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Cochrane Database Syst Rev 2019 Apr 17;4:CD008123. Epub 2019 Apr 17.

Department of Neurology & Neurosurgery, McGill University, Montreal General Hospital - Room L7-313, 1650 Cedar Avenue, Montreal, QC, Canada, H3G 1A4.

Background: Botulism is an acute paralytic illness caused by a neurotoxin produced by Clostridium botulinum. Supportive care, including intensive care, is key, but the role of other medical treatments is unclear. This is an update of a review first published in 2011. Read More

Toxins (Basel) 2019 Apr 6;11(4). Epub 2019 Apr 6.

Department of Anesthesia and Perioperative Care, University of California, 1001 Potrero Ave., San Francisco, CA 94110, USA.

Botulinum neurotoxins (BoNT) are some of the most toxic proteins known, with a human LD 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. Read More

Am J Med 2019 Apr 2. Epub 2019 Apr 2.

University of Colorado School of Medicine, Division of Internal Medicine.

Vet Ital 2019 Mar 31;55(1):57-62. Epub 2019 Mar 31.

Grosseto Section, Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana "M. Aleandri", Italy, Via Europa 30, Grosseto, Italy..

Botulism in cattle is rarely reported in Italy. This study describes an outbreak of botulism in a dairy herd in Central Italy in September 2012, and the notably high mortality rate it caused. Differential diagnoses involving toxicology and bacteriology, and electrolyte imbalances, all proved negative. Read More

Sci Rep 2019 Apr 2;9(1):5531. Epub 2019 Apr 2.

Biological Toxins (ZBS 3), Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Berlin, 13353, Germany.

Botulinum neurotoxins (BoNTs) are the most potent toxins known and cause the life threatening disease botulism. Sensitive and broad detection is extremely challenging due to the toxins' high potency and molecular heterogeneity with several serotypes and more than 40 subtypes. The toxicity of BoNT is mediated by enzymatic cleavage of different synaptic proteins involved in neurotransmitter release at serotype-specific cleavage sites. Read More

Foodborne Pathog Dis 2019 Mar 30. Epub 2019 Mar 30.

1 Centers for Disease Control and Prevention, Enteric Diseases Laboratory Branch, National Botulism and Enteric Toxins Team, Atlanta, Georgia.

Clostridium botulinum produces botulinum neurotoxin (BoNT), which is the causative agent of botulism, a rare but serious disease that can result in death if not treated. Infant botulism occurs when C. botulinum colonizes the intestinal tract of infants and produces BoNT. Read More

World J Plast Surg 2019 Jan;8(1):116-119

Department of Surgery, Iran University of Medical Science, Tehran, Iran.

Botulinum toxin (BTX) is also well-known as Botox is produced by a gram-positive anaerobic bacterium called Generally, clinical manifestations of BTX can be observed after consumption of contaminated food, from colonization of the infant gastrointestinal tract, as well as following the infection of the wound to this bacterium. There are seven types of this neurotoxin labeled as A, B, C (C1, C2), D, E, and F. Human botulinum is caused by types A, B, E and rarely F. Read More

MMWR Morb Mortal Wkly Rep 2019 Mar 15;68(10):251-252. Epub 2019 Mar 15.

Open Forum Infect Dis 2019 Feb 9;6(2):ofz014. Epub 2019 Feb 9.

County of Los Angeles, Department of Public Health, California.

Background: In 2017, local public health authorities in California received reports of 2 elderly patients with suspected botulism who knew each other socially. A multijurisdictional investigation was conducted to determine the source.

Methods: Investigators reviewed medical records, interviewed family to establish food and drink histories, and inspected a facility that produced liquid herbal tea. Read More

Anaerobe 2019 Apr 12;56:49-50. Epub 2019 Feb 12.

