10 independent antigenic sites, and many cross-reacted with the BoNT/DC and CD mosaic variants. As VHHs are highly suitable for genetically linking to increase antigen-binding affinity, 52 VHH multimers were produced and their affinity for BoNT/C, D, DC, and CD was determined. A selection of 15 multimers with high affinity (KD < 0.1 nM) was further shown to be resilient to a high salt wash that is used for samples from complex matrices and bound native BoNTs from culture supernatants as shown by Endopep-MS. High-affinity multimers suitable for further development of a highly sensitive Endopep-MS assay include four multimers that bind both BoNT/D and CD with KD of 14-99 pM, one multimer for BoNT/DC (65 pM) that also binds BoNT/C (75 pM), and seven multimers for BoNT/C (<1-19 pM), six of which also bind BoNT/DC with lower affinity (93-508 pM). In addition to application in diagnostic tests, these VHHs could be used for the development of novel therapeutics for animals or humans.
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Affiliation(s)
- Michiel M. Harmsen
- Wageningen Bioveterinary Research, Wageningen University & Research, 8221 RA Lelystad, The Netherlands (F.J.v.d.W.)
| | - Jan C. Cornelissen
- Wageningen Bioveterinary Research, Wageningen University & Research, 8221 RA Lelystad, The Netherlands (F.J.v.d.W.)
| | - Fimme J. van der Wal
- Wageningen Bioveterinary Research, Wageningen University & Research, 8221 RA Lelystad, The Netherlands (F.J.v.d.W.)
| | - Jan H. W. Bergervoet
- Wageningen Plant Research, Wageningen University & Research, 6708 PB Wageningen, The Netherlands
| | - Miriam Koene
- Wageningen Bioveterinary Research, Wageningen University & Research, 8221 RA Lelystad, The Netherlands (F.J.v.d.W.)
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16
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Mbhele Z, Thwala L, Khoza T, Ramagoma F. Evaluation of Aluminium Hydroxide Nanoparticles as an Efficient Adjuvant to Potentiate the Immune Response against Clostridium botulinum Serotypes C and D Toxoid Vaccines. Vaccines (Basel) 2023; 11:1473. [PMID: 37766149 PMCID: PMC10535070 DOI: 10.3390/vaccines11091473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/26/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Clostridium botulinum serotypes C and D cause botulism in livestock, a neuroparalytic disease that results in substantial economic losses. Vaccination with aluminium-based toxoid vaccines is widely used to control the spread of botulism. Aluminium-based adjuvants are preferred owing to their apparent stimulation of the immune responses to toxoid vaccines when compared to other adjuvants. The aim of our study was to evaluate aluminium hydroxide nanoparticles as a potential substitute for alhydrogel in the botulism bivalent vaccine. Botulism vaccines were formulated with either alhydrogel or nanoalum and comparative efficacy between the two formulations was conducted by evaluating the immune response in vaccinated guinea pigs. A significant increase in immunological parameters was observed, with the antibody titres higher in the serum of guinea pigs (20 IU/mL of anti-BoNT C/D) injected with nanoalum-containing vaccine than guinea pigs inoculated with the standard alhydrogel-containing vaccine (8.7 IU/mL and 10 IU/mL of anti-BoNT C and anti-BoNT D, respectively). Additionally, the nanoalum-containing vaccine demonstrated potency in a multivalent vaccine (20 IU/mL of anti-BoNT C/D), while the standard alhydrogel-containing vaccine showed a decline in anti-BoNT C (5 IU/mL) antibody titres.
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Affiliation(s)
- Ziphezinhle Mbhele
- Onderstepoort Biological Products, 100 Old Soutpan Road, Onderstepoort, Pretoria 0110, South Africa; (Z.M.); (L.T.)
- Discipline of Biochemistry, School of Life Sciences, University of KwaZulu Natal, Pietermaritzburg Campus, Private Bag X01, Scottsville 3209, South Africa;
| | - Lungile Thwala
- Onderstepoort Biological Products, 100 Old Soutpan Road, Onderstepoort, Pretoria 0110, South Africa; (Z.M.); (L.T.)
- Council for Scientific and Industrial Research, National Laser Centre, Pretoria 0001, South Africa
| | - Thandeka Khoza
- Discipline of Biochemistry, School of Life Sciences, University of KwaZulu Natal, Pietermaritzburg Campus, Private Bag X01, Scottsville 3209, South Africa;
| | - Faranani Ramagoma
- Onderstepoort Biological Products, 100 Old Soutpan Road, Onderstepoort, Pretoria 0110, South Africa; (Z.M.); (L.T.)
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17
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Gupta S, Pellett S. Recent Developments in Vaccine Design: From Live Vaccines to Recombinant Toxin Vaccines. Toxins (Basel) 2023; 15:563. [PMID: 37755989 PMCID: PMC10536331 DOI: 10.3390/toxins15090563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Vaccines are one of the most effective strategies to prevent pathogen-induced illness in humans. The earliest vaccines were based on live inoculations with low doses of live or related pathogens, which carried a relatively high risk of developing the disease they were meant to prevent. The introduction of attenuated and killed pathogens as vaccines dramatically reduced these risks; however, attenuated live vaccines still carry a risk of reversion to a pathogenic strain capable of causing disease. This risk is completely eliminated with recombinant protein or subunit vaccines, which are atoxic and non-infectious. However, these vaccines require adjuvants and often significant optimization to induce robust T-cell responses and long-lasting immune memory. Some pathogens produce protein toxins that cause or contribute to disease. To protect against the effects of such toxins, chemically inactivated toxoid vaccines have been found to be effective. Toxoid vaccines are successfully used today at a global scale to protect against tetanus and diphtheria. Recent developments for toxoid vaccines are investigating the possibilities of utilizing recombinant protein toxins mutated to eliminate biologic activity instead of chemically inactivated toxins. Finally, one of the most contemporary approaches toward vaccine design utilizes messenger RNA (mRNA) as a vaccine candidate. This approach was used globally to protect against coronavirus disease during the COVID-19 pandemic that began in 2019, due to its advantages of quick production and scale-up, and effectiveness in eliciting a neutralizing antibody response. Nonetheless, mRNA vaccines require specialized storage and transport conditions, posing challenges for low- and middle-income countries. Among multiple available technologies for vaccine design and formulation, which technology is most appropriate? This review focuses on the considerable developments that have been made in utilizing diverse vaccine technologies with a focus on vaccines targeting bacterial toxins. We describe how advancements in vaccine technology, combined with a deeper understanding of pathogen-host interactions, offer exciting and promising avenues for the development of new and improved vaccines.
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Affiliation(s)
| | - Sabine Pellett
- Department of Bacteriology, University of Wisconsin-Madison, Madison, WI 53706, USA;
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18
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Abstract
During 2006-2021, Canada had 55 laboratory-confirmed outbreaks of foodborne botulism, involving 67 cases. The mean annual incidence was 0.01 case/100,000 population. Foodborne botulism in Indigenous communities accounted for 46% of all cases, which is down from 85% of all cases during 1990-2005. Among all cases, 52% were caused by botulinum neurotoxin type E, but types A (24%), B (16%), F (3%), and AB (1%) also occurred; 3% were caused by undetermined serotypes. Four outbreaks resulted from commercial products, including a 2006 international outbreak caused by carrot juice. Hospital data indicated that 78% of patients were transferred to special care units and 70% required mechanical ventilation; 7 deaths were reported. Botulinum neurotoxin type A was associated with much longer hospital stays and more time spent in special care than types B or E. Foodborne botulism often is misdiagnosed. Increased clinician awareness can improve diagnosis, which can aid epidemiologic investigations and patient treatment.
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19
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Turin L, Piccione MM, Crosa F, Dall'Ara P, Filipe J, Zarucco L. Therapeutic Applications of Botulinum Neurotoxins in Veterinary Medicine. Vet Sci 2023; 10:460. [PMID: 37505863 PMCID: PMC10386576 DOI: 10.3390/vetsci10070460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
Botulinum neurotoxins (BoNTs) are emerging as multipurpose therapeutic compounds for the treatment of several different syndromes involving peripheral and central nervous systems, and muscular and musculoskeletal disorders both in human and veterinary medicine. Therefore, the study of BoNTs is rapidly developing and identifying newly produced BoNT variants. Efforts should be made to clarify the biological and pharmacological characteristics of these novel BoNTs as well as the natural ones. The high potential of BoNTs as a therapeutic compound for medical syndromes lies in its ability to reach a specific cell type while bypassing other cells, thus having mild or no side effects. In this paper the recent developments in BoNTs are reviewed with the aim of analyzing the current knowledge on BoNTs' biological mechanisms of action, immunogenicity, formulations, and therapeutic applications in the veterinary field, highlighting advantages and drawbacks and identifying the gaps to be filled in order to address research priorities.
