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Botulism is a rare neuroparalytic syndrome, caused by a neurotoxin produced by bacteria of the genus Clostridium. Signs and symptoms of food botulism begin 12 to 36 hours after the toxin enters the bloodstream. Clostridium botulinum is one of the most common life-threatening agents worldwide, producing the botulinum neurotoxin (BoNT). Poisoning is caused by the consumption of a highly toxic exotoxin produced during the growth of microorganisms in food. The growth of Clostridium botulinum strains and their production of toxins in vacuum processed foods have received special attention. Symptoms of botulism may appear 12 to 72 hours after eating foods that contain toxins, such as canned tuna, local dairy products, and home-made or commercial foods. Symptoms of poisoning include nausea, vomiting, bruising, dizziness and headache, dry skin, sore throat, constipation, mild fever (or no fever), muscle paralysis, diplopia, and eventually respiratory problems and death. On the other hand, botulinum neurotoxin is used in medicine and psychiatry. BoNT is involved in the management and control of many diseases such as depression and Parkinson’s, dermatitis such as psoriasis, as well as in the beauty and elimination of facial skin wrinkles.

Актуальність дослідження обумовлена великою кількістю сезонних грибних отруєнь дикорослими отруйними та умовно їстівними грибами на території Київської області, що супроводжується тяжким перебігом отруєння, особливо серед дітей, високими показниками стаціонарної летальності, надзвичайною вартістю та складністю лікування. Метою даного дослідження був обраний аналіз найбільш поширених токсичних синдромів і невідкладних станів, що виникають при отруєнні дикорослими отруйними та умовно їстівними грибами, поширеними на території Київської області. Матеріалом дослідження були обрані випадки гострих отруєнь дикорослими отруйними та умовно їстівними грибами серед дорослого населення м. Києва та області за 1995–2015 рр. (усього 1587 випадків). Усі пацієнти проходили стаціонарне лікування на базі токсикологічного відділення Київської міської клінічної лікарні швидкої медичної допомоги. Проведений ретроспективний аналіз результатів клініко-лабораторного обстеження та лікування пацієнтів. Використовувалися методи дослідження: аналітичний та порівняльного аналізу.За результатами проведеного дослідження встановлено, що залежно від виду грибного токсину, фази гострого отруєння та відповідно до клінічних проявів усі випадки гострих отруєнь дикорослими грибами були розподілені на три групи. Перша група об’єднала випадки отруєння грибами з гастроентеротропною дією; друга — з нейротропною дією; третя — з гепатонефротропною дією. За період дослідження отруєння грибами гепатонефротропної дії становили 15,2 % (242 випадки); гастроентеротропної дії — 81,3 % (1314 випадків); нейротропної дії — 1,9 % (31 випадок). Різноманітність і варіабельність симптомів гострих отруєнь дикорослими грибами обумовлюють необхідність проведення ретельної диференційної діагностики з широким спектром соматичних та інфекційних захворювань. Усі патологічні стани, що трактувались як отруєння грибами, були розподілені наступним чином: отруєння високотоксичними грибами (блідою поганкою та аманітальними мухоморами); токсикоінфекції і ботулізм; гострі отруєння пестицидами, металами, радіонуклідами та іншими токсикантами, що містилися у грибах у надмірно високих концентраціях; гострі та хронічні в стадії загострення захворювання органів черевної порожнини.З огляду на те, що в Україні не проводиться лабораторна ідентифікація грибних токсинів через високу вартість досліджень, відсутність обладнання, складність мікологічної ідентифікації, діагноз «отруєння грибами» повинен базуватися на токсикологічному та епідеміологічному анамнезі, клінічних проявах, клініко-біохімічних даних і результатах допоміжних методів дослідження. У складних для діагностики випадках слід залучати суміжних спеціалістів (неврологів, гастроентерологів, хірургів, інфекціоністів).