National Reference Center for Anaerobic Bacteria and Botulism, Pasteur Institute, 75015, Paris, France. Electronic address:

Botulism type C was suspected in a 46-year old man after consumption of sick poultry from a flock where botulism type C was confirmed. The patient developed characteristic signs of botulism, but investigation of biological samples did not confirm the presence of Clostridium botulinum or botulinum toxin. Despite having classical botulism symptoms, the man recovered very quickly. Read More

JAMA 2019 Feb;321(6):538

Surg Innov 2019 Feb 8:1553350619828888. Epub 2019 Feb 8.

1 Anne Arundel Medical Center, Annapolis, MD, USA.

Background: Giant inguinoscrotal hernias (GIH) are defined as groin hernias extending below the mid-thigh when standing, often significantly encumbering activities of daily living. To date, there are no reports utilizing the combination of progressive pneumoperitoneum (PPP), botulinum toxin A injection (BTI), and enhanced view-totally extraperitoneal (eTEP) technique for GIH repair. In this report, we present 2 such cases of this unique minimally invasive multidisciplinary approach to address GIH. Read More

Sci Rep 2019 Feb 7;9(1):1634. Epub 2019 Feb 7.

Department of Biology, University of Waterloo, 200 University Ave. West, Waterloo, Ontario, N2L 3G1, Canada.

Clostridial neurotoxins (CNTs), which include botulinum neurotoxins (BoNTs) and tetanus neurotoxin (TeNT), are the most potent toxins known to science and are the causative agents of botulism and tetanus, respectively. The evolutionary origins of CNTs and their relationships to other proteins remains an intriguing question. Here we present a large-scale bioinformatic screen for putative toxin genes in all currently available genomes. Read More

Ann Ig 2019 Mar-Apr;31(2):181-185

Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.

We report the epidemiology of food-borne botulism in Puglia, Italy, between 1977-2017, using surveillance data and Experts' personal observations. As the disease is rare, the diagnosis is often missed or delayed, and cases are initially misdiagnosed. This was the case of a family outbreak of botulism in the 1970s. Read More

Microbiol Resour Announc 2019 Jan 31;8(5). Epub 2019 Jan 31.

National Botulism and Enteric Toxins Team, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, Georgia, USA.

In 2010, a Clostridium botulinum type B isolate was recovered from fermented soybeans during a foodborne botulism investigation. Molecular investigation of the botulinum neurotoxin () gene operon determined that the sequence was a new subtype, denoted B8. Here, we describe the draft whole-genome sequence of the organism. Read More

Ter Arkh 2018 Nov;90(11):102-104

Bashkir State Medical University, Ufa, Bashkortostan, Russia.

Injections of botulinum toxin are widely used in different medical fields, namely neurology, urology, stomatology, cosmetology, gastroenterology etc. Preparations of botulinum toxin type A (BTA) prevent the release of acetylcholine at the endings of motor nerves leading to the long-term muscle relaxation. It has been acknowledged that treatment with BTA has very good safety profile and tolerability. Read More

J Shoulder Elbow Surg 2019 Jan 23. Epub 2019 Jan 23.

Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA, USA. Electronic address:

Background: Conversion disorder in children presents a challenge to orthopedic surgeons. The condition is frequently associated with unnecessary diagnostic tests, treatments, and cost. The purpose of this study was to report a series of children with upper extremity conversion disorder to raise awareness for this uncommon condition and to assist with its diagnosis and management. Read More

Infect Dis (Lond) 2019 Feb 21;51(2):91-96. Epub 2019 Jan 21.

c Department of Infectious Diseases and Clinical Microbiology , Abant Izzet Baysal University School of Medicine , Bolu , Turkey.

Objective: The aim of this study is to assess the epidemiology of foodborne botulism cases which were seen and published in Turkey.

Material And Methods: This study covers the cases and outbreaks of botulism that have been identified and published in any region of Turkey, between 1983 and 2017. This systematic review was performed in accordance with the guidelines for performing and reporting systematic reviews and meta-analyses. Read More

Toxins (Basel) 2019 Jan 11;11(1). Epub 2019 Jan 11.