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Affiliation(s)
- Lauretta Turin
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Marina Michela Piccione
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Fabio Crosa
- Department of Veterinary Sciences (DSV), University of Turin, Largo Paolo Braccini 2, 10095 Grugliasco, TO, Italy
| | - Paola Dall'Ara
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Joel Filipe
- Department of Veterinary Medicine and Animal Sciences (DIVAS), University of Milan, Via dell'Università 6, 26900 Lodi, LO, Italy
| | - Laura Zarucco
- Department of Veterinary Sciences (DSV), University of Turin, Largo Paolo Braccini 2, 10095 Grugliasco, TO, Italy
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20
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Affiliation(s)
- Fabrizio Anniballi
- Istituto Superiore di Sanità, Department of Food Safety, Nutrition and Veterinary Public Health, National Reference Centre for Botulism, Rome, Italy
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21
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Miyashita SI, Karatsu S, Fujiishi M, Huang IH, Nagashima Y, Morobishi T, Hosoya K, Hata T, Dong M, Sagane Y. Characterization of Serotype CD Mosaic Botulinum Neurotoxin in Comparison with Serotype C and A. Toxins (Basel) 2023; 15:123. [PMID: 36828437 PMCID: PMC9962336 DOI: 10.3390/toxins15020123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Botulinum neurotoxin (BoNT), produced by Clostridium botulinum, cleaves proteins involved in neurotransmitter release, thereby triggering flaccid paralyses, which are responsible for botulism. BoNT is classified into seven serotypes (BoNT/A-G); BoNT/A and BoNT/B are used as medical therapeutics and anti-wrinkle reagents. In this study, we investigated the efficacy of BoNT/CD, a mosaic toxin of BoNT/C and BoNT/D, to assess its potential as a therapeutic alternative for BoNT/A. In a cultured neuron assay, BoNT/CD cleaved syntaxin and SNAP-25 with higher efficacy than BoNT/C and BoNT/A. Intramuscularly administrated BoNT/CD induced dose-dependent muscle paralysis, and the paralysis lasted ~21 days in a mouse digit abduction score assay (BoNT/A-induced paralysis lasted ~30 days). BoNT/C failed to induce local paralysis without systemic toxicity. Multiple alignment analyses of the amino acid sequences of the receptor binding domain (HC) of eight BoNT/CDs and two BoNT/Ds showed sequence clustering in five groups. Comparing BoNT/CD strain 003-9 (BoNT/CD003-9) and strain 6813 (BoNT/CD6813) showed that both BoNT/CDs displayed similar efficacies in cultured neurons, but BoNT/CD003-9 displayed higher efficacy in a mouse model than BoNT/CD6813. These findings suggest that BoNT/CD may be a potential alternative for patients who do not respond to existing BoNT-based therapeutics.
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Affiliation(s)
- Shin-Ichiro Miyashita
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Shura Karatsu
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Mako Fujiishi
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - I Hsun Huang
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Yuki Nagashima
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Tamaki Morobishi
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Keita Hosoya
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Tsuyoshi Hata
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
| | - Min Dong
- Department of Urology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Microbiology, Harvard Medical School, Boston, MA 02115, USA
- Department of Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Yoshimasa Sagane
- Department of Food, Aroma and Cosmetic Chemistry, Faculty of Bioindustry, Tokyo University of Agriculture, Abashiri 099-2493, Hokkaido, Japan
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22
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Meurens F, Carlin F, Federighi M, Filippitzi ME, Fournier M, Fravalo P, Ganière JP, Grisot L, Guillier L, Hilaire D, Kooh P, Le Bouquin-Leneveu S, Le Maréchal C, Mazuet C, Morvan H, Petit K, Vaillancourt JP, Woudstra C. Clostridium botulinum type C, D, C/D, and D/C: An update. Front Microbiol 2023; 13:1099184. [PMID: 36687640 PMCID: PMC9849819 DOI: 10.3389/fmicb.2022.1099184] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
Clostridium botulinum is the main causative agent of botulism, a neurological disease encountered in humans as well as animals. Nine types of botulinum neurotoxins (BoNTs) have been described so far. Amongst these "toxinotypes," the A, the B and E are the most frequently encountered in humans while the C, D, C/D and D/C are mostly affecting domestic and wild birds as well as cattle. In France for instance, many cases and outbreaks are reported in these animal species every year. However, underestimation is very likely at least for avifauna species where the detection of dead animals can be challenging. Knowledge about BoNTs C, D, C/D, and D/C and the diseases they cause in animals and humans is still scarce and unclear. Specifically, the potential role of animal botulism outbreaks in cattle and poultry as a source of human illness needs to be further assessed. In this narrative review, we present the current knowledge about toxinotypes C, D, C/D, and D/C in cattle and poultry with, amongst various other aspects, their epidemiological cycles. We also discuss the zoonotic potential of these toxinotypes and some possible ways of risk mitigation. An adapted and effective management of botulism outbreaks in livestock also requires a better understanding of these less common and known toxinotypes.
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Affiliation(s)
- François Meurens
- INRAE, Oniris, BIOEPAR, Nantes, France,Department of Veterinary Microbiology and Immunology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada,*Correspondence: François Meurens,
| | | | | | - Maria-Eleni Filippitzi
- Laboratory of Animal Health Economics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthieu Fournier
- Univ Rouen Normandie, Univ Caen Normandie, CNRS, M2C, UMR 6143, Rouen, France
| | - Philippe Fravalo
- Chaire Agroalimentaire du Cnam, Conservatoire des Arts et Métiers, EPN7, Ploufragan, France
| | | | | | | | | | - Pauline Kooh
- Risk Assessment Department, ANSES, Maisons-Alfort, France
| | - Sophie Le Bouquin-Leneveu
- Hygiene and Quality of Poultry and Pig Products Unit, ANSES, French Agency for Food, Environmental and Occupational Health Safety, Ploufragan, France
| | - Caroline Le Maréchal
- Hygiene and Quality of Poultry and Pig Products Unit, ANSES, French Agency for Food, Environmental and Occupational Health Safety, Ploufragan, France
| | - Christelle Mazuet
- Institut Pasteur, Université Paris Cité, CNR Bactéries anaérobies et Botulisme, Paris, France
| | | | - Karine Petit
- Risk Assessment Department, ANSES, Maisons-Alfort, France
| | - Jean-Pierre Vaillancourt
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - Cédric Woudstra
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
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23
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Oliveira LM, Gonçalves DB, Cabral LDCR, Bernardino MRA, Feitoza PVS. Botulism in the Brazilian Amazon: a life-threatening disease in a neglected population. Arq Neuropsiquiatr 2022; 80:1227-1232. [PMID: 36580960 PMCID: PMC9800156 DOI: 10.1055/s-0042-1758651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Botulism is a rare and potentially fatal neuroparalytic syndrome caused by the gram-positive anaerobe spore-forming bacterium Clostridium botulinum. The microorganism produces a neurotoxin that inhibits the presynaptic release of acetylcholine at the neuromuscular junction, clinically leading to a myasthenic syndrome. OBJECTIVE To describe the recent outbreak of botulism cases and its demographic, clinical, and laboratory characteristics. METHODS We report 4 patients with botulism in the recent outbreak occurred between 2017 and 2019 in the state of Amazon. RESULTS Out of four patients with botulism, three contracted it from eating contaminated food and one had wound botulism. We emphasize the excellent clinical outcome of the different disease presentations in our case series. CONCLUSION The temporal proximity of these reports may suggest a new rise in the number of cases in the upcoming years. A possible hypothesis is that the rarity of the disease decreased the awareness regarding the primary prevention or even a diagnosis by an untrained physician.
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Affiliation(s)
| | | | | | - Marília Rosa Abtibol Bernardino
- Universidade Federal do Amazonas, Faculdade de Medicina, Manaus AM, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus AM, Brazil.
| | - Pablo Vinícius Silveira Feitoza
- Universidade Federal do Amazonas, Faculdade de Medicina, Manaus AM, Brazil.,Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus AM, Brazil.,Address for correspondence Pablo Vinícius Silveira Feitoza
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Peñuelas M, Guerrero-Vadillo M, Valdezate S, Zamora MJ, Leon-Gomez I, Flores-Cuéllar Á, Carrasco G, Díaz-García O, Varela C. Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997-2019. Toxins (Basel) 2022; 15:2. [PMID: 36668823 PMCID: PMC9863742 DOI: 10.3390/toxins15010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Botulism is a low incidence but potentially fatal infectious disease caused by neurotoxins produced mainly by Clostridium botulinum. There are different routes of acquisition, food-borne and infant/intestinal being the most frequent presentation, and antitoxin is the treatment of choice in all cases. In Spain, botulism is under surveillance, and case reporting is mandatory. METHODS This retrospective study attempts to provide a more complete picture of the epidemiology of botulism in Spain from 1997 to 2019 and an assessment of the treatment, including the relationship between a delay in antitoxin administration and the length of hospitalization using the Cox proportional hazards test and Kruskal-Wallis test, and an approach to the frequency of adverse events, issues for which no previous national data have been published. RESULTS Eight of the 44 outbreaks were associated with contaminated commercial foods involving ≤7 cases/outbreak; preserved vegetables were the main source of infection, followed by fish products; early antitoxin administration significantly reduces the hospital stay, and adverse reactions to the antitoxin affect around 3% of treated cases.
