Botulism in a pregnant intravenous drug abuser

Abstract

Summary A case of botulism is reported in a heroin‐abusing parturient who initially presented with lethargy and slurred speech. The diagnostic difficulty, complications, intensive care and anaesthetic management of this case are discussed, with particular reference to the pregnancy and the effects of both botulism and its empirical treatment on the fetus. A short review is provided of a condition that has seen a marked increase in its incidence since 2000.

An Integrative Approach to Computational Modelling of the Gene Regulatory Network Controlling Clostridium botulinum Type A1 Toxin Production

“…BoNTs cause botulism, a severe neuro-paralytic disease that can lead to death in humans as well as in a range of other mammals and birds [3,4]. BoNTs enter into the blood stream in one of three ways: (1) toxin production by bacteria that have colonized the digestive tract of either children less than 12 months of age (infant botulism) or individuals with a suppressed normal intestinal flora (e.g., following antibiotic treatment) including those that have anatomical or functional bowel abnormalities (Adult intestinal toxemia botulism) [2,5,6]; (2) infection and toxin formation in a wound (wound botulism) [5,7,8]; and (3) following oral ingestion of pre-formed toxin in contaminated foods (foodborne botulism) [2,5]. BoNTs target the peripheral motor nerve terminals, blocking neurotransmission by selectively hydrolysing proteins that are involved in the fusion of synaptic vesicles with the presynaptic plasma membrane, thereby preventing acetylcholine release [5,6,9–11].…”

Foodborne Botulism in Canada, 1985–2005

“…One of the patients had persistent toxemia for > 10 days during the first trimester of pregnancy and later delivered a normal infant. Five previous cases of botulism during pregnancy have been reported; none of the infants appeared to have clinical botulism at birth ( 27 – 31 ). No evidence shows that botulinum toxin can cross the placenta ( 32 ) or that the neuromuscular effects of botulinum toxin on the mother would affect the development of the fetus ( 28 ).…”

Gravidez, Aleitamento e Fármacos em Dermatologia: Tratamento Tópico

“…Existem inclusivamente relatos de mães com botulismo adquirido durante o segundo ou terceiro trimestres da gestação em que os fetos não foram afetados, parecendo por isso improvável que a toxina atravesse a barreira placentária. [65][66][67][68][69] Apesar de a exposição sistémica à toxina botulínica ser improvável pela injeção intramuscular local, o seu uso durante a amamentação não é recomendado. Apesar desta recomendação, há um caso descrito de botulismo sistémico numa mulher a amamentar, cujos níveis de toxina eram detetáveis no sangue, mas não no leite.…”