Bacterial Toxins, Institut Pasteur, 75015 Paris, France.

Botulinum neurotoxins (BoNTs) are the most lethal toxins among all bacterial, animal, plant and chemical poisonous compounds. Although a great effort has been made to understand their mode of action, some questions are still open. Why, and for what benefit, have environmental bacteria that accidentally interact with their host engineered so diverse and so specific toxins targeting one of the most specialized physiological processes, the neuroexocytosis of higher organisms? The extreme potency of BoNT does not result from only one hyperactive step, but in contrast to other potent lethal toxins, from multi-step activity. Read More

Pediatr Neurol 2019 Mar 30;92:71-72. Epub 2018 Nov 30.

Baylor College of Medicine, Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Texas Children's Hospital, Houston, Texas.

PLoS One 2019 11;14(1):e0209019. Epub 2019 Jan 11.

Research and Development, Emergent BioSolutions Canada Inc., Winnipeg, Manitoba, Canada.

Background: Botulism is a disease caused by neurogenic toxins that block acetylcholine release, resulting in potentially life threatening neuroparalysis. Seven distinct serotypes of botulinum neurotoxins (BoNTs) have been described and are found in nature world-wide. This, combined with ease of production, make BoNTs a significant bioweapon threat. Read More

MMWR Morb Mortal Wkly Rep 2019 Jan 4;67(5152):1415-1418. Epub 2019 Jan 4.

During September 29-October 6, 2017, the County of San Diego Public Health Services (COSD) was notified of two patients with suspected wound botulism and a history of using black tar heroin. On October 9, COSD, which had reported an average of one wound botulism case per year during 2001-2016, sent a health alert through the California Health Alert Network, notifying Southern California providers of these two patients, including their signs and symptoms and black tar heroin exposure. In collaboration with the California Department of Public Health, COSD conducted an investigation to identify additional cases, determine risk factors for illness, estimate cost of medical care, and develop recommendations to prevent further illness. Read More

J R Army Med Corps 2018 Dec 7. Epub 2018 Dec 7.

Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

This paper reviews changes in the ethical challenges that have arisen in military medicine over the past four decades. This includes the degree, if any, to which providers during the Vietnam conflict have carried out what we now refer to as harsh interrogation measures in an attempt to extract information from captured enemy soldiers, the extent, if any, to which the USA used medicine as a means to try to win over the hearts and minds of civilians in occupied territory and how providers should treat service members who return from the front with combat fatigue. An issue that arose during the first Gulf War in 1991 is discussed, namely US service persons being required to take botulism vaccine without their consent. Read More

Acta Med Port 2018 Nov 30;31(11):691-693. Epub 2018 Nov 30.

Serviço de Medicina Interna. Hospital Sousa Martins. Guarda. Portugal.

Botulism is a serious illness caused by exposure to botulinum toxin. It is manifested by flaccid, paralysis, symmetric and in descending pattern affecting cranial and peripheral nerves. Given the frequent need for invasive mechanical ventilation, these patients should be approached in an intensive care setting. Read More

Harmful Algae 2018 Dec 3;80:117-129. Epub 2018 Nov 3.

GreenWater Laboratories/CyanoLab, 205 Zeagler Drive, Palatka, FL, 32177, United States.

In the summer of 2012, over 750 dead and dying birds were observed at the Paul S. Sarbanes Ecosystem Restoration Project at Poplar Island, Maryland, USA (Chesapeake Bay). Clinical signs suggested avian botulism, but an ongoing dense Microcystis bloom was present in an impoundment on the island. Read More

Infect Dis (Lond) 2019 Feb 30;51(2):97-101. Epub 2018 Nov 30.

a Department of Food Safety, Nutrition and Veterinary Public Health , Istituto Superiore di Sanità , Rome , Italy.