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Affiliation(s)
- Marina Peñuelas
- Escuela Internacional de Doctorado, Universidad Nacional de Educación a Distancia (UNED), Calle de Bravo Murillo, 38, 28015 Madrid, Spain
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - María Guerrero-Vadillo
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - Sylvia Valdezate
- Laboratorio de Referencia e Investigación en Taxonomía, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo-Majadahonda Km 2.2, 28220 Madrid, Spain
| | - María Jesús Zamora
- Servicio de Microbiología Alimentaria, Centro Nacional de Alimentación, Agencia Española de Seguridad Alimentaria y Nutrición, Ctra. Pozuelo a Majadahonda Km 5.1, 28220 Madrid, Spain
| | - Inmaculada Leon-Gomez
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - Ángeles Flores-Cuéllar
- Medicines for Human Use Department, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), C/Campezo 1, Edificio 8, 28022 Madrid, Spain
| | - Gema Carrasco
- Laboratorio de Referencia e Investigación en Taxonomía, Bacteriología, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Pozuelo-Majadahonda Km 2.2, 28220 Madrid, Spain
| | - Oliva Díaz-García
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
| | - Carmen Varela
- Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, C/Monforte de Lemos 5, Pabellón 12, 28029 Madrid, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
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Zhao B, Jin Z, Yu Y, Li Y, Wang J, Wan W, Hu C, Li X, Li Y, Xin W, Kang L, Yang H, Wang J, Gao S. A Thermostable Dissolving Microneedle Vaccine with Recombinant Protein of Botulinum Neurotoxin Serotype A. Toxins (Basel) 2022; 14:toxins14120881. [PMID: 36548778 PMCID: PMC9781108 DOI: 10.3390/toxins14120881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/30/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND As a Class A bioterrorism agent, botulinum neurotoxin serotype A (BoNT/A) carries the risk of being used by terrorists to cause mass poisoning. The microneedle (MN) patch has a great potential for application as a novel vaccine delivery method. The aim of this study is to develop a thermally stable, dissolving microneedle patch for the delivery of a recombinant protein vaccine using a recombinant C-terminal heavy chain of BoNT/A (Hc of BoNT/A, AHc) to prevent botulism. METHODS Fish gelatin, a natural non-toxic and bacteriostatic material, was selected as the microneedle matrix for the preparation of the dissolving microneedle vaccine. Subsequently, the mechanical performance, bacteriostatic properties, vaccination effect, and stability of the microneedle patches were evaluated using instruments such as the displacement-force test station and optical coherence tomography (OCT) scanner. RESULTS Fish gelatin matrix at high concentrations has good bacteriostatic properties, and excellent mechanical performance and vaccination effect, meeting the necessities of a vaccine. In both in vivo and in vitro neutralization experiments, MN vaccines containing different antigen doses achieved the same protective efficacy as subcutaneous vaccinations, protecting mice against 106 LD50 of BoNT/A injected intraperitoneally. Thermal stability analysis of the MN vaccines revealed that the fish gelatin matrix protected the AHc vaccine from protein denaturation even after 7 days of storage at 37 °C and enabled the vaccine patches to maintain good immunogenicity and protective efficacy even after 6 months of storage at room temperature. CONCLUSION In this study, we successfully prepared a bacteriostatic MN patch using a fish gelatin matrix that not only has a good vaccination effect, but also obviates the need for a cold chain for the AHc vaccine, providing the possibility of rapid, painless, and large-scale vaccination.
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Affiliation(s)
- Baohua Zhao
- Hebei Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology, College of Life Sciences, Hebei Normal University, Shijiazhuang 050024, China
| | - Zhiying Jin
- Hebei Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology, College of Life Sciences, Hebei Normal University, Shijiazhuang 050024, China
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Yunzhou Yu
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Yue Li
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Jing Wang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Wei Wan
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Chenyi Hu
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Xiaoyang Li
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Yanwei Li
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Wenwen Xin
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Lin Kang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
| | - Hao Yang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
- Correspondence: (H.Y.); (J.W.); (S.G.); Tel./Fax: +86+010+66948643 (H.Y. & S.G.); +86+010+66948531 (J.W.)
| | - Jinglin Wang
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
- Correspondence: (H.Y.); (J.W.); (S.G.); Tel./Fax: +86+010+66948643 (H.Y. & S.G.); +86+010+66948531 (J.W.)
| | - Shan Gao
- State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences (AMMS), Beijing 100071, China
- Correspondence: (H.Y.); (J.W.); (S.G.); Tel./Fax: +86+010+66948643 (H.Y. & S.G.); +86+010+66948531 (J.W.)
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Le Bouquin S, Lucas C, Souillard R, Le Maréchal C, Petit K, Kooh P, Jourdan-Da Silva N, Meurens F, Guillier L, Mazuet C. Human and animal botulism surveillance in France from 2008 to 2019. Front Public Health 2022; 10:1003917. [PMID: 36504929 PMCID: PMC9730534 DOI: 10.3389/fpubh.2022.1003917] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
Botulism is a human and animal neurological disease caused by the action of bacterial neurotoxins (botulinum toxins) produced by bacteria from the genus Clostridium. This disease induces flaccid paralysis that can result in respiratory paralysis and heart failure. Due to its serious potential impact on public health, botulism is a closely monitored notifiable disease in France through a case-based passive surveillance system. In humans, this disease is rare, with an average of 10 outbreaks reported each year, mainly due to the consumption of contaminated foods. Type B and to a lesser extend type A are responsible for the majority of cases of foodborne botulism. Each year, an average of 30 outbreaks are recorded on poultry farms, about 20 cases in wild birds and about 10 outbreaks in cattle, involving a large number of animals. Mosaic forms C/D and D/C in birds and cattle, respectively, are the predominant types in animals in France. Types C and D have also been observed to a lesser extent in animals. With the exception of botulinum toxin E, which was exceptionally detected throughout the period in wild birds, the types of botulism found in animal outbreaks are different from those identified in human outbreaks over the last ten years in France and no human botulism outbreaks investigated have been linked to animal botulism. In line with the One Health concept, we present the first integrative approach to the routine surveillance of botulism in humans and animals in France.
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Affiliation(s)
- Sophie Le Bouquin
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), National Reference Laboratory for Avian Botulism, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France,*Correspondence: Sophie Le Bouquin
| | - Camille Lucas
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), National Reference Laboratory for Avian Botulism, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Rozenn Souillard
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), National Reference Laboratory for Avian Botulism, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Caroline Le Maréchal
- French Agency for Food, Environmental and Occupational Health & Safety (ANSES), National Reference Laboratory for Avian Botulism, Ploufragan-Plouzané-Niort Laboratory, Ploufragan, France
| | - Karine Petit
- ANSES, Risk Assessment Department, Maisons-Alfort, France
| | - Pauline Kooh
- ANSES, Risk Assessment Department, Maisons-Alfort, France
| | - Nathalie Jourdan-Da Silva
- Sante Publique France (French Public Health Agency), Direction des Maladies Infectieuses, Saint Maurice, France
| | - François Meurens
- French National Research Institute for Agriculture, Food and Environment (INRAE), Oniris, Unit of Biology, Epidemiology and Risk Analysis in Animal Health (BIOEPAR), Nantes, France,Department of Veterinary Microbiology and Immunology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Christelle Mazuet
- Institut Pasteur, National Reference Center for Anaerobic Bacteria and Botulism, Université Paris Cité, Paris, France
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Chen BC, Huang YC, Huang SH, Yu PC, Wang BL, Lin FH, Chou YC, Hsieh CJ, Yu CP. Epidemiology and risk factors for notifiable Clostridium botulinum infections in Taiwan from 2003 to 2020. Medicine (Baltimore) 2022; 101:e31198. [PMID: 36281180 PMCID: PMC9592386 DOI: 10.1097/md.0000000000031198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Botulinum toxin is produced by Clostridium botulinum, a gram-positive anaerobic bacterium. This study aimed to examine the epidemiological characteristics, including sex, age, season in which infection occurred, place of residence, and epidemiological trends, of confirmed botulism cases in Taiwan from 2003 to 2020. This study examined the annual summary data on reported botulism in Taiwan' s Center for Disease Control from 2003 to 2020 available to the public on the internet. We found that there were 50 confirmed domestic cases of botulism. The incidence of botulism ranged from 0 to 0.48 per 1000,000 from 2003 to 2020 and peaked in 2008 and 2010. During the 18-year investigation period in which 6-year intervals were used, the study results showed a decreasing trend (2003-2008, 2009-14, and 2015-2020, had 22, 19, 9 cases each). In terms of patients' gender, age, and place of residence, most of the patients were females (56%), were aged ≥ 50 years (48%), and resided in Taipei and northern Taiwan (44%). The number of botulism cases in Taiwan from 2012 to 2020 compared with other years (from 2003 to 2011) found that there were significant differences among patients within an age group of <20 years (P = .003, odds ratio = 18.500, and 95% confidence interval = 3.287-104.111), and there were significant differences among patients whose place of residence was Taipei metropolitan area (P = .025, odds ratio = 5.667, and 95% confidence interval = 1.248-25.734). During 2003 to 2009, there was no case of botulism among those aged <20 years. Over the last 10 years, botulism in children showed an increasing trend. A total of 9 children were found to have botulism during 2010 to 2020; most of these children were male (66.7%) and were infected during spring and summer (66.7%). This study is the first to report the number of confirmed domestic cases with botulism from surveillance data from Taiwan's Center for Disease Control during 2003 to 2020. This study also found that the place of residence and age were associated with an increased risk of botulism in Taiwan. This information may be useful for policymakers and clinical experts to direct prevention- and control-based activities regarding botulism that result in the most severe illness and the greatest burden on Taiwanese.
