Those olives were strongly positive for botulinum neurotoxin type B, and the gastric content and fecal samples of both patients tested by multiplex PCR were positive for Clostridium botulinum type B. In addition, the serum of patient 1 was weakly positive for botulinum neurotoxin [ 1 ]. Botulinum toxin binds irreversibly to presynaptic plates of the neuromuscular junction causing dysfunction of voluntary muscles, inner organs and the autonomic nervous system.
In addition, the toxin may modify the inhibition in the central nervous system, possibly due to altered afferent input from the muscle spindles [ 2 ]. Botulinum antitoxin neutralizes only the circulating toxin and should thus be administrated as soon as possible before completing the laboratory tests. The diagnosis must therefore be based on clinical findings; bulbar palsy with descending paralysis is the most typical finding.
Especially the combination of bilateral drooping of the eye lids, absent gag reflex and respiratory failure with relatively well preserved limb forces and a clear mental status are suggestive of botulism and, more uncommonly, of other possible diagnoses like brainstem ischemia or polyradiculitis.
According to the literature, as a sign of presynaptic transmission defect, high-frequency RNS shows often an incremental motor response in botulism patients.
However, no increment was observed in our two cases, possibly due to largely destroyed endplates. Neurological symptoms may develop acutely in food-borne botulism and may therefore be misinterpreted as brainstem ischemia. This may delay antitoxin treatment and worsen the prognosis of the patient. National Center for Biotechnology Information , U. Journal List Case Rep Neurol v. Case Rep Neurol. BONT genes can also be directly amplified from food and clinical samples if organisms are still present there.
As Botulinum toxin is an important bioterrorism agent, there is an urgent need to develop in-house diagnostic asssay. The article by Jain et al 8 published in this issue was aimed to develop an immunodetection system for botulinum neurotoxin serotype B using synthetic gene approach.
An ELISA test was developed for the detection of botulinum neurotoxin and the minimum detection limit was also estimated. ELISA is a potential technique which can replace the bioassay. The developed ELISA system was highly specific, rapid and could be applied to the testing of a large number of specimens. Various ELISA formats have been developed utilizing fluorescent or chemiluminescent substrates to improve assay sensitivity fold but require more specialized equipment 9. Our group 10 described a multiplex PCR for the simultaneous detection of botulinum neurotoxin and perfringens toxin genes.
These methods however, can be made available at reference centres only. Therefore, ELISA developed by Jain et al 8 is an important step towards rapid diagnosis of botulinum toxin in food and clinical samples. The number of cases of foodborne and infant botulism has changed little in recent years, but wound botulism has increased because of the use of black tar heroin, especially in California Although the botulinum toxin is destroyed by thorough cooking over the course of a few minutes, the spore itself is not killed by the temperature reached with normal sea-level-pressure boiling, leaving it free to grow and produce the toxin when conditions are right.
The only known prevention measure for infant botulism is to avoid feeding honey to infants less than 12 months of age.
Treatment may include antitoxins, intensive medical care or surgery of infected wounds. Therefore, timely diagnosis can be life saving. National Center for Biotechnology Information , U. Indian J Med Res. Electrodiagnosis of infant botulism. J Child Neurol1 ; Supportive care is the mainstay of therapy.
Infants with botulism should stay in an intensive care unit because they frequently require airway management, nasogastric tube feedings, and physical and occupational therapy. Parents are usually permitted hour visitation and should be encouraged to participate in the care of their infant.
A variety of complications can occur in these infants during hospitalization Table 4. Historically, administration of antitoxin involved an equine-derived product.
Side effects, including anaphylaxis, occurred in 20 percent of patients, and the antitoxin is no longer considered beneficial given the self-limiting course of infant botulism. The use of botulinum immune globulin in infants has successfully reduced the time spent in the hospital and the need for mechanical ventilation and tube feeding.
The prognosis is excellent, with a case-fatality rate of less than 2 percent. Diaphragmatic function returns before peripheral muscle recovery. For infants who require mechanical ventilation, the average duration is 23 days. On average, infants were able to feed orally 51 days from admission. The average hospital stay is 44 days. Persistent hypotonia may be present at the time of hospital discharge, but full recovery can be expected with time. Relapse of infant botulism has been reported in infants demonstrating complete resolution of symptoms.
No predictors of relapse were identified. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more. The authors indicate that they do not have any conflicts of interest. Sources of funding: none reported. Address correspondence to Randy Hinkle, D.
Reprints are not available from the authors. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med. The large intestine as the site of Clostridium botulinum colonization in human infant botulism. J Infect Dis. Adv Pediatr Infect Dis. Midura TF. Update: infant botulism. Clin Microbiol Rev. Infant botulism.
Clin Pediatr. Heart Lung. Hatheway CL. Botulism: the present status of the disease. Curr Top Microbiol Immunol. Food and environ mental aspects of infant botulism in California. Rev Infect Dis. Survey of infant foods for Clostridium botulinum spores. J Assoc Off Anal Chem. Section Navigation. Facebook Twitter LinkedIn Syndicate. Diagnosis and Treatment. Minus Related Pages. Links with this icon indicate that you are leaving the CDC website.
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