Medical Countermeasures for Intoxication by Botulinum Neurotoxin
Brian J. Lukey, James A. Romano, Salem Harry in Chemical Warfare Agents, 2019
Systematic research on the mechanism of action of botulinum neurotoxin (BoNT) began with the work of Justinus Kerner, a German medical officer, who provided the first complete description of botulism while investigating outbreaks of foodborne illnesses in southwestern Germany that were linked to consumption of sausages. The seminal work of van Ermengem revealed that foodborne botulism is intoxication, not an infection, and that the toxin is not destroyed by the harsh conditions in the gastrointestinal tract. The gene coding for the first non-clostridial BoNT-like toxin was identified in Weisella oryzae, a Gram-positive non-spore-forming bacterium found in fermented rice. The exquisite selectivity of BoNT led to its use as a precise chemical tool to identify the role of cholinergic systems in synaptic transmission and for elucidating the role of neural activity and acetylcholine (ACh) secretion in mediating the consequences of disuse atrophy. The clinical syndrome of botulism reflects toxin-induced blockade of ACh release from neuromuscular and neuroeffector junctions.
Neuromuscular Junction Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
Myasthenia gravis (MG) is an acquired autoimmune disorder characterized by fatigable and fluctuating muscle weakness preferentially affecting certain muscle groups. In most cases, it results from serum antibodies targeting the acetylcholine receptors on the postsynaptic membrane of the neuromuscular junction. Treatment of MG consists of symptomatic control with cholinesterase inhibitors and immunotherapies. Myasthenic crisis is respiratory failure as a result of severe respiratory muscle weakness requiring intubation and mechanical ventilation. Chest computed tomography or magnetic resonance imaging should be done in every MG patient to evaluate for the presence of thymoma. Plasma exchange is mainly used in patients who are in crisis, prior to thymectomy or in combination with high-dose corticosteroids to prevent a steroid-induced exacerbation. Congenital myasthenic syndrome is a heterogeneous group of disorders caused by various genetic mutations resulting in failed neuromuscular transmission. Botulism is caused by neurotoxins released by Clostridium botulinum , a gram-positive, spore-forming anaerobic bacterium.
The history of botulinum toxin
Michael Parker in Fundamentals for Cosmetic Practice, 2022
In 1820, a German medical officer, Justinius Kerner, first described the effects of botulism after systematically observing the effects of the disease then known as “sausage poisoning”. He discovered through numerous experiments on both himself and animal models that botulinum toxin would interrupt somatic and autonomic nerves without having any impact on the sensory or cognitive functions of the individual tested. Seventy-five years later in 1895, Professor Emile van Ermengem identified Clostridium botulinum as the causative organism for the disease botulism after 34 funeral attendees were noted to develop symptoms of this disease after eating partially salted ham. The medical implications of botulinum toxin were first successfully utilised in the 1970s by Dr Alan Scott. His initial studies on primates revealed that injecting mere picograms of the toxin into the muscles around the eye caused long-lasting paralysis with no significant side effects. The cosmetic implications for botulinum toxin were identified in the late 1980s by Dr Richard Clark.
Foodborne botulism: an evolving public health challenge
Published in Infectious Diseases, 2019
Concetta Scalfaro, Bruna Auricchio, Dario De Medici, Fabrizio Anniballi
Foodborne botulism is a life-threatening disease caused by the ingestion of food containing preformed botulinum neurotoxins, the most potent natural poisons known to humans. On the basis of the new challenges in management of the diseases as well as considering the potential use of botulinum toxins as biological weapons, foodborne botulism is still considered a public health emergency. Each suspected case should be immediately notified to public health authorities with the aim of preparing a prompt response. With the aim of improving botulism surveillance systems, health authorities as well as governmental organizations should enhance national and international cooperation. Education and training activities devoted to operators involved in the disease management, and to general population, may significantly contribute to strengthen the system.
New targets in the search for preventive and therapeutic agents for botulism
Published in Expert Review of Anti-infective Therapy, 2014
Fabrizio Anniballi, Davide Lonati, Alfonsina Fiore, Bruna Auricchio, Dario De Medici, Carlo Alessandro Locatelli
Botulism is a severe neuroparalytic disease resulting from exposure to one of the most poisonous toxins to humans. Because of this high potency and the use of toxins as biological weapons, botulism is a public health concern and each case represents an emergency. Current therapy involves respiratory supportive care and anti-toxins administration. As a preventive measure, vaccination against toxins represents an effective strategy but is undesirable due the rarity of botulism and the effectiveness of toxins in treating several neuromuscular disorders. This paper summarizes the current issues in botulism treatment and prevention, highlighting the challenge for future researches.
Botulism Outbreak in a Regional Community Hospital: Lessons Learned in Transfer and Transport Considerations
Published in Prehospital Emergency Care, 2019
William Krebs, Terri Higgins, Martha Buckley, James J. Augustine, Bradley D. Raetzke, Howard A. Werman
Botulism is a potentially lethal disease caused by a toxin released by Clostridium botulinum. Outbreaks of botulism from food sources can lead to a Mass Casualty Incident (MCI) involving sometimes hundreds of individuals. We report on a recent outbreak of botulism treated at a regional community hospital with a focus on emergency medical services (EMS) response and transport considerations. Case Presentation: There were 53 patient evaluated for botulism at the sending facility. In total, 11 botulism exposures required intubation at the sending facility. Twenty-four patients were ultimately transported by critical care capable ALS crews with the majority (16) of these transports occurred in the first 24 hours. There was one fatality in the first days of the outbreak and a second death that occurred in a patient who died after long-term acute care (LTAC) placement several months after hospital discharge. Conclusion: Local EMS providers and public safety officers have a critical role in identifying and following up on potentially exposed botulism cases. The organization of transporting agencies and the logistics of transfer turned out to be 2 opportunities for improvement in response to this mass casualty incident.
Related Knowledge Centers
- Acetylcholinesterase
- Diplopia
- Gastrointestinal Tract
- Neuromuscular Junction
- Clostridium Infections
- Foodborne Diseases
- Neuromuscular Junction Diseases