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Affiliation(s)
- Bao-Chung Chen
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
| | - Yao-Ching Huang
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei City, Taiwan
| | - Shi-Hao Huang
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- Department of Chemical Engineering and Biotechnology, National Taipei University of Technology, Taipei City, Taiwan
| | - Pi-Ching Yu
- Cardiovascular Intensive Care Unit, Department of Critical Care Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Bing-Long Wang
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Yu-Ching Chou
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
| | - Chi-Jeng Hsieh
- Department of Health Care Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan
| | - Chia-Peng Yu
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan
- School of Public Health, National Defense Medical Center, Taipei City, Taiwan
- *Correspondence: Chia-Peng Yu, School of Public Health, National Defense Medical Center, Taipei City 114, Taiwan (e-mail: )
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Gayou N, Plumb ID, Edwards L, Pomeroy M, Herlihy RK, Johnson R, Pattison K, Dykes J, Gómez GA, Jervis RH. Outbreak of Foodborne Botulism Associated with a Commercially Produced Multipack Potato Product, Colorado: September 2019. Foodborne Pathog Dis 2022; 19:713-715. [PMID: 36149750 DOI: 10.1089/fpd.2022.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
During September 2019, public health authorities in El Paso County, Colorado, were notified of four patients who had presented to nearby hospitals with clinical features consistent with botulism, a paralytic illness caused by botulinum neurotoxin. One patient died soon after presentation; the other three patients required intensive care but recovered after receiving botulism antitoxin. Botulinum toxin type A was detected in serum from all patients. On further investigation, all four patients had shared a meal that included commercially prepared roasted potatoes from an individual package without refrigeration instructions that had been left unrefrigerated for 15 d. Storage of the product at ambient temperature likely allowed botulism spores to produce botulinum toxin, resulting in severe illness and death. The manufacturer improved labeling in response to this outbreak. Public health officials should consider unrefrigerated potato products as a potential source of botulism; clinicians should consider botulism as a possible cause of paralytic illness.
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Affiliation(s)
- Natalia Gayou
- El Paso County Public Health, Colorado Springs, Colorado, USA
| | - Ian D Plumb
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Leslie Edwards
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Mary Pomeroy
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel K Herlihy
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
| | - Robin Johnson
- El Paso County Public Health, Colorado Springs, Colorado, USA
| | | | - Janet Dykes
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Gerardo A Gómez
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rachel H Jervis
- Colorado Department of Public Health and Environment, Denver, Colorado, USA
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Casado-Ruiz V, Cano A, Suárez-López A, Muriana D, Guanyabens-Buscà N, Sanz-Cartagena P, Álvarez-Larruy M, Palomeras E. Food borne-botulism during SARS-CoV-2 pandemic time. A case and a possible familial outbreak in Barcelona. Rev Neurol 2022; 75:71-74. [PMID: 35879883 PMCID: PMC10280771 DOI: 10.33588/rn.7503.2021294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Botulism is a potentially fatal neuroparalytic syndrome caused by Clostridium botulinum neurotoxin. The 25% are food-borne botulism cases. CASE REPORT We describe a confirmed case of botulism attended in our hospital in September 2020, together with a second case in a patient's relative, suspected but not confirmed by laboratory tests. Clinical presentation consisted on general weakness, bilateral cranial palsy, mydriasis, and rapidly progressive tetraparesis in case 1, involving respiratory and swallowing function so she required hospitalization and support treatment. Non specific and transient symptoms occurred in case 2. SARS-CoV-2 infection was initially suspected in both cases due to pandemic situation in our country, ruled out by negative PCR. When B neurotoxin was detected in stool sample of patient 1 we confirmed the diagnosis of food-borne botulism probably linked to home-made conserved beans. CONCLUSION Early clinical suspicion, together with laboratory and electromyography findings, and support treatment provided at hospital were crucial for favourable outcome. Being aware of this rare syndrom might contribute to its better management.
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Affiliation(s)
- V Casado-Ruiz
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | - A Cano
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | - A Suárez-López
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | - D Muriana
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | | | - P Sanz-Cartagena
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | - M Álvarez-Larruy
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
| | - E Palomeras
- Hospital de Mataró. Consorci Sanitari del Maresme, 08304 Mataró, España
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Edmunds S, Vugia DJ, Rosen HE, Wong KK, Dykes JK, Griffin PM, Chatham-Stephens K. Inadequate Refrigeration of Some Commercial Foods Is a Continued Cause of Foodborne Botulism in the United States, 1994-2021. Foodborne Pathog Dis 2022; 19:417-422. [PMID: 35713923 DOI: 10.1089/fpd.2021.0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Foodborne botulism is a rapidly progressive potentially fatal paralyzing illness caused by the consumption of botulinum neurotoxin, which is most commonly produced by Clostridium botulinum. Refrigeration is the primary barrier to botulinum neurotoxin production in many processed foods. C. botulinum toxin production has occurred and caused botulism in the United States when foods that were not processed to destroy spores of C. botulinum were stored in an anaerobic environment and not properly refrigerated. We identified 37 cases, including 4 deaths, that occurred during 1994-2021 in the United States from 13 events associated with inadequate refrigeration of commercially produced products. In 11 events, the patient stored the product unrefrigerated at home; in 2 events, a product was kept unrefrigerated at the store before the consumer purchased it. In three events, refrigeration instructions were inadequate or not easily accessible (one label printed on outer but not inner packaging, one label not clearly visible, and one label was not in English). The number of people affected per event ranged from 1 to 16. Using enhanced cost estimates for foodborne botulism cases from a published economic model, these events were estimated to cost >$79M. Potential solutions to this recurring problem include the addition of a secondary barrier, such as an acidifier, to prevent botulinum toxin production, and better labeling to convey risks of refrigerated foods that have not been processed to destroy spores of C. botulinum and to decrease the occurrence of improper storage and handling.
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Affiliation(s)
- Seth Edmunds
- Centers for Disease Control and Prevention, Enteric Diseases Epidemiology Branch, Atlanta, Georgia, USA.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Duc J Vugia
- California Department of Public Health, Richmond and Los Angeles, California, USA
| | - Hilary E Rosen
- California Department of Public Health, Richmond and Los Angeles, California, USA
| | - Karen K Wong
- Centers for Disease Control and Prevention, Enteric Diseases Epidemiology Branch, Atlanta, Georgia, USA
| | - Janet K Dykes
- Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, Atlanta, Georgia, USA
| | - Patricia M Griffin
- Centers for Disease Control and Prevention, Enteric Diseases Epidemiology Branch, Atlanta, Georgia, USA
| | - Kevin Chatham-Stephens
- Centers for Disease Control and Prevention, Enteric Diseases Epidemiology Branch, Atlanta, Georgia, USA
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Parrera GS, Astacio H, Tunga P, Anderson DM, Hall CL, Richardson JS. Use of Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G)-(Equine) (BAT ®) in Clinical Study Subjects and Patients: A 15-Year Systematic Safety Review. Toxins (Basel) 2021; 14:19. [PMID: 35050996 DOI: 10.3390/toxins14010019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 01/04/2023] Open
Abstract
Botulism is a rare, sometimes fatal paralytic illness caused by botulinum neurotoxins. BAT® (Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G)—(Equine)) is an equine-derived heptavalent botulinum antitoxin indicated for the treatment of symptomatic botulism in adult and pediatric patients. This review assesses the cumulative safety profile for BAT product from 2006 to 2020, using data received from clinical studies, an expanded-access program, a post-licensure registry, spontaneous and literature reports. The adverse event (AE) incidence rate for BAT product was calculated conservatively using only BAT product exposures for individuals with a record (512) and was alternatively estimated using all BAT product exposure data, including post-licensure deployment information (1128). The most frequently reported BAT product-related AEs occurring in greater than 1% of the 512–1128 BAT product-exposed individuals were hypersensitivity, pyrexia, tachycardia, bradycardia, anaphylaxis, and blood pressure increase reported in 2.3–5.1%, 1.8–3.9%, 1.0–2.2%, 0.89–2.0%, 0.62–1.4%, and 0.62–1.4%, respectively. For patients properly managed in an intensive care setting, the advantages of BAT product appear to outweigh potential risks in patients due to morbidity and mortality of botulism. AEs of special interest, including bradycardia, hemodynamic instability, hypersensitivity, serum sickness, and febrile reactions in the registry, were specifically solicited.