Aim. To study the clinical and epidemiological features of typical foodborne botulism in children.Materials and methods. We conducted an epidemiological investigation of 132 registered cases of typical foodborne botulism in the Republic of Tajikistan in 2019 and 2020. The clinical observation was carried out for 24 sick children in hospitals of the State Institution “City Children’s Clinical Infectious Diseases Hospital” and the Central District Hospital of Gissar. The diagnosis was established based on clinical and epidemiological data with the establishment of patients’ consumption of preservatives prepared from vegetables at homeResearch and discussion. In the Republic of Tajikistan, according to the Republican Sanitary and Epidemiological Service for 2019 and 2020, only 132 patients with botulism were registered, with the largest number of diseases, 68 (51.5%), registered in 2019, and in 2021, 64 (48.5%). Analysis of the incidence of botulism for The presented period indicates that the disease in the Republic of Tajikistan was registered in the form of sporadic cases. Botulism disease was of a group (mostly familial) nature and in 2019 19 (14.4%) cases were detected, in 2020 17 (12.8%) cases with the number of victims from 3 to 5. The age structure of patients with botulism was predominantly adults (62%) over children (38%).Conclusion. Epidemiological features of typical foodborne botulism in children in the Republic of Tajikistan showed that in cases 78 (59.1%) of the disease, it was registered after the consumption of traditional canned homemade products in the form of mixed vegetable spices (shakarob) and the autumn-winter period (100%).

Botulism is a rare, acute, life-threatening neuro-paralysis. The digestive onset may raise diagnostic issues. The objective of our study was to analyze the clinical and epidemiological data of patients diagnosed with botulism and hospitalized in “Gavril Curteanu” Municipal Clinical Hospital (Oradea, Romania). Detection of the Clostridium botulinum neurotoxin (type B) in the laboratories of the National Institute of Medical-Military Research Development “Cantacuzino”, Bucharest, Romania (using the mouse bioassays method) confirmed the diagnostics. The statistical analysis was performed using the IBM SPSS software. Forty-eight patients with the diagnosis of foodborne botulism were hospitalized between 2012 and 2018 (36.92% of the total number of cases of botulism reported in Romania). The winter-spring period was the period when most cases were registered (36 patients, p=0.020). Women from rural areas were predominant (but not statistically significant), and the patients’ mean age was 39.93±12.59 years. The most common source/cause of botulism was the consumption of homemade ham. The incubation period was 26.68±22.94 h, and 2.25±1.68 days passed from the clinical onset to diagnosis. The results prove that botulism is still a public health issue, especially in areas where homemade products are prepared using inappropriate/unsafe recipes/procedures.

Objective To report the temporal and spatial distribution of rainbow lorikeets presenting with lorikeet paralysis syndrome (LPS) and their clinicopathologic and pathologic findings, exposure to toxins, and response to treatment. Methods Records of lorikeets admitted in 2017 and 2018 to facilities in south‐east Queensland (QLD) were reviewed and LPS and non‐LPS cases were mapped and their distribution compared. Plasma biochemistries and complete blood counts were done on 20 representative lorikeets from south‐east QLD and Grafton, New South Wales (NSW). Tissues from 28 lorikeets were examined histologically. Samples were tested for pesticides (n = 19), toxic elements (n = 23), botulism (n = 15) and alcohol (n = 5). Results LPS occurred in warmer months. Affected lorikeets were found across south‐east QLD. Hotspots were identified in Brisbane and the Sunshine Coast. Lorikeets had a heterophilic leucocytosis, elevated muscle enzymes, uric acid and sodium and chloride. Specific lesions were not found. Exposure to cadmium was common in LPS and non‐LPS lorikeets. Treated lorikeets had a 60–93% See Table 2 depending on severity of signs. Clinical significance The primary differential diagnosis for lorikeets presenting with lower motor neuron signs during spring, summer and autumn in northern NSW and south‐east Queensland should be LPS. With supportive care, prognosis is fair to good.

