Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021

Abstract

Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. Botulinum neurotoxin, which inhibits acetylcholine release at the neuromuscular junction, is produced by the anaerobic, gram-positive bacterium Clostridium botulinum and, rarely, by related species (C. baratii and C. butyricum). Exposure to the neurotoxin occurs through ingestion of toxin (foodborne botulism), bacterial colonization of a wound (wound botulism) or the intestines (infant botulism and adult intestinal colonization botulism), and high-concentration cosmetic or therapeutic injections of toxin (iatrogenic botulism). In addition, concerns have been raised about the possibility of a bioterrorism event involving toxin exposure through intentional contamination of food or drink or through aerosolization. Neurologic symptoms are similar regardless of exposure route. Treatment involves supportive care, intubation and mechanical ventilation when necessary, and administration of botulinum antitoxin. Certain neurological diseases (e.g., myasthenia gravis and Guillain-Barré syndrome) have signs and symptoms that overlap with botulism. Before the publication of these guidelines, no comprehensive clinical care guidelines existed for treating botulism. These evidence-based guidelines provide health care providers with recommended best practices for diagnosing, monitoring, and treating single cases or outbreaks of foodborne, wound, and inhalational botulism and were developed after a multiyear process involving several systematic reviews and expert input.

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

“…Initial symptoms include fatigue, weakness, and dizziness followed by obvious cranial nerve dysfunction IX, X, XI, and XII with blurred vision due to dilation of the pupil, diplopia, and photophobia, drooping eyelids with symptoms of difficulty in articulation and speech. Symptoms may include vomiting, diarrhea or constipation, and bloating [30]. This is followed by paralysis of skeletal muscles such as those of the arms and legs with symmetrical progressive weakness.…”

“…This is followed by paralysis of skeletal muscles such as those of the arms and legs with symmetrical progressive weakness. The completion of the symptomatology is sudden respiratory failure (Figure 2) [30,31].…”

“…During the illness, the child's state of consciousness remains intact, and the central nervous system is not affected, while the possible appearance of fever is a consequence of concomitant infections. The typical sign of the clinical picture of infantile botulism is instead generalized paralysis involving the cranial nerves [30,36,38,39]. Adult intestinal toxemia is a very rare kind of botulism.…”

Mild Botulism From Illicitly Brewed Alcohol in a Large Prison Outbreak in Mississippi

“…In addition, low levels of botulinum toxin in human serum may be enough to cause symptomatic disease but may be below the mouse bioassay limit of detection. So it is not uncommon for patients fitting the description of botulism to test negative ( 16 , 17 ).…”

Foodborne Botulism Outbreaks in the United States, 2001–2017

“…Emergency preparedness planning by hospitals and local and state public health officials should incorporate consideration of such concerns into emergency planning. Clinical, laboratory diagnostic, and emergency preparedness considerations for botulism are comprehensively addressed in CDC's botulism clinical guidelines (Sobel and Rao, 2017;Rao et al, 2021).…”