Foodborne botulism is a life-threatening disease caused by the ingestion of food containing preformed botulinum neurotoxins, the most potent natural poisons known to humans. On the basis of the new challenges in management of the diseases as well as considering the potential use of botulinum toxins as biological weapons, foodborne botulism is still considered a public health emergency. Each suspected case should be immediately notified to public health authorities with the aim of preparing a prompt response. Read More

Toxins (Basel) 2018 Nov 26;10(12). Epub 2018 Nov 26.

Department of Anesthesia and Perioperative Care, University of California, San Francisco, Zuckerberg San Francisco General Hospital and Trauma Center, Room 3C-38, 1001 Potrero Avenue, San Francisco, CA 94110, USA.

Botulism, caused by exposure to one or more of the eight serotypes of botulinum neurotoxins (BoNTs) (BoNT/A through H), is often fatal without rapid treatment. [.. Read More

PLoS One 2018 28;13(11):e0207448. Epub 2018 Nov 28.

Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Materials Science, East China Normal University, Shanghai, China.

Background: Botulinum toxin type A (BoNT-A) is generally considered safe and is widely used to treat a variety of clinical conditions involving muscle hyperactivity and for cosmetic purposes. However, the effects of BoNT-A poisoning (botulism) on brain function are poorly understood.

Methodology/principal Findings: Herein, we investigated brain functions in 9 patients who received illegal cosmetic injections of botulinum and 18 matched controls by combining the analysis methods of regional homogeneity (ReHo) and amplitude of low-frequency fluctuation (ALFF) based on resting-state fMRI. Read More

J Matern Fetal Neonatal Med 2018 Nov 19. Epub 2018 Nov 19.

a Division of Foodborne, Waterborne, and Environmental Diseases , Centers for Disease Control and Prevention , Atlanta , GA , USA.

Clin Toxicol (Phila) 2019 Mar 17;57(3):223-224. Epub 2018 Nov 17.

c Department of Emergency Medicine , Drexel University College of Medicine , Philadelphia , PA , USA.

Toxins (Basel) 2018 Nov 15;10(11). Epub 2018 Nov 15.

Foodborne Toxin Detection and Prevention Research Unit, Western Regional Research Center, Agricultural Research Services, United States Department of Agriculture, 800 Buchanan Street, Albany, CA 94710, USA.

Botulinum neurotoxin (BoNT) intoxication can lead to the disease botulism, characterized by flaccid muscle paralysis that can cause respiratory failure and death. Due to the significant morbidity and mortality costs associated with BoNTs high toxicity, developing highly sensitive, rapid, and field-deployable assays are critically important to protect the nation's food supply against either accidental or intentional contamination. We report here that the B-cell based biosensor assay CANARY (Cellular Analysis and Notification of Antigen Risks and Yields) Zephyr detects BoNT/A holotoxin at limits of detection (LOD) of 10. Read More

Hum Vaccin Immunother 2019 4;15(3):755-760. Epub 2018 Dec 4.

a Department of Protein Engineering , Beijing Institute of Biotechnology , Beijing , China.

Botulinum neurotoxins (BoNTs) are potential biological weapons because of their high toxicity and mortality. Vaccination is an effective strategy to prevent botulism. The carboxyl-terminus of the heavy chain (Hc domain) is nontoxic and sufficient to generate protective immune responses against natural BoNTs in animals. Read More

Anaerobe 2019 Feb 6;55:103-106. Epub 2018 Nov 6.

Laboratory of Anatomic Pathology, College of Veterinary Medicine and Animal Sciences, Campo Grande, MS, Brazil. Electronic address:

A large outbreak of botulism in feedlot steers fed corn silage contaminated with Clostridium botulinum neurotoxin type C (BoNT/C) is reported occurring in Midwestern Brazil in August 2017. The onset of the outbreak occurred 15 days after 1700 steers started to be fed the contaminated corn silage. Affected steers were alert and afebrile with varying degrees of flaccid paralysis in various muscle groups. Read More

Anaerobe 2019 Feb 2;55:1-7. Epub 2018 Jul 2.