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Košenina S, Martínez-Carranza M, Davies JR, Masuyer G, Stenmark P. Structural Analysis of Botulinum Neurotoxins Type B and E by Cryo-EM. Toxins (Basel) 2021; 14:14. [PMID: 35050991 DOI: 10.3390/toxins14010014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022] Open
Abstract
Botulinum neurotoxins (BoNTs) are the causative agents of a potentially lethal paralytic disease targeting cholinergic nerve terminals. Multiple BoNT serotypes exist, with types A, B and E being the main cause of human botulism. Their extreme toxicity has been exploited for cosmetic and therapeutic uses to treat a wide range of neuromuscular disorders. Although naturally occurring BoNT types share a common end effect, their activity varies significantly based on the neuronal cell-surface receptors and intracellular SNARE substrates they target. These properties are the result of structural variations that have traditionally been studied using biophysical methods such as X-ray crystallography. Here, we determined the first structures of botulinum neurotoxins using single-particle cryogenic electron microscopy. The maps obtained at 3.6 and 3.7 Å for BoNT/B and /E, respectively, highlight the subtle structural dynamism between domains, and of the binding domain in particular. This study demonstrates how the recent advances made in the field of single-particle electron microscopy can be applied to bacterial toxins of clinical relevance and the botulinum neurotoxin family in particular.
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Diamant E, Torgeman A, Epstein E, Mechaly A, David AB, Levin L, Schwartz A, Dor E, Girshengorn M, Barnea A, Mazor O, Zichel R. A cell-based alternative to the mouse potency assay for pharmaceutical type E botulinum antitoxins. ALTEX 2021; 39:113-122. [PMID: 34798660 DOI: 10.14573/altex.2105251] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/05/2021] [Indexed: 11/23/2022]
Abstract
The pharmacopeia mouse neutralization assay (PMNA) is the standard method for determining the potency of pharmaceutical botulinum antitoxins. However, a PMNA requires a large number of mice, and thus, an alternative in vitro method to replace it is needed. Herein, we developed an in vitro SiMa cell line-based neutralization assay (SBNA), compatible with a PMNA design, for therapeutic antitoxins against type E botulinum neurotoxin (BoNT/E). The SBNA measures the residual cellular activity of BoNT/E following antitoxin neutralization using a specific quantitative sandwich ELISA for its cleaved cellular target protein, i.e., SNAP-25. The potencies of pharmaceutical antitoxin preparations were determined by applying two different quantification approaches: (1) a cutoff value, in accordance with the pharmacopeia concept, and (2) nonlinear regression of a standard curve generated by serial dilutions of a standard antitoxin. Both approaches achieved accurate potencies compared to the PMNA (average %RE of ~16%). Furthermore, the SBNA was able to determine in vitro, for the first time, the accurate neutralizing activity (%RE ≤20) of next-generation equine and nonequine therapeutic antitoxins. Collectively, a high correlation between SBNA and PMNA results was obtained for all antitoxin preparations (r = 0.99, P < 0.0001 for the standard curve approach, and r = 0.97, p < 0.0001 for the cutoff approach). In conclusion, the SBNA can potentially replace the PMNA and markedly reduce the need for laboratory animals for the approval of botulinum antitoxin preparations.
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Affiliation(s)
- Eran Diamant
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Amram Torgeman
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Eyal Epstein
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Adva Mechaly
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Alon Ben David
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Lilach Levin
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Arieh Schwartz
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Eyal Dor
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Meni Girshengorn
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ada Barnea
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ohad Mazor
- Department of Infectious Diseases, Israel Institute for Biological Research, Ness Ziona, Israel
| | - Ran Zichel
- Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona, Israel
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Tomic MT, Farr-Jones S, Syar ES, Niemuth N, Kobs D, Hackett MJ, Espinoza Y, Martinez Z, Pham K, Snow DM, Marks JD, Cobb RR. Neutralizing Concentrations of Anti-Botulinum Toxin Antibodies Positively Correlate with Mouse Neutralization Assay Results in a Guinea Pig Model. Toxins (Basel) 2021; 13:671. [PMID: 34564675 DOI: 10.3390/toxins13090671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/24/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Botulinum neurotoxins (BoNT) are some of the most toxic proteins known and can induce respiratory failure requiring long-term intensive care. Treatment of botulism includes the administration of antitoxins. Monoclonal antibodies (mAbs) hold considerable promise as BoNT therapeutics and prophylactics, due to their potency and safety. A three-mAb combination has been developed that specifically neutralizes BoNT serotype A (BoNT/A), and a separate three mAb combination has been developed that specifically neutralizes BoNT serotype B (BoNT/B). A six mAb cocktail, designated G03-52-01, has been developed that combines the anti-BoNT/A and anti-BoNT/B mAbs. The pharmacokinetics and neutralizing antibody concentration (NAC) of G03-52-01 has been determined in guinea pigs, and these parameters were correlated with protection against an inhalation challenge of BoNT/A1 or BoNT/B1. Previously, it was shown that each antibody demonstrated a dose-dependent mAb serum concentration and reached maximum circulating concentrations within 48 h after intramuscular (IM) or intraperitoneal (IP) injection and that a single IM injection of G03-52-01 administered 48 h pre-exposure protected guinea pigs against an inhalation challenge of up to 93 LD50s of BoNT/A1 and 116 LD50s of BoNT/B1. The data presented here advance our understanding of the relationship of the neutralizing NAC to the measured circulating antibody concentration and provide additional support that a single IM or intravenous (IV) administration of G03-52-01 will provide pre-exposure prophylaxis against botulism from an aerosol exposure of BoNT/A and BoNT/B.
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Marlow M, Edwards L, McCrickard L, Francois Watkins LK, Anderson J, Hand S, Taylor K, Dykes J, Byers P, Chatham-Stephens K. Mild Botulism From Illicitly Brewed Alcohol in a Large Prison Outbreak in Mississippi. Front Public Health 2021; 9:716615. [PMID: 34504830 PMCID: PMC8421542 DOI: 10.3389/fpubh.2021.716615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Botulism is typically described as a rapidly progressing, severe neuroparalytic disease. Foodborne botulism is transmitted through consuming food or drink that has been contaminated with botulinum toxin. During a botulism outbreak linked to illicitly brewed alcohol (also known as “hooch” or “pruno”) in a prison, 11 (35%) of 31 inmates that consumed contaminated hooch had mild illnesses. This includes 2 inmates with laboratory confirmed botulism. The most frequently reported signs and symptoms among the 11 patients with mild illness included dry mouth (91%), hoarse voice (91%), difficulty swallowing (82%), fatigue (82%), and abdominal pain (82%). Foodborne botulism is likely underdiagnosed and underreported in patients with mild illness. Botulism should be considered on the differential diagnosis for patients with cranial nerve palsies.
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Affiliation(s)
- Mariel Marlow
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Leslie Edwards
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Sheryl Hand
- Mississippi State Department of Health, Jackson, MS, United States
| | - Kathryn Taylor
- Mississippi State Department of Health, Jackson, MS, United States
| | - Janet Dykes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Paul Byers
- Mississippi State Department of Health, Jackson, MS, United States
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Marincu I, Bratosin F, Vidican I, Cerbu B, Suciu O, Turaiche M, Tirnea L, Timircan M. Foodborne Botulism in Western Romania: Ten Years' Experience at a Tertiary Infectious Disease Hospital. Healthcare (Basel) 2021; 9:healthcare9091149. [PMID: 34574922 PMCID: PMC8469094 DOI: 10.3390/healthcare9091149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/26/2021] [Accepted: 09/01/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The purpose of this study was to analyze epidemiological data concerning foodborne botulism in Western Romania over the last decade. Botulism, the toxin formed by the bacterium Clostridium botulinum, results in a neuroparalytic disorder capable of severe clinical progression that begins in the cranial nerves and progressively descends. Preventing progression to a severe case entails timely diagnosis since curative assets are restricted. Ingesting food containing a preformed toxin (foodborne botulism) is the most typical form. METHODS Medical records were retrospectively analyzed from 2010 to 2020 for all food botulism cases. A seroneutralization test was performed with type A, B and E anti-botulinum sera to establish the kind of toxin involved. RESULTS Overall, 18 cases of foodborne botulism were admitted to the hospital during this period and confirmed by laboratory analysis. Most of the participants in our study were men (61.1%), and 77.8% of the total lived in rural areas. All the participants showed classic symptoms of botulism, and dysphagia was present in all cases. The trivalent ABE antitoxin was administered by the hospital, and toxin type B was isolated in all patients. The main sources of the toxin were pork, ham and canned pork meat. CONCLUSIONS Stronger efforts are needed to foster community awareness of foodborne botulism, particularly in home-preserved food.