Background: Infant botulism is a rare toxicoinfectious disease caused by colonization of the infant’s intestine with botulinum neurotoxin-producing clostridia (i.e. Clostridium botulinum or neurotoxigenic strains of C. butyricum or C. baratii). Our goal was to examine data from laboratory-confirmed cases of infant botulism reported in Canada to summarize incidence over time, over geographic distribution by province or territory, and by sex, and to compare these parameters with data from the Canadian Notifiable Disease Surveillance System (CNDSS). The average age of onset, serotype of botulinum neurotoxin (BoNT), case outcomes, length of hospitalization and suitability of clinical specimens for laboratory confirmation were also determined. Methods: We examined laboratory records from the Health Canada Botulism Reference Service and the British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory. The Discharge Abstract Database (DAD) and the Hospital Morbidity Database (HMDB) of the Canadian Institute of Health Information (CIHI) were queried for data on hospitalization of infant botulism cases. The CNDSS was queried for data on reported cases of infant botulism. Results: From 1979 to 2019, 63 laboratory-confirmed cases of infant botulism were confirmed by the Health Canada Botulism Reference Service and the BCCDC Public Health Laboratory for an annual rate of 4.30 cases per million live births. From 1983 to 2018, 57 cases of infant botulism were reported to the CNDSS. Of the 63 cases confirmed by the reference laboratories, the median age of onset was 16 weeks with a range of 2 to 52 weeks. The majority of cases were type A (76%) and B (21%), with single cases of type F and type AB. Of the 23 laboratory-confirmed cases with matched hospital records, 13 were transferred to special care and eight needed ventilator support; no deaths were reported. Conclusion: Spores of C. botulinum are present naturally in the environment, thus diagnosis of infant botulism does not require a history of exposure to high-risk foods such as honey. Stool samples are the most useful diagnostic specimen.

Background Botulinum toxin is a neurotoxin generated during the growth of Clostridium botulinum and can lead to a rare but life-threatening disease with neurologic symptoms. Relatively little is known about the many types of botulinum toxins in China. The clinical symptoms of the different types of botulism toxin–induced illnesses appear after an incubation period and vary greatly by the serotype and degree of exposure to the toxin. Case Report We describe 4 patients who consumed vacuum-packaged salted fish and ham and then presented with severe gastrointestinal symptoms, resulting in vomiting and one death. Blood serum and urine samples tested by the botulinum neurotoxin Endopep-MS assay were positive for botulinum toxin types A, B, and E. The patient who consumed the largest amount of fish and ham died after 36 h, and the other patients were treated with botulism antitoxin after being diagnosed with a botulinum toxin–induced illness and recovered after 1 month. These cases illustrate the importance of early diagnosis and early treatment of botulism type E, in particular, because of the risk of respiratory failure and treatment delays, which can result in increased mortality and poorer overall outcomes. Why Should an Emergency Physician Be Aware of This? Our cases illustrate the importance of early diagnosis and especially the treatment of illnesses related to botulism type E because of the risk of respiratory failure and because treatment delays can result in increased mortality and worsened overall outcomes.

Botulism is a life-threatening presynaptic disorder of the neuromuscular transmission produced by the neurotoxin elaborated by the botulinum neurotoxin-producing clostridia. We describe the management of a case series of 14 patients, members of 5 different families that were exposed to home-canned tuna and developed symptoms compatible with a mild clinical presentation of foodborne botulism. The electrophysiological study of the index case represented a reliable diagnostic test as it demonstrated a slight presynaptic dysfunction of the neuromuscular junction. Definite diagnosis was later confirmed by microbiological tests. Out of 14, only 3 patients presenting with a shorter period from symptom onset and with signs of multiple cranial neuropathies received botulinum antitoxin. All the patients remained stable and recovered progressively. Treatment with antitoxin may not be necessary in patients with late-presenting disease and mild and stable clinical picture.

espanolLa presentacion del botulismo en adultos es extremadamente rara y los sintomas pueden confundirse facilmente con los sintomas de accidente cerebrovascular agudo, Guillain-Barre o miastenia gravis. El proposito de este informe de caso clinico es garantizar que el botulismo del adulto se incluya en los diagnosticos diferenciales de un paciente con esta presentacion, de modo que se pueda brindar una atencion rapida y precisa para garantizar un resultado optimo del paciente. Una mujer de 41 anos presento quejas de aparicion repentina de dificultad para hablar. El paciente refiere antecedentes de abuso de multiples sustancias por via intravenosa y los sintomas progresaron a debilidad facial bilateral, ptosis y oftalmoplejia externa. Sin hallazgos destacables de la tomografia computarizada sin contraste y la resonancia magnetica y ante la sintomatologia, se realizo el diagnostico de botulismo de la herida por uso de drogas intravenosas. Se le administro antitoxina de botulismo y la paciente fue ingresada en la unidad de cuidados intensivos para cuidados de seguimiento de apoyo. Se descubrio una colonia de especies de Clostridium en el brazo de esta paciente, mostrando una mejoria significativa despues de unos dias de atencion. EnglishPresentation of botulism in adults is extremely rare and symptoms can be easily confused for symptoms of acute stroke, Guillain-Barre, or myasthenia gravis. The purpose of this clinical case report is to ensure adult botulism will be included in the differential diagnoses for a patient with this presentation so swift and accurate care can be provided to ensure optimal patient outcome. A 41-year-old-female presented with complaints of sudden onset of difficulty speaking. The patient reports a history of intravenous polysubstance abuse and symptoms progressed to bilateral facial weakness, ptosis, and external ophthalmoplegia. With no notable findings from a non-contrast computed tomography and magnetic resonance imaging and given the symptoms, a diagnosis of wound botulism from intravenous drug use was made. Botulism antitoxin was given and the patient was admitted into the intensive care unit for supportive follow-up care. A colony of Clostridium species was discovered in this patient’s arm and the patient showed significant improvement after a few days of care.

