Botulism: Clinical Features, Laboratory Insights and Management Options
Year 2024,
Volume: 6 Issue: 3, 49 - 54, 31.12.2024
Handan Çiftçi
,
Ömer Çanacık
Abstract
Botulism is a neuroparalytic disease caused by the neurotoxin produced by Clostridium botulinum (a gram-positive, anaerobic, endospore-forming bacillus). Botulinum neurotoxin (BoNT) is one of the most potent substance known, and seven toxin serotypes (serotypes A–G) have been identified. Type A serotype botulism is the most common cause of human botulism, and can occur in epidemics. Botulism occurs ingestion of food contaminated with BoNT, colonization of a wound by neurotoxin-producing Clostridium species, exposure to botulinum neurotoxins by inhalation or injection. All forms of botulism, progressive muscle weakness is usually seen, begins in the cranial nerves and progressing from proximal to distal to the extremities. This descending paralysis can lead to respiratory failure and death with involvement of the respiratory muscles. Treatment includes supportive care, intubation, and early administration of botulinum antitoxin.
References
-
Chatham-Stephens K, Fleck-Derderian S, Johnson SD,
Sobel J, Rao AK, Meaney-Delman D. Clinical features of
foodborne and wound botulism: a systematic review of the
literature, 1932–2015. Clinical Infectious Diseases. 2018;
66(suppl_1):11-6. https://doi.org/10.1093/cid/cix811
-
Rawson AM, Dempster AW, Humphreys C M, Minton
NP. Pathogenicity and virulence of Clostridium
botulinum. Virulence. 2023;14(1): 2205251. https://doi.org/10.
1080/21505594.2023.2205251
-
Sobel J. Chapter 5 Botulism. In: Lutwick LI, Lutwick SM,
editors. Beyond Anthrax, The Weaponization Of İnfectious
Disease, Humana Press. 2009.p.85–105. https://doi.
org/10.1007/978-1-59745-326-4_5
-
Dembek ZF, Smith LA, Rusnak JM. Botulism: cause,
effects, diagnosis, clinical and laboratory identification, and
treatment modalities. Disaster medicine and public health
preparedness. 2007;1(2);122-34. https://doi.org/10.1097/
DMP.0b013e318158c5fd
-
Lund BM, Peck MW. Clostridium botulinum. In: Guide to
Foodborne Pathogens, 2nd ed.; Labbé RG, García S, editors.John Wiley & Sons Ltd.: Chichester, UK. 2013; pp. 91–111.
https://doi.org/10.1002/9781118684856.ch6
-
Caleo M, Restani L. Exploiting botulinum neurotoxins for the
study of brain physiology and pathology. Toxins. 2018; 10(5);
175. https://doi.org/10.3390/toxins10050175
-
Fleck-Derderian S, Shankar M, Rao AK, Chatham-Stephens K,
Adjei S, Sobel J, Pillai S K. The epidemiology of foodborne
botulism outbreaks: a systematic review. Clinical infectious
diseases. 2018;66(suppl_1):73-S81. https://doi.org/10.1093/
cid/cix846
-
Humeau Y, Doussau F, Grant NJ, Poulain B. How botulinum and
tetanus neurotoxins block neurotransmitter release. Biochimie.
2000; 82(5); 427-446. https://doi.org/10.1016/S0300-
9084(00)00216-9
-
Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical
Guidelines for Diagnosis and Treatment of Botulism,
2021. MMWR Recommendations Rep. 2021;70(2):1-30.
-
Rao AK, Lin NH, Griese SE, Chatham-Stephens K, Badell
ML, Sobel, J. Clinical criteria to trigger suspicion for botulism:
an evidence-based tool to facilitate timely recognition of
suspected cases during sporadic events and outbreaks. Clinical
Infectious Diseases. 2018;66(suppl_1), 38-42. https://doi.
org/10.1093/cid/cix814
-
Singh M, Fernández-Frackelton M. Section Twelve: Infectious
Diseases, Chapter 118: Bacteria. In: Walls RM, Robert S,
Hockberger R S, Gausche-Hill M, Erickson TB, Wilcox SR,
editors. Rosen’s, Emergency Medicine: Concepts and Clinical
Practise, 10th Edition, Elsevier: 2023. p. 1586-1609.