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Affiliation(s)
- Iosif Marincu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Felix Bratosin
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
- Correspondence: ; Tel.: +40-721919123
| | - Iulia Vidican
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Bianca Cerbu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Oana Suciu
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Mirela Turaiche
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Livius Tirnea
- Methodological and Infectious Diseases Research Center, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (I.M.); (I.V.); (B.C.); (O.S.); (M.T.); (L.T.)
| | - Madalina Timircan
- Department of Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
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Huntsman RE, Schauble A. The Role of the Pharmacist in the Treatment of Infantile Botulism. HCA Healthc J Med 2021; 2:251-256. [PMID: 37424847 PMCID: PMC10324806 DOI: 10.36518/2689-0216.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Description Infantile botulism is a potentially devastating disease caused by ingestion of Clostridium botulinum spores through food products or dust particles. The toxin produced by the spores can lead to descending paralysis requiring hospitalization for supportive care which sometimes includes mechanical ventilation. Human Botulism Immune Globulin-Intravenous (BIG-IV or BabyBIG) from the Infant Botulism Treatment and Prevention Program (IBTPP) has been shown to greatly improve outcomes. A previously healthy 5-month-old infant was admitted to her regional hospital for poor feeding and lethargy. When the weakness progressed and she had trouble with protecting her airway, she was intubated and transferred to our institution. The primary diagnosis was infantile botulism and the decision was made to treat with BabyBIG. The pharmacy department was able to assist with obtaining BabyBIG, ensuring proper preparation, and coordinating the team for swift administration. In the days following the BabyBIG administration, the patient slowly started to recover her respiratory function and muscle tone. On day five of admission the patient was extubated. After transfer to the general pediatric floor the patient was given a transpyloric feeding tube and worked with gastrointestinal and nutrition services to improve oral feeding. She was discharged on day seventeen with plans to continue working with therapy and nutrition. BIG-IV can have a major impact in the recovery of infantile botulism. Pharmacists are in an optimal position to assist with coordinating the multidisciplinary team regarding its procurement, preparation, and administration.
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Affiliation(s)
- Rachel E Huntsman
- Presbyterian/St. Luke's Medical Center/Rocky Mountain Hospital for Children, Denver, CO
| | - Abigail Schauble
- Presbyterian/St. Luke's Medical Center/Rocky Mountain Hospital for Children, Denver, CO
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38
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Brier S, Rasetti-Escargueil C, Wijkhuisen A, Simon S, Marechal M, Lemichez E, Popoff MR. Characterization of a highly neutralizing single monoclonal antibody to botulinum neurotoxin type A. FASEB J 2021; 35:e21540. [PMID: 33817838 DOI: 10.1096/fj.202002492r] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/25/2021] [Accepted: 03/03/2021] [Indexed: 01/15/2023]
Abstract
Compared to conventional antisera strategies, monoclonal antibodies (mAbs) represent an alternative and safer way to treat botulism, a fatal flaccid paralysis due to botulinum neurotoxins (BoNTs). In addition, mAbs offer the advantage to be produced in a reproducible manner. We previously identified a unique and potent mouse mAb (TA12) targeting BoNT/A1 with high affinity and neutralizing activity. In this study, we characterized the molecular basis of TA12 neutralization by combining Hydrogen/Deuterium eXchange Mass Spectrometry (HDX-MS) with site-directed mutagenesis and functional studies. We found that TA12 recognizes a conformational epitope located at the interface between the HCN and HCC subdomains of the BoNT/A1 receptor-binding domain (HC ). The TA12-binding interface shares common structural features with the ciA-C2 VHH epitope and lies on the face opposite recognized by ciA-C2- and the CR1/CR2-neutralizing mAbs. The single substitution of N1006 was sufficient to affect TA12 binding to HC confirming the position of the epitope. We further uncovered that the TA12 epitope overlaps with the BoNT/A1-binding site for both the neuronal cell surface receptor synaptic vesicle glycoprotein 2 isoform C (SV2C) and the GT1b ganglioside. Hence, TA12 potently blocks the entry of BoNT/A1 into neurons by interfering simultaneously with the binding of SV2C and to a lower extent GT1b. Our study reveals the unique neutralization mechanism of TA12 and emphasizes on the potential of using single mAbs for the treatment of botulism type A.
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Affiliation(s)
- Sébastien Brier
- Biological NMR Technological Platform, Institut Pasteur, CNRS UMR3528, Paris, France
| | | | - Anne Wijkhuisen
- Département Médicaments et Technologies pour la santé, Université Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Stéphanie Simon
- Département Médicaments et Technologies pour la santé, Université Paris-Saclay, CEA, INRAE, Gif-sur-Yvette, France
| | - Maud Marechal
- Institut Pasteur, Unité des Toxines Bactériennes, UMR CNRS 2001, Paris, France
| | - Emmanuel Lemichez
- Institut Pasteur, Unité des Toxines Bactériennes, UMR CNRS 2001, Paris, France
| | - Michel R Popoff
- Institut Pasteur, Unité des Toxines Bactériennes, UMR CNRS 2001, Paris, France
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Gladney L, Halpin JL, Lúquez C. Genomic Characterization of Strains From a Cluster of Infant Botulism Type A in a Small Town in Colorado, United States. Front Microbiol 2021; 12:688240. [PMID: 34326824 PMCID: PMC8313963 DOI: 10.3389/fmicb.2021.688240] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Three cases of infant botulism were reported in a small Colorado town between 1981 and 1984. The first two cases occurred in 1981, 6 months apart, and the third case occurred in 1984. Clostridium botulinum type A was isolated from stool of all three case patients and from environmental samples of the patient's homes. An epidemiological investigation and follow-up study were conducted from 1981 to 1986 and concluded the cases were likely related. In this study, we sought to determine whether the C. botulinum type A clinical isolates were related to each other and to isolates obtained from environmental samples. We performed whole genome sequencing (WGS) for 17 isolates associated with this potential cluster of infant botulism. Fifteen isolates were confirmed to be C. botulinum type A(B) and contained botulinum toxin gene subtypes A1 and B5 by WGS; these strains formed a monophyletic cluster in a phylogeny and were considered closely related to each other (0-18 high-quality single-nucleotide polymorphisms), but distinct from other C. botulinum type A(B) in Colorado and elsewhere in the United States. Results of our study suggest that the three infant botulism cases could have represented a cluster due to a C. botulinum type A(B) strain present in the environment.
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Affiliation(s)
- Lori Gladney
- National Botulism Laboratory, Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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Yutani M, Matsumura T, Fujinaga Y. Effects of antibiotics on the viability of and toxin production by Clostridium botulinum. Microbiol Immunol 2021; 65:432-437. [PMID: 34219270 DOI: 10.1111/1348-0421.12928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 11/30/2022]
Abstract
Clostridium botulinum causes infant and adult intestinal botulism by colonizing in the intestine and producing botulinum neurotoxin (BoNT). Antimicrobial agents are not currently used for treatment due to the potential facilitation of BoNT production and bacterial cell lysis, which releases toxins into the intestinal lumen. In this study, we analyzed effects of four antibiotics on the viability of and BoNT production by four C. botulinum group I strains. Our results indicate that metronidazole rapidly reduced their viability without enhancing BoNT production. Antibiotics with these properties may promote elimination of C. botulinum from the intestines while maintaining low levels of BoNT. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Masahiro Yutani
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Takuhiro Matsumura
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
| | - Yukako Fujinaga
- Department of Bacteriology, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takara-machi, Kanazawa, Ishikawa, 920-8640, Japan
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Souillard R, Grosjean D, Le Gratiet T, Poezevara T, Rouxel S, Balaine L, Macé S, Martin L, Anniballi F, Chemaly M, Le Bouquin S, Le Maréchal C. Asymptomatic Carriage of C. botulinum Type D/C in Broiler Flocks as the Source of Contamination of a Massive Botulism Outbreak on a Dairy Cattle Farm. Front Microbiol 2021; 12:679377. [PMID: 34276611 PMCID: PMC8279769 DOI: 10.3389/fmicb.2021.679377] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/07/2021] [Indexed: 12/03/2022] Open
Abstract
In winter 2018, a massive type D/C cattle botulism outbreak occurred on a mixed dairy and broiler farm in France. An investigation was conducted based on the hypothesis of asymptomatic carriage in poultry. We set out to identify the source of contamination of the dairy cattle and to monitor the contamination of broilers over time, including the hatchery delivering chicks to the farm. Environmental samples were collected on the farm during the cattle outbreak (n = 40), after the outbreak for three successive broiler flocks (n = 128), and once in the hatchery delivering the chicks (n = 58). These samples were analyzed using real-time PCR after an enrichment step to detect Clostridium botulinum type D/C. The results showed contamination in the manure from the broilers raised just before the onset of the cattle outbreak (5 + /5), as well as in some of the components of the cattle ration (3 + /17). This latter contamination is likely due to the use of the same tractor bucket to remove litter from the poultry house and to prepare the cattle ration on the same day. Contamination monitoring over several months revealed continuous asymptomatic carriage in the broilers (4 + /20 and 17 + /20 cloacal swabs in 2 successive flocks), a persistence of C. botulinum type D/C in the ventilation system of the poultry house (8 + /14), and contamination of the equipment coming from the hatchery used for delivering the chicks (3 + /18). Further investigations conducted in the hatchery demonstrated contamination in the hatchery by C. botulinum type D/C (6 + /58). Comparison of samples using a multilocus variable number tandem repeat analysis showed the same profile for samples collected on broilers, cattle and in the hatchery. This study highlighted the crucial role of the implementation of biosecurity measures in mixed farms to avoid cross-contamination between production units given the potential asymptomatic carriage of poultry. This study also revealed the contamination of the poultry hatchery. Further investigations are required to better understand the role of hatcheries in the epidemiology of animal botulism.