Clinical and epidemiological characteristics of botulism in the Astrakhan region for the period from 2013 to 2019 are presented. 37 people with a diagnosis of Botulism were under observation. It was found that most often (28 (75.7%) cases) patients associated their disease with the use of canned home-made products. Canned vegetables (cucumbers, tomatoes, vegetable salad, eggplant, cabbage) were consumed by 18 (48.7%) people, mushrooms 10 (27%), dried fish 7 (18.9%), herring-balyk 1 (2.7%) and home-made liver pate-1 (2.7%) patient. The incubation period in the observed patients was on average 2.4 days. It lasted 12 days in 24 (64.9%) patients, 3-5 days in 12 (32.4%) patients, and 6 days in 1 (2.7%) patient. According to the severity of the condition, 17 (45.9%) patients were hospitalized in the intensive care unit. Severe course of the disease was in 17 (45.9%) patients, moderate-in 20 (54.1%) patients. Early and persistent symptoms in all patients were marked muscle weakness, in 78.4% of patients dizziness, in 83.8% of patients difficulty walking and unsteadiness of gait. In 34 (91.9%) patients, the most pronounced symptoms were ophthalmoplegic: blurred vision, fog, flies in front of the eyes, inability to read the text. In General, up to 10 cases of botulism are registered annually in the Astrakhan region. Almost half of the patients (45.9%) have severe botulism. The disease is mostly sporadic and is associated with the use of canned vegetables and home-made mushrooms. In addition, cases of botulism associated with the use of dried fish have become more frequent in the Astrakhan region. Late hospitalization was observed in 1/3 of patients (11 (29.7%) cases) with botulism. This is due to untimely diagnosis at the pre-hospital stage and late access of patients to medical care.

Summary Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.

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.

We aim to identify possible biological, social, and economic factors that could influence the prevalence of foodborne botulism (FB). The objective of this article is to assess epidemiological peculiarities of FB in Ukraine from 1955 to 2018 using national epidemiological surveillance data. This article presents an epidemiological descriptive population-based study of the epidemiology of FB using correlation analysis. From 1955 to 2018, 8614 cases of botulism were recorded in Ukraine causing 659 deaths. The distribution of types of botulism toxins is represented by type A (7.97%), B (59.64%), suspected as C (0.56%), E (25.47%), others (5.33%), and unidentified (1.04%). From 1990 to 2015, the rate correlation between Human Development Index (HDI) and incidence of botulism was -0.75 ± 0.20. Homemade canned meat and fish continue to be the leading causes of botulism in Ukraine. Cases related to commercial food were rare or absent, but in recent years (2017-2018), their percentage has increased to 32.56%. The HDI and botulism have an inverse mathematical correlation and predictable logical relationship: with an HDI increase, the incidence of FB decreased. In general, food botulism in Ukraine is related to traditional socioeconomic factors related to cultural food habits. In the face of declining living standards and uncertainty that food products will be physically or economically available, homemade preservation increases. Home food preservation is a major cause of botulism in Ukraine. The elimination of FB is possible in Ukraine only with the complete cessation of home canning and state control over the manufacture and sale of commercial canned products.

Purpose of review The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. Recent findings Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers. Summary Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient's history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.

