Iatrogenic Botulism After the Therapeutic Use of Botulinum Toxin-A

Ghasemi, Majid; Norouzi, Rasul; Salari, Mehri; Asadi, Beheshteh

doi:10.1097/wnf.0b013e31826248b8

Cited by 35 publications

(33 citation statements)

References 24 publications

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“…Thus, it is unlikely that topical therapy can be used to achieve a significantly improved outcome. There have been case reports describing the risk of clinical botulism use [29] during the treatment of primary focal hyperhidrosis, and this risk is theoretically higher if larger areas are treated.…”

Section: Commentmentioning

confidence: 99%

Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin

Teivelis

Wolosker

Krutman

et al. 2014

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin

Teivelis

Wolosker

Krutman

et al. 2014

The Annals of Thoracic Surgery

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“…On the other hand, adult intestinal colonization (or adult intestinal toxemia) and wound botulism are rare forms of botulism. There are also reports of botulism caused by accidental overdose of BoNTs during medical and cosmetic use (21,22).…”

mentioning

confidence: 99%

Genetic Characterization and Comparison of Clostridium botulinum Isolates from Botulism Cases in Japan between 2006 and 2011

Kenri

Sekizuka

Yamamoto

et al. 2014

Appl Environ Microbiol

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Genetic characterization was performed for 10 group I Clostridium botulinum strains isolated from botulism cases in Japan between 2006 and 2011. Of these, 1 was type A, 2 were type B, and 7 were type A(B) {carrying a silent bont/B [bont/(B)] gene} serotype strains, based on botulinum neurotoxin (BoNT) production. The type A strain harbored the subtype A1 BoNT gene (bont/ A1), which is associated with the ha gene cluster. The type B strains carried bont/B5 or bont/B6 subtype genes. The type A(B) strains carried bont/A1 identical to that of type A(B) strain NCTC2916. However, bont/(B) genes in these strains showed singlenucleotide polymorphisms (SNPs) among strains. SNPs at 2 nucleotide positions of bont/(B) enabled classification of the type A(B) strains into 3 groups. Pulsed-field gel electrophoresis (PFGE) and multiple-locus variable-number tandem-repeat analysis (MLVA) also provided consistent separation results. In addition, the type A(B) strains were separated into 2 lineages based on their plasmid profiles. One lineage carried a small plasmid (5.9 kb), and another harbored 21-kb plasmids. To obtain more detailed genetic information about the 10 strains, we sequenced their genomes and compared them with 13 group I C. botulinum genomes in a database using whole-genome SNP analysis. This analysis provided high-resolution strain discrimination and enabled us to generate a refined phylogenetic tree that provides effective traceability of botulism cases, as well as bioterrorism materials. In the phylogenetic tree, the subtype B6 strains, Okayama2011 and Osaka05, were distantly separated from the other strains, indicating genomic divergence of subtype B6 strains among group I strains.

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“…However, despite its well‐established safety, post‐injection adverse effects may occur, sometimes responsible for systemic toxicity due to the spread of the toxin beyond the injection site . To date, rare cases of iatrogenic systemic botulism have been reported .…”

Section: Discussionmentioning

confidence: 99%

“…Treatment has been regularly reported as safe, despite possible post-injection adverse effects, most notably injection site reactions, flulike symptoms, ptosis, weakness and allergic reactions [8]. Rare cases of iatrogenic systemic botulism have been described [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], and no case of significant respiratory depression or death has been reported after US Food and Drug Administration (FDA)-approved regimens [8]. Here, we report a large iatrogenic botulism outbreak that occurred in Egypt in June-July 2017.…”

mentioning

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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Iatrogenic Botulism After the Therapeutic Use of Botulinum Toxin-A

Cited by 35 publications

References 24 publications

Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin

Compensatory Hyperhidrosis: Results of Pharmacologic Treatment With Oxybutynin

Genetic Characterization and Comparison of Clostridium botulinum Isolates from Botulism Cases in Japan between 2006 and 2011

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

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