Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT)

Bai, Lili; Peng, Xiaobo; Liu, Yanqing; Sun, Yawei; Wang, Xin; Wang, Xingwang; Lin, Guo-Dong; Zhang, Peng; Wan, Kun; Qiu, Zewu

doi:10.1097/md.0000000000010659

Cited by 32 publications

(32 citation statements)

References 16 publications

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“…Our patient experienced an unusually long delay between BoNT-A injection and symptom onset (about 6 weeks). This contrasts with the other reported cases whose latency period ranged from 1 to 36 days [6]. We do not know the reason for this delayed course.…”

Section: Discussioncontrasting

confidence: 89%

“…Nevertheless, in rare cases, systemic diffusion leads to clinical manifestations of variable severity (dysphagia, generalized muscular weakness, respiratory failure, …) [3, 4, 5]. This condition, referred to as iatrogenic botulism, remains exceptional in healthy subjects and often results, at least in cosmetic cases, from inappropriate injections of unlicensed toxins in beauty salons [6]. By contrast, in patients with an underlying neuromuscular disease such as myasthenia gravis (MG), the potency of BoNT-A is increased, even at low dose.…”

Section: Introductionmentioning

confidence: 99%

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Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

et al. 2019

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Cosmetic or therapeutic use of botulinum toxin type A (BoNT-A) is usually safe but can rarely cause iatrogenic botulism. Iatrogenic botulism and myasthenia gravis (MG) share similar clinical features, because both BoNT-A and anti-acetylcholine receptorantibodies impair neuromuscular transmission. We report a patient who underwent cosmetic BoNT-A injection and later developed serious local and systemic adverse reactions. The peculiarity of this case is that a latent seropositive MG was eventually discovered, suggesting that both iatrogenic botulism and MG contributed to the clinical picture. This patient is one of the less than 10 reported cases worldwide in whom MG was unmasked by BoNT-A injection. He is the first to be assessed in detail by single-fiber electromyography. This case emphasizes the risk associated with BoNT-A injection in patients with subclinical impairment of neuromuscular transmission and prompts the search for MG in case of exaggerated response.

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Section: Discussioncontrasting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

et al. 2019

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“…BoNT serotypes A, B, E, F cause the disease botulism in humans [14,15,16]. Botulism is a disease with four distinct, naturally occurring etiologies: foodborne, wound, infant botulism and adult intestinal botulism and a fifth etiology being iatrogenic botulism, for example caused by therapeutic administration of BoNT for cosmetic or movement disorders [17,18]. Botulism can also occur by the inhalation route [19,20] but there is only a single case report of naturally occurring inhalational botulism in laboratory workers [21].…”

Section: Introductionmentioning

confidence: 99%

Monoclonal Antibody Combinations Prevent Serotype A and Serotype B Inhalational Botulism in a Guinea Pig Model

Tomic¹,

Espinoza²,

Martinez³

et al. 2019

Toxins

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Botulinum neurotoxins (BoNT) are some of the most toxic proteins known, with a human LD50 of ~1 ng/kg. Equine antitoxin has a half-life in circulation of less than 1 day and is limited to a treatment rather than a prevention indication. The development of monoclonal antibodies (mAbs) may represent an alternative therapeutic option that can be produced at high quantities and of high quality and with half-lives of >10 days. Two different three mAb combinations are being developed that specifically neutralize BoNT serotypes A (BoNT/A) and B (BoNT/B). We investigated the pharmacokinetics of the anti-BoNT/A and anti-BoNT/B antibodies in guinea pigs (Cavia porcellus) and their ability to protect guinea pigs against an aerosol challenge of BoNT/A1 or BoNT/B1. Each antibody exhibited dose-dependent exposure and reached maximum circulating concentrations within 48 h post intraperitoneal or intramuscular injection. A single intramuscular dose of the three mAb combination protected guinea pigs against an aerosol challenge dose of 93 LD50 of BoNT/A1 and 116 LD50 of BoNT/B1 at 48 h post antibody administration. These mAbs are effective in preventing botulism after an aerosol challenge of BoNT/A1 and BoNT/B1 and may represent an alternative to vaccination to prevent type A or B botulism in those at risk of BoNT exposure.

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“…As well as leading to unsatisfactory results, poor understanding of facial anatomy can lead to suboptimal outcomes and complications, which may present legal risks to clinicians. Whilst not a fatal mistake, this leads to severe and undesirable side effects for patients, with muscular paralysis lasting weeks to months; BoNT spread to nearby muscles can also cause delocalisation of effects [1].…”

Section: Introductionmentioning

confidence: 99%

Applied Anatomy for Botulinum Toxin Injection in Cosmetic Interventions

D’Souza

2020

Curr Otorhinolaryngol Rep

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Purpose of Review To provide the reader with a clear overview of facial anatomy as it relates to injection of botulinum toxin. Recent Findings The review suggests the presentation of multiple combinations of facial musculature, with the forehead, glabellar, and nasal base areas as particular areas of variation. Differences in musculature result in different wrinkling patterns; with age, these changes first become apparent in the upper face, particularly in the forehead and glabellar area. Summary Botulinum toxin is well suited to achieve the optimal outcome: it is popular, safe, and non-invasive and presents with few adverse effects. Though limited, when adverse effects do arise these are primarily related to poor injection technique, often fuelled by poor anatomical knowledge. For clinicians to achieve the best outcomes with botulinum toxin use, an understanding of the facial muscles’ anatomy, actions, and interactions is key. This paper discusses the broad and intricate detail regarding the key target muscles of botulinum toxin, based on both literature review and cadaveric dissection carried out by the authors.

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Clinical analysis of 86 botulism cases caused by cosmetic injection of botulinum toxin (BoNT)

Cited by 32 publications

References 16 publications

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

Cosmetic Injection of Botulinum Toxin Unmasking Subclinical Myasthenia Gravis: A Case Report and Literature Review

Monoclonal Antibody Combinations Prevent Serotype A and Serotype B Inhalational Botulism in a Guinea Pig Model

Applied Anatomy for Botulinum Toxin Injection in Cosmetic Interventions

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