Botulinum neurotoxin type A (BoNT/A) is traditional medicine and well known for its therapeutic use as an anesthetic and in cosmetic applications that work through the inhibition of acetylcholine exocytosis in neuronal cells. BoNT/A also has the potential to function as a biological weapon due to its high mortality rate and ease of dispersal. Emerging evidence suggests that BoNT/A exhibits biological effects on nonneuronal cells. In cytology experiments, BoNT/A induces global gene expression alterations. However, pulmonary effects from exposure to aerosolized BoNT/A have not been evaluated. This study investigated the global transcriptional profile of lung tissues after botulism inhalation. A mice model of inhaled botulism was established using intratracheal exposure to aerosolized BoNT/A and described through histological examination and flow cytometry. Transcriptomic analysis revealed that genes related to acute inflammatory responses were upregulated at 12-h postexposure. Increased expression of multiple anti-inflammatory marker genes and decreased expression of pro-inflammatory marker genes were observed at 48- to 72-h postexposure, underscoring a transcriptional shift toward a pro-reparative phenotype. Histological examination and cell proportions analysis mirrored these expression patterns. Accordingly, the orchestration of a quick phenotype transition prompted by BoNT/A may have the potential for promoting the resolution of the inflammatory lung. To our knowledge, this study represents the first research to investigate the pulmonary transcriptional responses of aerosolized BoNT/A exposure; the results may provide new insights in elucidating the molecular mechanism for pulmonary inhaled botulism and highlight the potential therapeutic application of BoNT/A in mitigating inflammatory conditions.

A 13-year-old boy presented to an urgent care clinic with 4 days of fatigue, vomiting, shortness of breath, and difficulty ambulating. Aside from a recent viral upper respiratory infection, he was healthy. He was sent to the emergency department, where weakness was noted in his lower extremities and right arm. Within hours, he declined, was emergently intubated for respiratory distress, and was transferred to a children's hospital.

Background Botulism occurs periodically or in outbreaks in Iran. Botulism is lethal and accordingly a considerable issue in environmental health, although it is uncommon. This study was performed to evaluate the potential predictive factors in foodborne botulism in a 10-year span. Materials and methods All medical records from patients with foodborne botulism admitted to Imam Reza Hospital in 10 years (2005–2015) were analyzed retrospectively. Results 61 cases were included (38 men, mean age ± SD 28.93 ± 19.14 years). All cases were treated with antitoxin. 6.6% of cases died. Canned beans were correlated with the admission to intensive care unit (ICU), and also, it increased the length of ICU stay significantly (P = 0.007 and 0.023, respectively). The incidence of dizziness and diplopia significantly induced excess demands for higher doses of antitoxin (P = 0.038 and 0.023, respectively). Risk of dysphagia was remarkably higher in cases with ptosis (P = 0.039, odds ratio: 3). While in this study, time elapsed between the onset of clinical manifestations and antitoxin administration was correlated with the occurrence of dysphagia, constipation, and blurred vision, and early treatment did not improve the outcomes. Multiple analysis of potential variables by a logistic regression model disclosed that the independent significant factors affecting mortality were the need for mechanical ventilation (P = 0.000), dyspnea (P = 0.044), general weakness (P = 0.044), and lack of consciousness (P = 0.008) at the time of admission. Conclusions Taking clinical signs and symptoms into account upon patient arrival is important and, of course, is a key to further management in the emergency setting. How to cite this article Saeidi S, Dadpour B, Jarahi L, Ghamsari AA, Nooghabi MN. Clinical Predictive Values in Botulism: A 10-year Survey. Indian J Crit Care Med 2021;25(4):411–415.

Clostridium (C.) botulinum is the causative agent of foodborne poisoning such as botulism, which includes high mortality rates in animals and humans. Probiotic bacteria play critically functional roles in food matrices, as well as agricultural, clinical and nutritional fields. In this review, potentials of various probiotic bacteria and their metabolites to prevent C. botulinum toxicity are reviewed. For this purpose, an introduction about C. botulinum and its mechanisms of action is provided. After a short introduction of probiotic bacteria and their beneficial health effects on humans, the bacterial mechanisms of their action are reviewed. Then bacteriocin production by probiotic bacteria is described. After description of C. botulinum and its neurotoxins, effects of probiotic bacteria on C. botulinum are reviewed with a special focus on effects of the bacterial bacteriocins on this pathogen. Furthermore, physicochemical factors, which show great effects on potential of nisin to prevent growth and toxin production of the bacteria, are introduced. This study has shown that probiotic bacteria and their bacteriocins can be effective on growth, toxin formation and toxicity of C. botulinum. In conclusion, probiotic use in food safety studies can be effective in preventing or treating toxicity of C. botulinum.