-
Krebs W, Higgins T, Buckley M, Augustine JJ, Raetzke
BD, Werman HA. Botulism outbreak in a regional
community hospital: lessons learned in transfer and transport
considerations. Prehospital emergency care. 2019;23(1);49-57.
https://doi.org/10.1080/10903127.2018.1476636
-
Sobel J. The Organism And Its Toxins. Clinical Infectious
Diseases. 2005 Oct 15;41(8):1167-73. https://doi.
org/10.1086/444507.
-
Fokke C, Van Den Berg B, Drenthen J, Walgaard C, Van Doorn
PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and
validation of Brighton criteria. Brain. 2014 Jan;137(Pt 1):33-
43. https://doi.org/10.1093/brain/awt285. Epub 2013 Oct 26.
PMID: 24163275.
-
Maselli RA, Bakshi N. AAEM case report 16. Botulism.
American Association of Electrodiagnostic Medicine. Muscle
Nerve. 2000 Jul;23(7):1137-44. https://doi.org/10.1002/1097-
4598(200007)23:7<1137::aid-mus21>3.0.co;2-7. PMID:
10883013.
-
Maslanka SE, Solomon HM, Sharma S, Johnson EA. Chapter
32. Clostridium botulinum and its toxins. In: Salfinger Y,
Tortorello ML, editors. Compendium of methods for the
microbiological examination of foods: Washington, DC:
American Public Health Association Press; 2013.p.1-11.
-
Kalb SR, Baudys J, Wang D, Barr JR. Recommended mass
spectrometry-based strategies to identify botulinum neurotoxincontaining
samples. Toxins (Basel). 2015 May 19;7(5):1765-
78. https://doi.org/10.3390/toxins7051765. PMID: 25996606;
PMCID: PMC4448173.
-
Griese SE, Kisselburgh HM, Bartenfeld MT, Thomas E, Rao
AK, Sobel J, Dziuban EJ. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review.
Clin Infect Dis. 2017 Dec 27;66(suppl_1):17-29. https://doi.
org/10.1093/cid/cix812. PMID: 29293924.
-
Hutchinson D, Whyte K. Neuromuscular disease and
respiratory failure. Pract Neurol. 2008 Aug;8(4):229-37.
https://doi.org/10.1136/pn.2008.152611. PMID: 18644909.
-
Hughes RA, Bihari D. Acute neuromuscular respiratory
paralysis. J Neurol Neurosurg Psychiatry. 1993 Apr;56(4):334-
43. https://doi.org/10.1136/jnnp.56.4.334. PMID: 8482951;
PMCID: PMC1014946.
-
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks
EF. Anticipating mechanical ventilation in Guillain-Barré
syndrome. Arch Neurol. 2001 Jun;58(6):893-8. https://doi.
org/10.1001/archneur.58.6.893. PMID: 11405803.
-
Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, Gu W,
Clements J, Kim HJ, Rao AK. Safety and Improved Clinical
Outcomes in Patients Treated With New Equine-Derived
Heptavalent Botulinum Antitoxin. Clin Infect Dis. 2017 Dec
27;66(suppl_1):57-64. https://doi.org/10.1093/cid/cix816.
PMID: 29293928; PMCID: PMC5866099.
-
Botulism antitoxin heptavalent. (A, B, C, D, E, F, G)—(Equine)
[package insert]. Gaithersburg, MD: Cangene Corporation
(as Emergent Biosolutions); 2017. https://www.fda.gov/
media/85514/download
-
Badell ML, Rimawi BH, Rao AK, Jamieson DJ, Rasmussen
S, Meaney-Delman D. Botulism During Pregnancy and the
Postpartum Period: A Systematic Review. Clin Infect Dis.
2017 Dec 27;66(suppl_1):30-S37. https://doi.org/10.1093/cid/
cix813. PMID: 29293925.
