Adult Intestinal Toxemia Botulism

Harris, Richard A.; Anniballi, Fabrizio; Austin, John W.

doi:10.3390/toxins12020081

Cited by 34 publications

(26 citation statements)

References 77 publications

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“…More rarely, botulism by intestinal colonization occurs in infants above 1 year and in adults (adult intestinal toxemia botulism). Predisposing factors allowing spore germination, bacterial growth, and toxin production in the intestine include recent use of antibiotics, which can perturb the resident microbiota, previous gastric and/or intestinal surgery, and bowel anomalies such as Meckel’s diverticulum [ 22 , 95 , 115 ]. In a limited number of cases, the pathophysiology of botulism by intestinal colonization is similar to that of infant botulism.…”

Section: Detection Of Bont In Sera Of Patients With Intestinal Colmentioning

confidence: 99%

“…More rarely, botulism by intestinal colonization (also called intestinal toxemia botulism) occurs in children above 1 year and adults. Factors that might impair the regular intestinal microflora such as bowel surgery, bowel anomalies, antibiotics, chemotherapy, radiation, immunosuppressive drugs, and altered nutritional patterns have been reported to be predisposing factors for adult intestinal toxemia botulism [ 22 ]. Wound botulism results from a wound contaminated with C. botulinum spores and subsequent in situ growth of C. botulinum and BoNT production.…”

Section: Introductionmentioning

confidence: 99%

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Toxemia in Human Naturally Acquired Botulism

Rasetti-Escargueil

Lemichez

Popoff

2020

Toxins

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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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Section: Detection Of Bont In Sera Of Patients With Intestinal Colmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Toxemia in Human Naturally Acquired Botulism

Rasetti-Escargueil

Lemichez

Popoff

2020

Toxins

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“…Typically, patients that have some anatomical or functional abnormalities of the intestine or are subjected to prolonged antimicrobial therapies, can allow bacterial colonization. Thus, the adult intestinal colonization botulism is the result of the production of the toxin in the intestinal lumen of adults that leads to gut microbiota dysbiosis [40][41][42].…”

Section: Resultsmentioning

confidence: 99%

“…The criteria for laboratory conferment of botulism for all the clinical forms are based on the detection of BoNTs in serum, feces, and/or food samples and on the identification of Clostridi, which produces BoNTs in feces, wound sites, and in food samples (Figure 3) [38,45,47]. The electromyogram shows the typical results of exposure to botulism including normal nerve conduction velocity, normal sensory nerve function, a pattern of short small-amplitude motor potentials, and a clear incremental response (facilitation) to repetitive stimulation often seen only at 50 Hz [40]. The CT/CT-Angio imaging of the brain, spine, and chest are normal in botulism and the CSF is unchanged in botulism and autoantibodies are not present in botulism [38,41,45].…”

Section: Poliomyelitis Reye's Syndrome Tick Paralysis Werdnig-hoffman Diseasementioning

confidence: 99%

Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

et al. 2021

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Botulinum toxins or neurotoxins (BoNTs) are the most potent neurotoxins known, and are currently extensively studied, not only for their potential lethality, but also for their possible therapeutic and cosmetic uses. Currently, seven types of antigenically distinct toxins are known and characterized, produced by a rod-shaped bacterium, Clostridium botulinum. Human poisoning by botulism (presenting with severe neuromuscular paralytic disease) is usually caused by toxins A, B, E, and F type. Poisoning from contaminated food preparations is the most common cause of noniatrogenic botulism. The spores are highly resistant to heat but are easily destroyed at 80 °C for thirty minutes. Type A and B toxins are resistant to digestion by the enzymes of the gastrointestinal system. After their entry, BoNTs irreversibly bind to cholinergic nerve endings and block the release of acetylcholine from the synapses. In contrast, in wound botulism, the neurotoxin is instead product by the growth of C.botulium in infected tissues. The contamination by BoNT inhalation does not occur by a natural route but it is certainly the most dangerous. It can be caused by the dispersion of the botulinum toxin in the atmosphere in the form of an aerosol and therefore can be deliberately used for bioterrorist purposes (e.g., during CBRN (chemical, biological, radiological, and nuclear) unconventional events). In addition, BoNTs are currently used to treat a variety of diseases or alleviate their symptoms, such as the onabotulinumtoxinA for migraine attacks and for cosmetic use. Indeed, this paper aims to report on updated knowledge of BoNTs, both their toxicological mechanisms and their pharmacological action.

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“….As concerns other forms of botulism, it is acknowledged that intestinal botulism (due to intestinal colonization by neurotoxigenic clostridia) can mimic a surgical emergency [ 11 ]. Three cases have been reported of intestinal botulism in adult patients presenting with acute abdominal symptoms [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Foodborne botulism presenting as small bowel obstruction: a case report

et al. 2021

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Background Small bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment. Case presentation A 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution. Conclusions Though very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.

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Adult Intestinal Toxemia Botulism

Cited by 34 publications

References 77 publications

Toxemia in Human Naturally Acquired Botulism

Toxemia in Human Naturally Acquired Botulism

Botulinum Neurotoxins (BoNTs) and Their Biological, Pharmacological, and Toxicological Issues: A Scoping Review

Foodborne botulism presenting as small bowel obstruction: a case report

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