Botulism is a rare but potentially life-threatening neuroparalytic syndrome caused by the action of a neurotoxin caused by the bacterium Clostridium botulinum. Early diagnosis and early treatment is important. In cases where botulism occurs sporadically, there is a need for easily applicable and rapid methods for diagnosis. The patient was admitted to the emergency department with complaints of dysarthria and sleepiness at the age of 7 years. During follow-up, bilateral ptosis, nystagmus, facial asymmetry, double vision and dysphagia developed. Electroneuromyography (ENMG) was performed in our case. It was evaluated as compatible with botulismus. Antitoxin treatment was performed. Six hours after the end of the antitoxin infusion, the ocular findings regressed, swallowing function improved, and dysarthric speech improved. Inconclusion, ENMG is found to be helpful in treatment decisions before toxin detection. Although toxin cannot be detected in patients, ENMG findings play an important role in the diagnosis of botulism.

Botulism is an acute paralytic disease caused by botulinum neurotoxin (BoNT)-mediated inhibition of neurosignaling at the neuromuscular junction. BoNTs are produced by gram positive, anaerobic, spore-forming bacteria from the genus Clostridium,most commonly Clostridium botulinum. Over the last decade, a previously uncommon form of botulism, wound botulism, has increased in prevalence possibly due to the rise in parenteral drug abuse. A 53-year-old patient with a history of drug abuse presents to a rural emergency department with rapidly progressing lower extremity weakness over the past few days. He reports a recent heroin injection into right buttock and diffuse skin-popping scarring was observed throughout. The patient was treated with heptavalent botulinum antitoxin obtained from the Center for Disease Control and Prevention (CDC). A right thigh abscess culture was positive for Clostridium tertium, a left hip abscess culture was positive for methicillin-susceptible Staphylococcus aureus (MSSA), and blood culture confirmed multi-microbial bacteremia caused by Staphylococcus epidermidis and Streptococcus mitis. Serum analysis was positive for BoNT type A from a suspected concurrent Clostridium botulinum infection as C. tertium is not known to produce BoNT type A. This case report highlights the importance of early antitoxin treatment for patients with suspected wound botulism.

Botulism is a rare but serious disease, which appears in different forms. In this study, we reviewed the clinical features, laboratory data, and outcomes of patients who referred to our tertiary center.All confirmed cases of botulism referred to an academic referral center and a teaching hospital during 2009-2019, were retrospectively reviewed.Fifty-three cases of clinical or laboratory-confirmed botulism were examined in this study. Nineteen patients were confirmed by laboratory data (serotype A (89.5%) and serotype E (10.5%)). In seven cases, the cause of botulism was unclear. In two patients, systemic symptoms emerged after the therapeutic injection of botulinum neurotoxin. The majority of cases (83%) were caused by an obvious food source. In 66% of cases, the initial symptoms emerged within less than 36 h, while in 20.8% of cases, the symptoms developed within or after 36 h; however, in seven patients that their botulism sources were unclear, the onset could not be estimated. All patients showed cranial involvement and generalized manifestation, and 49.1% had gastrointestinal symptoms. Except for two patients who were not treated due to immediate drug reactions who manifested severe hemodynamic instability, the rest of the patients were treated with trivalent antitoxin (A, B, and E). The complete resolution of the symptoms during hospitalization was documented in 50.9% of the patients. About 17% of the patients were intubated. Two patients died due to massive bilateral pulmonary thromboembolism and cardiac asystole following respiratory failure.Although the complete resolution of the symptoms usually takes several weeks, in our experience, most patients showed at least partial resolution upon discharge. Early treatment results in better outcomes.