-
Robinson RF, Nahata MC. Management of botulism. Ann
Pharmacother. 2003 Jan;37(1):127-31. https://doi.org/10.1345/
aph.1C034. PMID: 12503947.
-
Lee JH, Lee SI, Chung CJ, Lee JH, Lee SC, Choi SR, Oh JN,
Bae JY. The synergistic effect of gentamicin and clindamycin
on rocuronium-induced neuromuscular blockade. Korean J
Anesthesiol. 2013 Feb;64(2):143-51. https://doi.org/10.4097/
kjae.2013.64.2.143.
-
Mazuet C, Dano J, Popoff MR, Créminon C, Volland H.
Characterization of botulinum neurotoxin type A neutralizing
monoclonal antibodies and influence of their half-lives on
therapeutic activity. PLoS One. 2010 Aug 26;5(8):e12416.
https://doi.org/10.1371/journal.pone.0012416.
-
Osterhoudt KC, Alpern ER, Durbin D, Nadel F, Henretig FM.
Activated charcoal administration in a pediatric emergency
department. Pediatr Emerg Care. 2004 Aug;20(8):493-8.
https://doi.org/10.1097/01.pec.0000136064.14704.d1.
-
Paterson DL, King MA, Boyle RS, Pond SM, Whitby M,
Wright M, Henderson A. Severe botulism after eating homepreserved
asparagus. Med J Aust. 1992 Aug 17;157(4):269-70.
https://doi.org/10.5694/j.1326-5377.1992.tb137135.x. PMID:
1435446.
-
Merz B, Bigalke H, Stoll G, Naumann M. Botulism type B
presenting as pure autonomic dysfunction. Clin Auton Res.
2003 Oct;13(5):337-8. https://doi.org/10.1007/s10286-003-
0118-2. PMID: 14564656.
-
Jenzer G, Mumenthaler M, Ludin HP, Robert F. Autonomic
dysfunction in botulism B: a clinical report. Neurology. 1975
Feb;25(2):150-3. https://doi.org/10.1212/wnl.25.2.150.
-
Simpson LL. Identification of the major steps in botulinum
toxin action. Annu Rev Pharmacol Toxicol. 2004;44:167-93.
https://doi.org/10.1146/annurev.pharmtox.44.101802.121554.
-
Cohen RE, Anderson DL. Botulism: emotional impact on
patient and family. J Psychosom Res. 1986;30(3):321-6.
https://doi.org/10.1016/0022-3999(86)90009-7.
Year 2024,
Volume: 6 Issue: 3, 49 - 54, 31.12.2024
Handan Çiftçi
,
Ömer Çanacık
References
-
Chatham-Stephens K, Fleck-Derderian S, Johnson SD,
Sobel J, Rao AK, Meaney-Delman D. Clinical features of
foodborne and wound botulism: a systematic review of the
literature, 1932–2015. Clinical Infectious Diseases. 2018;
66(suppl_1):11-6. https://doi.org/10.1093/cid/cix811
-
Rawson AM, Dempster AW, Humphreys C M, Minton
NP. Pathogenicity and virulence of Clostridium
botulinum. Virulence. 2023;14(1): 2205251. https://doi.org/10.
1080/21505594.2023.2205251
-
Sobel J. Chapter 5 Botulism. In: Lutwick LI, Lutwick SM,
editors. Beyond Anthrax, The Weaponization Of İnfectious
Disease, Humana Press. 2009.p.85–105. https://doi.
org/10.1007/978-1-59745-326-4_5
-
Dembek ZF, Smith LA, Rusnak JM. Botulism: cause,
effects, diagnosis, clinical and laboratory identification, and
treatment modalities. Disaster medicine and public health
preparedness. 2007;1(2);122-34. https://doi.org/10.1097/
DMP.0b013e318158c5fd
-
Lund BM, Peck MW. Clostridium botulinum. In: Guide to
Foodborne Pathogens, 2nd ed.; Labbé RG, García S, editors.John Wiley & Sons Ltd.: Chichester, UK. 2013; pp. 91–111.
