Toxin-associated infectious diseases: tetanus, botulism and diphtheria

Abstract

Purpose of review The incidence rates of the toxin-related infectious diseases, tetanus, diphtheria and botulism declined dramatically over the past decades mainly because of the implementation of immunization programs also in low-and-middle-income countries (LAMICs) and by improving hygiene conditions. But still, single cases occur, and they need fastest possible recognition and management. Recent findings Over the past 20 years, the incidence of neonatal tetanus has declined by more than 90%. This success was achieved by immunizing women in reproductive age in areas of high risk as sub-Saharan Africa and parts of Asia. Larger regional outbreaks of diphtheria have been reported from the former Soviet Union in the 1990s and from India in 2017. Botulism is still rare, mainly seen in infants and, in recent years, in intravenous drug abusers. Summary Tetanus, diphtheria and botulism are rarities in high-income countries (HICs) with unlimited access to immunization programs and standard hygiene procedures. The diagnosis of all three diseases is still, even in the 21st century, based upon patient‘s history and clinical signs and symptoms. Neither biochemical bedside tests nor neuroradiological investigations help to confirm the diagnosis in an emergency situation.

Botulism after intragastric botulinum toxin injections for weight reduction

“…There is minimal evidence on treatment strategies for iatrogenic botulism [3]. Guidelines suggest applying the antitoxin within 48 h after symptom onset [4], because BoNT/A-once taken up into nerve terminals-immediately and irreversibly cleaves the SNAP-25 protein. However, because symptom improvement has been reported after antitoxin application 7-9 and even 15 days after symptom onset in single cases [3], we here chose to treat the severely affected patients albeit at such delay since symptom onset.…”

Peripheral nervous system and neuromuscular disorders in the emergency department: A review

“…Diaphragmatic weakness and autonomic dysfunction may occur. 19,20 The antitoxin ideally needs to be administered within 1-2 days of the onset of symptoms. Death may occur due to cardiac arrhythmias, myocarditis, respiratory failure, or autonomic dysfunction.…”

“…In addition to supportive treatment, trivalent antitoxin may be administered to neutralize the circulating antitoxin in serum. 5,20 Snake envenomation…”

“…Classically, there is descending weakness with loss of accommodation, convergence, pupillary reflexes, and extraocular movements. Diaphragmatic weakness and autonomic dysfunction may occur 19,20 . The antitoxin ideally needs to be administered within 1–2 days of the onset of symptoms.…”

“…Autonomic involvement in the form of anhidrosis, loss of pupillary reflexes, constipation, and urinary retention can occur. In addition to supportive treatment, trivalent antitoxin may be administered to neutralize the circulating antitoxin in serum 5,20 …”