Diplopia as the primary presentation of foodborne botulism

Khakshoor, Hamid; Moghaddam, Ali Akbar Saber; Vejdani, Amir Hossein; Armstrong, Blair K.; Moshirfar, Majid

doi:10.4103/0974-620x.99375

Cited by 5 publications

(6 citation statements)

References 6 publications

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“…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].…”

Section: Resultsmentioning

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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Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“…The different complaints reported by our patients were initially believed to be coincidental occurrences of distinct medical conditions. Our male patient was admitted for diplopia, a rare initial manifestation 8 , 9 . In line with most reports, gastrointestinal symptoms preceded the onset of neurological symptoms in our female patient, and during the disease, constipation was a relevant issue experienced by both patients.…”

Section: Discussionmentioning

confidence: 99%

Concurrent hospitalization of a married couple presenting with distinct symptoms but diagnosed with a life-threatening infectious disease

Osawa

Maciel

2022

Rev. Soc. Bras. Med. Trop.

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We described the cases of a married couple hospitalized for distinct symptoms and developed a neuroparalytic syndrome with rapid progression. In Case 1, a 75-year-old woman was admitted for abdominal pain, diarrhea, and blurred vision. The patient developed acute respiratory failure, ptosis, and ophthalmoplegia. She died on day 15 because of an acute abdomen. In Case 2, her husband, a 71-year-old man, was admitted for diplopia. The patient developed abdominal distension and slurred speech. Later, he developed bilateral ptosis, ophthalmoparesis, and mydriasis. Botulism was suspected, and both patients received botulinum antitoxin. Our male patient survived but underwent prolonged rehabilitation.

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“…The standard treatment for botulism is based on the early administration of the trivalent (A, B and E) botulinum antitoxin 13 . The antitoxin must be administrated soon after clinical suspicion of botulism made 8 , since even mouse bioassays may not confirm the diagnosis, justifying why waiting for laboratory confirmation to initiate treatment is described as a serious mistake 14 .…”

Section: Discussionmentioning

confidence: 99%

“…Typically characterized by bilateral cranial neuropathy followed by descending flaccid symmetric paralysis and potential ventilatory impairment, the differential diagnosis of botulism can be challenging, as the disease may share some features with several other clinical entities. Moreover, the differential diagnosis includes some atypical clinical presentations of botulism itself 4 , 8 , 13 . Considering the high mortality rates related to this form of botulism, ranging from 40-50% in untreated cases 13 , prompt diagnosis is crucial for the specific treatment with the antitoxin, besides the supportive care 4 , 8 , 10 , 13 .…”

Section: Introductionmentioning

confidence: 99%

Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient

Fonseca

Carvalho

Moraes

et al. 2019

Rev. Inst. Med. trop. S. Paulo

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This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes.

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Diplopia as the primary presentation of foodborne botulism

Cited by 5 publications

References 6 publications

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

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

Concurrent hospitalization of a married couple presenting with distinct symptoms but diagnosed with a life-threatening infectious disease

Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient

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