https://doi.org/10.1002/9781118684856.ch6
-
Caleo M, Restani L. Exploiting botulinum neurotoxins for the
study of brain physiology and pathology. Toxins. 2018; 10(5);
175. https://doi.org/10.3390/toxins10050175
-
Fleck-Derderian S, Shankar M, Rao AK, Chatham-Stephens K,
Adjei S, Sobel J, Pillai S K. The epidemiology of foodborne
botulism outbreaks: a systematic review. Clinical infectious
diseases. 2018;66(suppl_1):73-S81. https://doi.org/10.1093/
cid/cix846
-
Humeau Y, Doussau F, Grant NJ, Poulain B. How botulinum and
tetanus neurotoxins block neurotransmitter release. Biochimie.
2000; 82(5); 427-446. https://doi.org/10.1016/S0300-
9084(00)00216-9
-
Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical
Guidelines for Diagnosis and Treatment of Botulism,
2021. MMWR Recommendations Rep. 2021;70(2):1-30.
-
Rao AK, Lin NH, Griese SE, Chatham-Stephens K, Badell
ML, Sobel, J. Clinical criteria to trigger suspicion for botulism:
an evidence-based tool to facilitate timely recognition of
suspected cases during sporadic events and outbreaks. Clinical
Infectious Diseases. 2018;66(suppl_1), 38-42. https://doi.
org/10.1093/cid/cix814
-
Singh M, Fernández-Frackelton M. Section Twelve: Infectious
Diseases, Chapter 118: Bacteria. In: Walls RM, Robert S,
Hockberger R S, Gausche-Hill M, Erickson TB, Wilcox SR,
editors. Rosen’s, Emergency Medicine: Concepts and Clinical
Practise, 10th Edition, Elsevier: 2023. p. 1586-1609.
-
Krebs W, Higgins T, Buckley M, Augustine JJ, Raetzke
BD, Werman HA. Botulism outbreak in a regional
community hospital: lessons learned in transfer and transport
considerations. Prehospital emergency care. 2019;23(1);49-57.
https://doi.org/10.1080/10903127.2018.1476636
-
Sobel J. The Organism And Its Toxins. Clinical Infectious
Diseases. 2005 Oct 15;41(8):1167-73. https://doi.
org/10.1086/444507.
-
Fokke C, Van Den Berg B, Drenthen J, Walgaard C, Van Doorn
PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and
validation of Brighton criteria. Brain. 2014 Jan;137(Pt 1):33-
43. https://doi.org/10.1093/brain/awt285. Epub 2013 Oct 26.
PMID: 24163275.
-
Maselli RA, Bakshi N. AAEM case report 16. Botulism.
American Association of Electrodiagnostic Medicine. Muscle
Nerve. 2000 Jul;23(7):1137-44. https://doi.org/10.1002/1097-
4598(200007)23:7<1137::aid-mus21>3.0.co;2-7. PMID:
10883013.
-
Maslanka SE, Solomon HM, Sharma S, Johnson EA. Chapter
32. Clostridium botulinum and its toxins. In: Salfinger Y,
Tortorello ML, editors. Compendium of methods for the
microbiological examination of foods: Washington, DC:
American Public Health Association Press; 2013.p.1-11.
-
Kalb SR, Baudys J, Wang D, Barr JR. Recommended mass
spectrometry-based strategies to identify botulinum neurotoxincontaining
samples. Toxins (Basel). 2015 May 19;7(5):1765-
78. https://doi.org/10.3390/toxins7051765. PMID: 25996606;
PMCID: PMC4448173.
-
Griese SE, Kisselburgh HM, Bartenfeld MT, Thomas E, Rao
AK, Sobel J, Dziuban EJ. Pediatric Botulism and Use of Equine Botulinum Antitoxin in Children: A Systematic Review.
Clin Infect Dis. 2017 Dec 27;66(suppl_1):17-29. https://doi.
org/10.1093/cid/cix812. PMID: 29293924.
-
Hutchinson D, Whyte K. Neuromuscular disease and
respiratory failure. Pract Neurol. 2008 Aug;8(4):229-37.
https://doi.org/10.1136/pn.2008.152611. PMID: 18644909.