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Affiliation(s)
- Rozenn Souillard
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Epidemiology, Health and Welfare Unit, Ploufragan, France
| | - Daniel Grosjean
- DDCSPP de la Meuse, Departmental Authority in Charge of Veterinary Services for Meuse Department, Bar-le-Duc, France
| | - Thibault Le Gratiet
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Typhaine Poezevara
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Sandra Rouxel
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Loïc Balaine
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Epidemiology, Health and Welfare Unit, Ploufragan, France
| | - Sabrina Macé
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Laure Martin
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Fabrizio Anniballi
- Department of Veterinary Public Health and Food Safety, National Reference Centre for Botulism, Istituto Superiore di Sanità, Rome, Italy
| | - Marianne Chemaly
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
| | - Sophie Le Bouquin
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Epidemiology, Health and Welfare Unit, Ploufragan, France
| | - Caroline Le Maréchal
- ANSES, French Agency for Food, Environmental and Occupational Health Safety, Hygiene and Quality of Poultry and Pig Products Unit, Ploufragan, France
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Beth Z, Hahn D, Kramer B, Tirre C, Kruse D, Stone PA. Open Tibial Fracture Complicated by Wound Botulism: A Case Study. J Foot Ankle Surg 2021; 60:600-604. [PMID: 33653654 DOI: 10.1053/j.jfas.2019.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/15/2019] [Accepted: 04/30/2019] [Indexed: 02/03/2023]
Abstract
Botulism is a neuroparalytic disease most commonly caused by foodborne ingestion of neurotoxin types A, B, and E, and is often fatal if untreated. Clinicians should be able to recognize the classic symptoms of botulinum intoxication (12). Owing to its rarity, there are a limited number of studies evaluating the clinical care of patients with wound botulism (10). We present an infected tibial non-union with botulism who underwent a successful radical excision and bone transport. The patient tolerated the procedure well.
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Affiliation(s)
- Zach Beth
- Second Year Resident, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218
| | - David Hahn
- Orthopedic Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1601 E 19th Ave #3300, Denver, CO 80218
| | - Bryan Kramer
- Vascular Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1601 East 19th Ave Ste 3950, Denver, CO 80218
| | - Conrad Tirre
- Plastic Surgeon Attending, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 2535 S Downing St #440, Denver, CO 80210
| | - Dustin Kruse
- Director of Research, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218
| | - Paul A Stone
- Residency Director, Highlands-Presbyterian/St. Luke's Podiatric Medicine and Surgery Residency Program, 1719 East 19th Avenue #520, Denver, CO 80218.
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Larison B, Lindsay AR, Bossu C, Sorenson MD, Kaplan JD, Evers DC, Paruk J, DaCosta JM, Smith TB, Ruegg K. Leveraging genomics to understand threats to migratory birds. Evol Appl 2021; 14:1646-1658. [PMID: 34178110 PMCID: PMC8210798 DOI: 10.1111/eva.13231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 12/05/2022] Open
Abstract
Understanding how risk factors affect populations across their annual cycle is a major challenge for conserving migratory birds. For example, disease outbreaks may happen on the breeding grounds, the wintering grounds, or during migration and are expected to accelerate under climate change. The ability to identify the geographic origins of impacted individuals, especially outside of breeding areas, might make it possible to predict demographic trends and inform conservation decision-making. However, such an effort is made more challenging by the degraded state of carcasses and resulting low quality of DNA available. Here, we describe a rapid and low-cost approach for identifying the origins of birds sampled across their annual cycle that is robust even when DNA quality is poor. We illustrate the approach in the common loon (Gavia immer), an iconic migratory aquatic bird that is under increasing threat on both its breeding and wintering areas. Using 300 samples collected from across the breeding range, we develop a panel of 158 single-nucleotide polymorphisms (SNP) loci with divergent allele frequencies across six genetic subpopulations. We use this SNP panel to identify the breeding grounds for 142 live nonbreeding individuals and carcasses. For example, genetic assignment of loons sampled during botulism outbreaks in parts of the Great Lakes provides evidence for the significant role the lakes play as migratory stopover areas for loons that breed across wide swaths of Canada, and highlights the vulnerability of a large segment of the breeding population to botulism outbreaks that are occurring in the Great Lakes with increasing frequency. Our results illustrate that the use of SNP panels to identify breeding origins of carcasses collected during the nonbreeding season can improve our understanding of the population-specific impacts of mortality from disease and anthropogenic stressors, ultimately allowing more effective management.
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Affiliation(s)
- Brenda Larison
- Department of Ecology and Evolutionary BiologyUniversity of CaliforniaLos AngelesCaliforniaUSA
- Center for Tropical ResearchInstitute of the Environment and SustainabilityUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Alec R. Lindsay
- Department of BiologyNorthern Michigan UniversityMarquetteMichiganUSA
| | - Christen Bossu
- Department of BiologyColorado State UniversityFort CollinsColoradoUSA
| | | | | | | | - James Paruk
- Biology DepartmentSaint Joseph’s CollegeStandishMaineUSA
| | | | - Thomas B. Smith
- Department of Ecology and Evolutionary BiologyUniversity of CaliforniaLos AngelesCaliforniaUSA
- Center for Tropical ResearchInstitute of the Environment and SustainabilityUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Kristen Ruegg
- Center for Tropical ResearchInstitute of the Environment and SustainabilityUniversity of CaliforniaLos AngelesCaliforniaUSA
- Department of BiologyColorado State UniversityFort CollinsColoradoUSA
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Abstract
We developed a sandwich ELISA that detects Clostridium botulinum C and D toxins and reverse-transcription real-time PCRs (RT-rtPCRs) that detect botulinum C and D toxin genes, respectively, to replace the mouse bioassay. The toxin genes were closely associated with the toxin molecules and used as surrogates for the presence of toxin. Samples (638) from 103 clinical cases of birds (302) with suspected botulinum toxicity came from wild birds and poultry (9 cases). Samples tested included blood serum, other body fluids, various tissues, gut contents, maggots, water, and sediment. Botulism was diagnosed in 34 cases (all of which had positive samples in the ELISA, the C toxin gene RT-rtPCR, or both assays). Botulism was suspected in 16 cases (each of which had 1 positive sample either in the ELISA or the C toxin gene RT-rtPCR). In the remaining 53 cases, no samples were positive, but botulism could not be excluded in 32 of these cases, whereas there was no indication of botulism or another diagnosis in 21 cases. The D toxin gene was not detected in any of the clinical samples. No C or D toxin genes were detected in 71 pooled cloacal swabs from 213 healthy migratory birds. The use of an ELISA that detects botulinum C and D toxins in combination with a RT-rtPCR for the botulinum C toxin gene can help confirm the diagnosis of botulism in birds.
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Affiliation(s)
- Anne M Masters
- DPIRD Diagnostics & Laboratory Services, Department of Primary Industries and Regional Development Western Australia, South Perth, Australia
| | - Dieter G Palmer
- DPIRD Diagnostics & Laboratory Services, Department of Primary Industries and Regional Development Western Australia, South Perth, Australia
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45
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Palazón-García R, Benavente-Valdepeñas AM. Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury. Int J Mol Sci 2021; 22:ijms22094886. [PMID: 34063051 PMCID: PMC8125452 DOI: 10.3390/ijms22094886] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/03/2021] [Indexed: 12/18/2022] Open
Abstract
Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.
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Affiliation(s)
- Ramiro Palazón-García
- Physical Medicine and Rehabilitation Department, Hospital Nacional de Parapléjicos, 45004 Toledo, Spain
- Correspondence:
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46
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Okunromade O, Dalhat MM, Umar AM, Dada AO, Nikau J, Maneh L, Ita OI, Balogun MS, Nguku P, Ojo O, Ihekweazu C. Emergency response to a cluster of suspected food-borne botulism in Abuja, Nigeria: challenges with diagnosis and treatment in a resource-poor setting. Pan Afr Med J 2021; 36:287. [PMID: 33117481 PMCID: PMC7572660 DOI: 10.11604/pamj.2020.36.287.20872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/15/2020] [Indexed: 11/11/2022] Open
Abstract
Food-borne botulism is a rare, acute and potentially fatal neurologic disorder that results from ingestion of food contaminated by botulinum toxin released from the anaerobic, spore-forming, gram-positive bacterium Clostridium botulinum. We reported an unusual cluster of botulism outbreak with high case fatality affecting a family following ingestion of home-made fish. A suspected outbreak of botulism affecting three patients in a family of six was reported to the Nigeria Centre for Disease Control. A rapid response team investigated by line-listing all the family members, interviewed extended family members, caregivers, clinicians, and nurses to collect socio-demographic and clinico epidemiological information using a semi-structured questionnaires. We collected blood from patients and food samples and locally made drink from the family home for laboratory testing. All family members ingested the same home-made food within the 48hrs before onset of symptoms in the index case. The clinical presentation of the three affected cases (AR=50.0%) was consistent with botulinum poisoning. Two of the affected cases died (CFR=66.7%) within 48hrs of admission, before antitoxin was made available. The third case had a milder presentation and survived, after administration of appropriate antitoxin. The remaining three children developed no symptoms. None of the samples cultured Clostridium botulinum. The blood samples were negative for mouse lethality test. Our report describes the challenges of diagnosis and management of rare emerging infectious disease outbreaks in resource-constrained settings.
