Emergency Department Identification and Critical Care Management of a Utah Prison Botulism Outbreak

Williams, Benjamin T.; Schlein, Sarah; Caravati, E. Martin; Ledyard, Holly K.; Fix, Megan L.

doi:10.1016/j.annemergmed.2013.10.027

Cited by 8 publications

(8 citation statements)

References 10 publications

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“… Antitoxin given after 144 hours: 10–36 days Carrot juice (USA 2006, A) [ 17 ] 6/6 (5 of 6 were treated with antitoxin) 8–96 38–72 ( a ) Patient 1–3: 37–41 Patient 4: ~293 Patient 5: ~1057 Antitoxin given: 54 to > 365 (one patient died). Antitoxin not given: 129 “Pruno” home-canned wine (USA 2011, A) [ 18 ] 8/3 39–89 39–89 72–99 Patient 1: 6 Patient 2: 19 Patient 3: 80 a Two patients with unknown time of ingestion. resp.…”

Section: Discussionmentioning

confidence: 99%

Foodborne botulism due to ingestion of home-canned green beans: two case reports

et al. 2018

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BackgroundFoodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The only specific treatment is the administration of botulism antitoxin. According to the German guidelines administration of antitoxin is recommended only in the first 24 hours after oral ingestion of the toxin.Case presentationA 47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans. The disease was complicated by autonomic changes like hypertension, febrile temperatures, and a paralytic ileus. The diagnosis was confirmed by identification of botulinum neurotoxin type A in the serum of the woman. In accordance with the German guidelines, antitoxin was not given due to the prolonged time interval at diagnosis. Both patients had a long intensive care unit course requiring ventilation for approximately 5 months. Finally they recovered completely.ConclusionsA full recovery from foodborne botulism is possible even in patients with intensive care lasting several months. There are only case reports indicating that administration of antitoxin may shorten the course of the disease, even if given later than 24 hours after intoxication. Due to the rarity of the disease and its rapid course there are no randomized controlled trials. Thus, evidence of the superiority of this treatment is lacking. However, the prevailing view according to the German guidelines to administer antitoxin only within 24 hours after ingestion of the toxin should be questioned in the case of progression of the disease with proof of remaining toxin in the blood.

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Section: Discussionmentioning

confidence: 99%

Foodborne botulism due to ingestion of home-canned green beans: two case reports

et al. 2018

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“…Despite the absence of randomized placebo‐controlled trials, observations suggest that early antitoxin administration could be life‐saving . Accelerated recovery may be related to: (i) neutralization of the persistent circulating toxin in the bloodstream, as previously demonstrated in a case of foodborne botulism (i.e.…”

Section: Discussionmentioning

confidence: 97%

“…Botulism management, regardless of the exposure route, relies on supportive care in an intensive care setting with provision of mechanical ventilation when indicated awaiting the recovery of the body's neuromuscular signalling mechanisms . Additionally, in wound and foodborne botulism, evidence suggests that the rapid administration of the antitoxin (optimally within 24 hr) is able to significantly reduce respiratory complications and fatalities . However, experience with iatrogenic botulism is limited and the efficiency of antitoxin therapy is controversial.…”

Section: Discussionmentioning

confidence: 99%

Iatrogenic Botulism Outbreak in Egypt due to a Counterfeit Botulinum Toxin A Preparation – A Descriptive Series of Patient Features and Outcome

Rashid

El-Mahdy

Kharoub

et al. 2018

Basic Clin Pharma Tox

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Iatrogenic botulism resulting from the substantial increase in use of botulinum neurotoxin type A (BoNT-A) treatment is rarely reported. We aimed to describe a large iatrogenic botulism outbreak in Egypt in June-July 2017. Nine patients developed botulism after receiving intramuscular injections of BoNT-A (dose: 200-300 IU) to treat cerebral palsy (N = 7), spastic dystonia (N = 1) and hyperhidrosis (N = 1). Detailed findings were available in five of nine cases. Patients were admitted to the hospital 5-10 days after the BoNT-A injection. Complaints included muscle weakness in the upper and lower limbs (N = 5), dysphagia (N = 5), dizziness (N = 2), dyspnoea (N = 2), dysphonia (N = 2), dysarthria (N = 2), fatigue (N = 1), diplopia (N = 1) and blurred vision (N = 1). Physical examination showed bilateral ptosis (N = 5), diminished gag reflex (N = 2), ophthalmoparesis (N = 1), facial paresis (N = 1) and tongue weakness (N = 1). Diagnosis was based on the patients' history and presentation and did not require any confirmatory test. On hospital admission, patients received supportive care and trivalent botulism type A/B/E antitoxin (250-500 IU) was started. No patient required mechanical ventilation. Immediate reversal of the most severe features was observed while varying degrees of peripheral muscular weakness persisted. Full recovery required 6-12 weeks. Cases were promptly reported to the Egyptian health authorities, and epidemiological investigations revealed that the outbreak was related to a recently imported highly concentrated unlicensed BoNT-A preparation sold as Neuroxin . Immediate withdrawal from the market was ordered. In conclusion, iatrogenic botulism outbreak due to counterfeit botulism toxin may result in life-threatening features. The early administration of botulism antitoxin in addition to supportive care is life-saving. Clinicians should remain mindful of the risk of systemic botulism with BoNT-A therapy.

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“…Botulism has been particularly associated with use of potatoes in the fermenting brew (21). Symptoms of botulism in these cases, including dysphagia, diplopia, dysarthria, and weakness, present 54.5 hours post-ingestion, on average (23). In the cases in a Utah outbreak of pruno-associated botulism, some involved prisoners suffered respiratory failure, and all were hospitalized (21, 23).…”

Section: Discussionmentioning

confidence: 99%

Investigation of Deaths and Injury of Prison Inmates

Knight

Stoppacher

2014

Academic Forensic Pathology

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The death of a person who is incarcerated often raises public concern, family inquiries, and media attention, and such deaths require special handling. The careful investigation of deaths of individuals held in the custody of the corrections system is necessary not only to discover any evidence of abuse, but moreover to ensure that the custodians are cleared of any false allegations of mistreatment. The same logic applies to use-of-force cases resulting in inmate injury but not fatality, in which inmate and correctional officers’ accounts of the events may be incongruous. The forensic pathologist is indispensible in both situations. The purpose of this article is to consider all aspects of the inmate's uniquely vulnerable situation relevant to the forensic pathologist, to review the various types of disease, injury and death occurring in the incarcerated and their relative prevalence, to present a 4.5-year retrospective review of inmate death investigations, and to describe best practices to be utilized in the medicolegal investigation of deaths of incarcerated individuals.

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Emergency Department Identification and Critical Care Management of a Utah Prison Botulism Outbreak

Cited by 8 publications

References 10 publications

Foodborne botulism due to ingestion of home-canned green beans: two case reports

Foodborne botulism due to ingestion of home-canned green beans: two case reports

Iatrogenic Botulism Outbreak in Egypt due to a Counterfeit Botulinum Toxin A Preparation – A Descriptive Series of Patient Features and Outcome

Investigation of Deaths and Injury of Prison Inmates

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