Botulinum toxin treatment is the most frequently performed noninvasive cosmetic procedure performed in the USA. Because of its widespread use, an analysis of the adverse event (AE) profile of Botox injections is needed. The FDA Adverse Event Report System was queried using an online web-based tool to determine the top 15 adverse events reported for four Botox brand names: Botox/Botox Cosmetic, Dysport, and Xeomin. The proportional reporting ratios (PRR) and relative odds ratios (ROR) were determined. A literature review was performed for eight AEs of clinical significance: eyelid/eyebrow ptosis, asthenia, muscular weakness, facial paresis, dysphagia, botulism, and death. Botox/Botox Cosmetic had 38367 AEs. Dysport had 3582 AEs. Xeomin had 1405 AEs. All drugs with reported cases of eyelid and eyebrow ptosis had significant PRR and ROR values. The PRR and ROR values for asthenia were not significant in any of the drugs and only reached significance for Dysport for muscular weakness and dysphagia. Both Botox/Botox Cosmetic and Dysport had elevated PRRs and RORs for facial paresis and botulism. While all drugs had at least one reported case of death related to Botox injection use, none of the PRR or ROR values were significant. Known AEs for Botox injection use include eyelid/brow ptosis and muscular weakness. Feared but rare complications of Botox injection use include dysphagia, botulism, and possibly death, owing to systemic spread of the toxin. This is the first study to analyze the AE data reported to the FDA on Botox injection use. III

Systemic botulism resulting from therapeutic Botox (OnabotulinumtoxinA) injection has been rarely reported, and never in the context of pylorus injection to treat gastroparesis. We report the case of a 27-year-old female with Emery-Dreifuss muscular dystrophy who developed severe systemic botulism toxicity following the intrapyloric injection of 100 units of Botox to treat gastroparesis. The patient eventually made a full recovery.

Background: With the flourishing application of botulinum toxin cosmetically and therapeutically is the emergence of iatrogenic botulism, a new type of botulism in addition to the traditional ones. Objectives: We aim at a comprehensive review of the clinical characteristics of iatrogenic botulism. Methods: The available publications are retrieved and studied. Results: Botulinum toxin blocks cholinergic transmission in the neuromuscular junctions and autonomic ganglia. The blockade can spread from the site of tissue injection to adjacent or sometimes far off structures, resulting in inadvertent disabling or even lethal effects. On literature review, weakness and dysphagia are the commonest complications of iatrogenic botulism, whereas ophthalmological and oropharyngeal symptoms are more prevalent in the cosmetic group and dyspnea in the therapeutic group. Antitoxin therapy is required in about 20% of the patients. Diagnosis of iatrogenic botulism is primarily clinical and should not be confused with the neurological diagnoses possessing similar clinical manifestations. Vigilance to the drug formulation, dosage, and administration during botulinum toxin injection are part of the preventive measures in minimizing the occurrence of iatrogenic botulism. Conclusion: While overlapping with the traditional types of botulism, iatrogenic botulism carries its unique clinical characteristics.

Botulinum toxin is a neurotoxin produced by Clostridium botulinum and some other relative species. It causes a lethal disease called botulism. It can enter the body via infections by Clostridium (e.g. wound and children botulism) or by direct contact with the toxin or eating contaminated food (food-borne botulism). Botulinum toxin is also considered as a relevant biological warfare agent with an expected high number of causalities when misused for bioterrorist or military purposes. The current paper surveys the actual knowledge about botulinum toxin pathogenesis, the manifestation of poisoning, and current trends in diagnostics and therapeutics. Relevant and recent literature is summarized in this paper.

Professional activity of intensivists consistently ranks high among the most «risky» areas of medicine. In 6 out of 89 criminal «iatrogenic» cases initiated by investigative authorities in the Moscow region in 2016–2018 anesthesiological or intensive care in the ICU was the subject of investigation. In 4 of these 6 cases, iatrogenic complications were detected during the forensic examination. Intensivist is considered an attending doctor and therefore holds responsibility for defects in the provision of medical care and its adverse outcome.The purpose of the study is to outline the professional risks in the work of an intensivist and identify ways to reduce them by using a case study with a fatal outcome, which led to criminal proceedings.Materials and methods. We studied and analyzed the criminal case files which included the complaint of the patient’s relatives with the prosecutor’s office, the explanations and interrogation records of the patient’s relatives (4) and healthcare workers (6), the minutes of the Morbidity and Mortality conference, the expert report on patient care quality issued by health insurance company, the final report of sanitary and epidemiological examination, autopsy protocol, emergency call files (3), the inpatient medical records, outpatient records and the final report of Commission of forensic medical examination.Results. Defects in the provision of medical care were not identified. The differential diagnosis was performed correctly. The severity of the patient's condition was due to brain infarction and associated abnormalities. Underdiagnosis of botulism did not affect the outcome of the disease and was not the cause of death of the patient.Conclusion. The reasons for filing a complaint with the Prosecutor's office and initiating a criminal case were organizational shortcomings and ethical and deontological aspects.