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Affiliation(s)
| | | | | | | | - Jamilu Nikau
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Lamin Maneh
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Okokon Ita Ita
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | | | - Patrick Nguku
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria
| | - Olubunmi Ojo
- Nigeria Centre for Disease Control, Abuja, Nigeria
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Rosen HE, Kimura AC, Crandall J, Poe A, Nash J, Boetzer J, Tecle S, Mukhopadhyay R, Mcauley K, Kasirye O, Garza A, Shahkarami M, Chaturvedi V, Kiang D, Vidanes J, Mccoy K, Barcellos M, Derby T, Jain S, Vugia DJ. Foodborne Botulism Outbreak Associated With Commercial Nacho Cheese Sauce From a Gas Station Market. Clin Infect Dis 2021; 70:1695-1700. [PMID: 31247064 DOI: 10.1093/cid/ciz479] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Botulism is a rare and potentially fatal paralytic disease caused by botulinum neurotoxin (BoNT). In April 2017, 4 California residents from 2 adjacent counties were hospitalized with suspected foodborne botulism, precipitating an investigation by state and local public health departments in California. METHODS We interviewed suspected botulism patients and their families, inspected the suspect establishment, and collected suspect food. We tested patient sera, stool, and gastric aspirates using mouse bioassay for BoNT and/or culture for Clostridium botulinum. We tested suspect food and environmental samples for BoNT and confirmed presumptive positives using direct mouse bioassay and culture. We performed whole-genome sequencing on food and clinical isolates. RESULTS From April 2017 through May 2017, 10 patients in the Sacramento area were hospitalized with laboratory-confirmed botulism; 7 required mechanical ventilation, and 1 died. Of 9 patients with information, all had visited Gas Station X before illness onset, where 8 reported consuming a commercial cheese sauce. BoNT/A and/or BoNT/A-producing C. botulinum were detected from each patient and from leftover cheese sauce. Clostridium botulinum isolates from 4 patients were closely related to cheese sauce isolates by whole-genome high-quality single-nucleotide polymorphism analysis. No other botulism cases associated with this cheese sauce were reported elsewhere in the United States. CONCLUSIONS This large foodborne botulism outbreak in California was caused by consumption of commercial cheese sauce dispensed at a gas station market. The epidemiologic and laboratory evidence confirmed the cheese sauce as the outbreak source. The cheese sauce was likely locally contaminated, although the mechanism is unclear.
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Affiliation(s)
- Hilary E Rosen
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Akiko C Kimura
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - John Crandall
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Alyssa Poe
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - June Nash
- Sacramento County Department Public Health, Mather
| | - Jason Boetzer
- Sacramento County Environmental Management Department, Mather
| | - Selam Tecle
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Rituparna Mukhopadhyay
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Kate Mcauley
- Sacramento County Department Public Health, Mather
| | | | - Alvaro Garza
- San Joaquin County Department of Health Care Services, Stockton
| | - Mahtab Shahkarami
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Vishnu Chaturvedi
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - David Kiang
- Division of Food, Drug, and Cannabis Safety, California Department of Public Health, Richmond and Sacramento
| | - Jeff Vidanes
- Division of Food, Drug, and Cannabis Safety, California Department of Public Health, Richmond and Sacramento
| | - Kelly Mccoy
- Sacramento County Environmental Management Department, Mather
| | - Mark Barcellos
- Sacramento County Environmental Management Department, Mather
| | - Tammy Derby
- Sacramento County Environmental Management Department, Mather
| | - Seema Jain
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
| | - Duc J Vugia
- Division of Communicable Disease Control, California Department of Public Health, Los Angeles, Richmond and Sacramento
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48
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Richardson JS, Parrera GS, Astacio H, Sahota H, Anderson DM, Hall C, Babinchak T. Safety and Clinical Outcomes of an Equine-derived Heptavalent Botulinum Antitoxin Treatment for Confirmed or Suspected Botulism in the United States. Clin Infect Dis 2021; 70:1950-1957. [PMID: 31209461 DOI: 10.1093/cid/ciz515] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 06/14/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Botulism is a rare, life-threatening paralytic illness. Botulism Antitoxin Heptavalent (A,B,C,D,E,F,G)-(Equine) (BAT) manufactured by Emergent BioSolutions Canada Inc is an equine-derived heptavalent botulinum antitoxin product indicated for the treatment of symptomatic botulism following documented or suspected exposure to botulinum neurotoxin serotypes A-G in adults and pediatric patients. BAT product was US-licensed in 2013. METHODS In the United States, from October 2014 through July 2017, safety and clinical outcomes data were collected under a registry for patients treated with BAT product. RESULTS Registry patients had a median age of 51 years (range, 32 days to 92 years). Among 162 patients, 7 (4.3%) experienced BAT product-related serious adverse events, including 1 (0.6%) report each of pneumonia, pneumonia aspiration, ventricular tachycardia, upper gastrointestinal hemorrhage, anaphylactic reaction, acute kidney injury, and acute myocardial infarction. Thirty-one (19.1%) patients had 41 BAT product-related adverse events. Six (3.7%) deaths were reported in the registry. All deaths were attributed to the underlying illness and were assessed as unlikely related to BAT product. Among 113 (69.8%) patients with a final diagnosis of botulism, those treated early (≤2 days) spent fewer days in the hospital (5 vs 15.5 days), in the intensive care unit (ICU) (4 vs 12 days), and on mechanical ventilation (6 vs 14.5 days) than those treated late (>2 days), respectively. CONCLUSIONS BAT product was well tolerated in patients. Treatment with BAT product at ≤2 days of symptom onset was associated with shorter hospital and ICU stays, and shorter duration and need for mechanical ventilation, showing clinical benefit associated with early treatment.
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Affiliation(s)
- Jason S Richardson
- Clinical Research Department, Emergent BioSolutions Canada, Inc., Winnipeg
| | | | - Hugo Astacio
- Pharmacovigilance Department, Emergent BioSolutions Canada, Inc., Winnipeg
| | - Harpreet Sahota
- Biostatistics Department, Emergent BioSolutions Canada, Inc., Winnipeg
| | | | - Christine Hall
- Clinical Research Department, Emergent BioSolutions Canada, Inc., Winnipeg
| | - Tim Babinchak
- Medical Affairs Department, Emergent BioSolutions, Inc., Gaithersburg, Maryland
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49
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Snow DM, Cobb RR, Martinez J, Finger-Baker I, Collins L, Terpening S, Syar ES, Niemuth N, Kobs D, Barnewall R, Farr-Jones S, Marks JD, Tomic MT. A Monoclonal Antibody Combination against both Serotypes A and B Botulinum Toxin Prevents Inhalational Botulism in a Guinea Pig Model. Toxins (Basel) 2021; 13:31. [PMID: 33466411 DOI: 10.3390/toxins13010031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/23/2020] [Accepted: 12/29/2020] [Indexed: 12/28/2022] Open
Abstract
Botulinum neurotoxins (BoNT) are extremely potent and can induce respiratory failure, requiring long-term intensive care to prevent death. Recombinant monoclonal antibodies (mAbs) hold considerable promise as BoNT therapeutics and prophylactics. In contrast, equine antitoxin cannot be used prophylactically and has a short half-life. Two three-mAb combinations are in development that specifically neutralize BoNT serotype A (BoNT/A) and B (BoNT/B). The three-mAb combinations addressing a single serotype provided pre-exposure prophylaxis in the guinea pig inhalation model. A lyophilized co-formulation of six mAbs, designated G03-52-01, that addresses both A and B serotypes is in development. Here, we investigated the efficacy of G03-52-01 to protect guinea pigs against an aerosol exposure challenge of BoNT/A1 or BoNT/B1. Previously, it was found that each antibody demonstrated a dose-dependent exposure and reached maximum circulating concentrations within 48 h after intramuscular (IM) or intravenous (IV) injection. Here we show that G03-52-01, in a single IM injection of G03-52-01 administered 48 h pre-exposure, protected guinea pigs against an aerosol challenge of up to 238 LD50s of BoNT/A1 and 191 LD50s of BoNT/B1. These data suggest that a single IM administration of G03-52-01 provides pre-exposure prophylaxis against botulism from an aerosol exposure of BoNT/A1 or BoNT/B1.
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50
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Rasetti-Escargueil C, Lemichez E, Popoff MR. Toxemia in Human Naturally Acquired Botulism. Toxins (Basel) 2020; 12:E716. [PMID: 33202855 DOI: 10.3390/toxins12110716] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [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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