State Key Laboratory of Pathogen and Biosecurity, Institute of Microbiology and Epidemiology, AMMS, Beijing 100071, China. Electronic address:

Infant botulism was rarely reported in China. The second reported event of the disease including three cases occurred in 2015. In the present study, one (the third case) of the three cases was identified and investigated to trace the sources of transmission. Read More

Curr Treat Options Gastroenterol 2018 Dec;16(4):541-547

Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, 69978, Ramat Aviv, Israel.

Purpose Of Review: To overview the current medical literature on the efficacy of botulism toxin treatment (BTX-A) for lower gastrointestinal disorders (GIT).

Recent Findings: BTX-A was found to have a short-term efficacy for the treatment of dyssynergic defecation. Surgical treatment was found to be more effective than BTX-A for the healing of chronic anal fissures, and BTX-A can be considered when surgery is undesirable. Read More

Arch Phys Med Rehabil 2018 Nov 4;99(11):2143-2150. Epub 2018 Jul 4.

Department of Rehabilitation Medicine, Mackay Memorial Hospital, Taipei, Taiwan, Republic of China; Department of Medicine, Mackay Medical College, Taipei, Taiwan, Republic of China. Electronic address:

Objective: To investigate whether extracorporeal shock wave therapy (ESWT) is noninferior to botulinum toxin type A (BoNT-A) for the treatment of poststroke upper limb spasticity.

Design: Randomized noninferiority trial.

Setting: Referral medical center. Read More

Appl Environ Microbiol 2018 Dec 30;84(24). Epub 2018 Nov 30.

Institute of Advanced Sciences, Dartmouth, Massachusetts, USA

Botulinum neurotoxins (BoNTs), the most poisonous proteins known to humankind, are a family of seven (serotype A to G) immunologically distinct proteins synthesized primarily by different strains of the anaerobic bacterium Being the causative agents of botulism, the toxins block neurotransmitter release by specifically cleaving one of the three soluble -ethylmaleimide-sensitive factor attachment receptor (SNARE) proteins, thereby inducing flaccid paralysis. The development of countermeasures and therapeutics against BoNTs is a high-priority research area for public health because of their extreme toxicity and potential for use as biowarfare agents. Extensive research has focused on designing antagonists that block the catalytic activity of BoNTs. Read More

Annu Rev Biochem 2018 Nov 2. Epub 2018 Nov 2.

Department of Biochemistry and Biophysics, Stockholm University, 106 91 Stockholm, Sweden; email:

Botulinum neurotoxins (BoNTs) and tetanus neurotoxin (TeNT) are the most potent toxins known and cause botulism and tetanus, respectively. BoNTs are also widely utilized as therapeutic toxins. They contain three functional domains responsible for receptor-binding, membrane translocation, and proteolytic cleavage of host proteins required for synaptic vesicle exocytosis. Read More

MMWR Morb Mortal Wkly Rep 2018 Nov 2;67(43):1221-1222. Epub 2018 Nov 2.

mSphere 2018 10 24;3(5). Epub 2018 Oct 24.

Department of Bacteriology, University of Wisconsin, Madison, Wisconsin, USA

Botulinum neurotoxins (BoNTs), the most potent toxins known to humans and the causative agent of botulism, exert their effect by entering motor neurons and cleaving and inactivating SNARE proteins, which are essential for neurotransmitter release. BoNTs are proven, valuable pharmaceuticals used to treat more than 200 neuronal disorders. BoNTs comprise 7 serotypes and more than 40 isoforms (subtypes). Read More

J Clin Neurosci 2019 Feb 19;60:138-141. Epub 2018 Oct 19.

Neuroscience Department, San Camillo-Forlanini Hospital, Circonvallazione Gianicolense 87, 00152 Rome, Italy.