-
Hughes RA, Bihari D. Acute neuromuscular respiratory
paralysis. J Neurol Neurosurg Psychiatry. 1993 Apr;56(4):334-
43. https://doi.org/10.1136/jnnp.56.4.334. PMID: 8482951;
PMCID: PMC1014946.
-
Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks
EF. Anticipating mechanical ventilation in Guillain-Barré
syndrome. Arch Neurol. 2001 Jun;58(6):893-8. https://doi.
org/10.1001/archneur.58.6.893. PMID: 11405803.
-
Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, Gu W,
Clements J, Kim HJ, Rao AK. Safety and Improved Clinical
Outcomes in Patients Treated With New Equine-Derived
Heptavalent Botulinum Antitoxin. Clin Infect Dis. 2017 Dec
27;66(suppl_1):57-64. https://doi.org/10.1093/cid/cix816.
PMID: 29293928; PMCID: PMC5866099.
-
Botulism antitoxin heptavalent. (A, B, C, D, E, F, G)—(Equine)
[package insert]. Gaithersburg, MD: Cangene Corporation
(as Emergent Biosolutions); 2017. https://www.fda.gov/
media/85514/download
-
Badell ML, Rimawi BH, Rao AK, Jamieson DJ, Rasmussen
S, Meaney-Delman D. Botulism During Pregnancy and the
Postpartum Period: A Systematic Review. Clin Infect Dis.
2017 Dec 27;66(suppl_1):30-S37. https://doi.org/10.1093/cid/
cix813. PMID: 29293925.
-
Robinson RF, Nahata MC. Management of botulism. Ann
Pharmacother. 2003 Jan;37(1):127-31. https://doi.org/10.1345/
aph.1C034. PMID: 12503947.
-
Lee JH, Lee SI, Chung CJ, Lee JH, Lee SC, Choi SR, Oh JN,
Bae JY. The synergistic effect of gentamicin and clindamycin
on rocuronium-induced neuromuscular blockade. Korean J
Anesthesiol. 2013 Feb;64(2):143-51. https://doi.org/10.4097/
kjae.2013.64.2.143.
-
Mazuet C, Dano J, Popoff MR, Créminon C, Volland H.
Characterization of botulinum neurotoxin type A neutralizing
monoclonal antibodies and influence of their half-lives on
therapeutic activity. PLoS One. 2010 Aug 26;5(8):e12416.
https://doi.org/10.1371/journal.pone.0012416.
-
Osterhoudt KC, Alpern ER, Durbin D, Nadel F, Henretig FM.
Activated charcoal administration in a pediatric emergency
department. Pediatr Emerg Care. 2004 Aug;20(8):493-8.
https://doi.org/10.1097/01.pec.0000136064.14704.d1.
-
Paterson DL, King MA, Boyle RS, Pond SM, Whitby M,
Wright M, Henderson A. Severe botulism after eating homepreserved
asparagus. Med J Aust. 1992 Aug 17;157(4):269-70.
https://doi.org/10.5694/j.1326-5377.1992.tb137135.x. PMID:
1435446.
-
Merz B, Bigalke H, Stoll G, Naumann M. Botulism type B
presenting as pure autonomic dysfunction. Clin Auton Res.
2003 Oct;13(5):337-8. https://doi.org/10.1007/s10286-003-
0118-2. PMID: 14564656.
-
Jenzer G, Mumenthaler M, Ludin HP, Robert F. Autonomic
dysfunction in botulism B: a clinical report. Neurology. 1975
Feb;25(2):150-3. https://doi.org/10.1212/wnl.25.2.150.
-
Simpson LL. Identification of the major steps in botulinum
toxin action. Annu Rev Pharmacol Toxicol. 2004;44:167-93.
https://doi.org/10.1146/annurev.pharmtox.44.101802.121554.
-
Cohen RE, Anderson DL. Botulism: emotional impact on
patient and family. J Psychosom Res. 1986;30(3):321-6.
https://doi.org/10.1016/0022-3999(86)90009-7.