The aim of the work was to present two clinical cases of botulism: the atypical course and the severe course with late administration of heptavalent botulinum antitoxin, which still had a significant positive clinical effect and contributed to a faster recovery of patients. The modern scientific literature regarding botulism was analyzed, hospital records of patients with botulism were presented. Conclusions. Characteristic symptoms of botulism are sometimes absent, for example, the inability to read the fine print, which is a significant challenge in diagnosing the disease. Atonic tetraparesis, dysmetabolic polyneuropathy of the lower extremities may be occasionally developed as a complication of botulism. In suspected case of botulism, even with a fuzzy epidemiological anamnesis and an unusual clinical picture, a targeted, specific examination and immediate administration of antitoxins are indicated. The heptavalent botulinum antitoxin has a significant clinical effect, contributes to recovery even at the late stages of a patient hospitalization.

Skin and soft tissue infections (SSTI) are the most common infections encountered in community and healthcare settings. There are different risk factors associated with SSTI including trauma, surgery, skin disease, immune defects and injection drug usage. Intravenous drug users (IDU) are frequently susceptible to SSTI due to unsafe injection practices, sharing of needles and low immunity. Intravenous drug usage is most common in young and homeless people globally. Although Staphylococcus aureus and Streptococcus pyogenes are the commonest pathogens however there are serious infections caused by rare pathogens such as botulism by Clostridium botulinum and tetanus by Clostridium Tetni. Prompt diagnosis and accurate management at the healthcare level will help in alleviating the symptoms and improve the outcomes. The continuous education and enhancing the implementation of prevention strategies are the responsibilities of local and national government to reduce the harmful drug use. In this review we are addressing the current challenges associated with causative pathogens for SSTI in IDU and their management and preventive strategies.

Background Miller Fisher syndrome is a variant of acute inflammatory demyelinating polyneuropathy classically characterized by ataxia, ophthalmoplegia, and areflexia. Miller Fisher syndrome can present with uncommon symptoms such as bulbar, facial, and somatic muscle palsies and micturition disturbance. Case presentation We describe the case of a 76-year-old white man with new-onset ataxia, stridor, areflexia, and upper and lower extremity weakness who required intubation at presentation. An initial work-up including imaging studies and serum tests was inconclusive. Eventually, neurophysiological testing and cerebrospinal fluid analysis suggested a diagnosis of Miller Fisher syndrome. Our patient responded to treatment with intravenous immunoglobulin and supportive therapy. Conclusion The occurrence of acute or subacute descending paralysis with involvement of bulbar muscles and respiratory failure can often divert clinicians to a diagnosis of neuromuscular junction disorders (such as botulism or myasthenia gravis), vascular causes like stroke, or electrolyte and metabolic abnormalities. Early identification of Miller Fisher syndrome with appropriate testing is essential to prompt treatment and prevention of further, potentially fatal, deterioration.

Background: Botulism is a severe neuroparalytic disease caused by toxins produced by several Clostridium species. This work presents the surveillance results of botulism in Iran, with the distribution of the cases by regions and by vehicle of transmission. Methods: We describe the findings of the Centers for Disease Control and Prevention (CDC) surveillance on 2037 suspected cases of food-borne botulism during 2007–2017. Results: A total of 252 (12.3%) cases were confirmed to food-borne botulism. The mean annual incidence per 100,000 Iranian Natives was 7.1 cases for male individuals and 3.3 cases for female individuals. All botulism events were confirmed to be foodborne. The most commonly implicated food was home-prepared traditional processed fish product, followed by the consumption of commercially canned products and non-pasteurized dairy products. Forty-eight (19%) fatal botulism were reported which, the case-fatality rate declined from 4.5% to 0.7% during the study period. Conclusion: Laboratory-based diagnosis of botulism is an imperative procedure to elucidate cases, particularly food-borne botulism, to identify toxins in food and confirm clinical diagnosis, helping sanitary control measures. In addition, educational materials related to botulism prevention should be disseminated to different communities.