Therapeutic use of botulinum neurotoxin type A (BoNT/A) is effective, and generally safe. Nevertheless, iatrogenic botulism (IB) is rarely reported as a result of systemic spread of the BoNT/A, causing general weakness, bulbar symptoms and dysautonomia. Suggestive clinical feature are decisive to raise the diagnostic suspicion, which however needs a confirmation in the electrodiagnostic (EDX) study, above all to exclude other treatable diseases. Read More

Toxins (Basel) 2018 Oct 20;10(10). Epub 2018 Oct 20.

Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, UK.

Botulinum neurotoxins (BoNTs) are categorised into immunologically distinct serotypes BoNT/A to /G). Each serotype can also be further divided into subtypes based on differences in amino acid sequence. BoNTs are ~150 kDa proteins comprised of three major functional domains: an N-terminal zinc metalloprotease light chain (LC), a translocation domain (H), and a binding domain (H). Read More

Infect Dis Rep 2018 Sep 5;10(2):7654. Epub 2018 Sep 5.

Department of Emergency Medicine, Maricopa Integrated Health System, University of Arizona, Phoenix, AZ, USA.

Botulism is caused by toxin production from many species of , most commonly as well as and . Development of wound botulism is associated with injection drug users but has also been described in traumatic injuries with exposure to soil. A patient presented to the emergency department with a complaint of descending, progressive weakness. Read More

Vet Rec 2018 10;183(14):452-453

Severn Edge Farm Vets, The Bullring, Hollybush Road, Bridgnorth, Shropshire WV16 4AR.

Rev Med Suisse 2018 Oct;14(622):1795-1798

Service des maladies infectieuses, Institut Central des Hôpitaux, Hôpital du Valais, Avenue du Grand-Champsec 86, 1950 Sion.

Clostridia cause severe diseases. Tetanus is rare in Switzerland because of vaccine coverage and the application of guidelines for the management of contaminated wounds. Tetanus requires wound debridement and the administration of antibiotics and anti-tetanus immune. Read More

Antimicrob Agents Chemother 2018 Dec 26;62(12). Epub 2018 Nov 26.

Infant Botulism Treatment and Prevention Program, California Department of Public Health, Richmond, California, USA

Infant botulism is an infectious intestinal toxemia that results from colonization of the infant large bowel by (or rarely, by neurotoxigenic or ), with subsequent intraintestinal production and absorption of botulinum neurotoxin that then produces flaccid paralysis. The disease is often initially misdiagnosed as suspected sepsis or meningitis, diagnoses that require prompt empirical antimicrobial therapy. Antibiotics may also be needed to treat infectious complications of infant botulism, such as pneumonia or urinary tract infection. Read More

Continuum (Minneap Minn) 2018 10;24(5, Neuroinfectious Disease):1459-1488

Purpose Of Review: This article reviews the pathophysiology, epidemiology, clinical manifestations, diagnosis, and treatment of tetanus, botulism, and diphtheric neuropathy.

Recent Findings: Tetanus is most common in lower-income settings, but rare cases are seen in higher-income settings because of the inadequate maintenance of vaccination status. Foodborne botulism remains rare, but botulism can also be caused by IV drug use (wound botulism) and medical use of botulinum toxin (iatrogenic botulism); botulinum toxin has also been considered a potential agent of bioterrorism. Read More

MBio 2018 09 25;9(5). Epub 2018 Sep 25.

The Pathogen and Microbiome Institute, Northern Arizona University, Flagstaff, Arizona, USA

Botulinum neurotoxins (BoNTs) are produced by a diverse set of seven clostridial species, though alternate naming systems have developed over the last 100 years. Starting in the 1950s, a single-species taxonomy where any bacterium producing BoNT would be designated was introduced. As the extreme diversity of these strains was recognized, a secondary system of taxonomic "groups" evolved. Read More