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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) 2018 Nov 30:1-5. 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) 2018 Nov 17. 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 2018 Nov 15. Epub 2018 Nov 15.

a 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 2018 Nov 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 2018 Jul 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 Nov 2. Epub 2018 Nov 2.

Institute of Advanced Sciences, 86-410 Faunce Corner Mall Road, Dartmouth, Massachusetts, USA

Botulinum neurotoxins (BoNTs), the most poisonous proteins known to mankind, are a family of seven (A-G) immunologically distinct proteins synthesized primarily by different strains of the anaerobic bacteria, Being the causative agents of botulism, the toxins block neurotransmitter release by specifically cleaving one of the three SNARE proteins thereby inducing flaccid paralysis. Developing countermeasures and therapeutics against BoNTs are high priority research areas for public health because of their extreme toxicity and potential as bio-warfare agents. Extensive research has been 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 2018 Oct 19. 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 Oct;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 Sep 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

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

Centro de Desenvolvimento Tecnológico, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul 96160-000, Brazil.

Botulism is a potentially fatal intoxication caused by botulinum neurotoxins (BoNTs) produced mainly by . Vaccination against BoNT serotypes C and D is the main procedure to control cattle botulism. Current vaccines contain formaldehyde-inactivated native BoNTs, which have a time-consuming production process and pose safety risks. Read More

Hum Vaccin Immunother 2018 Sep 20:1-8. Epub 2018 Sep 20.

e Bio-MAX/N-Bio , Seoul National University , Seoul , Republic of Korea.

Botulinum neurotoxins (BoNTs) produced by the spore-forming, gram-positive, anaerobic bacterium Clostridium botulinum are the most toxic substances known and cause botulism, flaccid paralysis, or death. Owing to their high lethality, BoNTs are classified as category A agents by the Centers for Disease Control (CDC). Currently, there are no vaccines available to protect against BoNTs, so the rapid development of a safe and effective vaccine is important. Read More

Mayo Clin Proc Innov Qual Outcomes 2018 Sep 3;2(3):291-296. Epub 2018 Aug 3.

Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL.

The cholinergic heat-labile neurotoxin produced by species is primarily responsible for the clinical manifestations of botulism. The classic phenotypic presentation of botulism consists of subacute descending flaccid paralysis with intact sensory function. Traditionally, it is classified into 3 main forms (foodborne, wound-related, and infantile) on the basis of primary site of toxin entry into the human nervous system. Read More

Prehosp Emerg Care 2018 Sep 10:1-9. Epub 2018 Sep 10.

Botulism is a potentially lethal disease caused by a toxin released by Clostridium botulinum. Outbreaks of botulism from food sources can lead to a Mass Casualty Incident (MCI) involving sometimes hundreds of individuals. We report on a recent outbreak of botulism treated at a regional community hospital with a focus on emergency medical services (EMS) response and transport considerations. Read More

Indian J Med Res 2018 06;147(6):603-610

School of Studies in Zoology, Jiwaji University, Gwalior, India.

Background & Objectives: Botulism, a potentially fatal paralytic illness, is caused by the botulinum neurotoxins (BoNTs) secreted by Clostridium botulinum. It is an obligate anaerobic, Gram-positive, spore-forming bacterium. BoNTs are classified into seven serotypes based on the serological properties. Read More

Scott Med J 2018 Aug 28:36933018793525. Epub 2018 Aug 28.

3 Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Golden Jubilee National Hospital, UK.

Introduction The Clostridia species are responsible for life-threatening conditions such as tetanus, botulism and gas gangrene. Clostridium septicum is a rare cause of clinical infection, accounting for less than 1% of blood culture samples that test positive for Clostridia. However, C. Read More

Medicine (Baltimore) 2018 Aug;97(34):e10659

Department of Poisoning Treatment, Affiliated Hospital, Academy of Military Medical Science, Poisoning Treatment Center of the Army, Beijing, China.

This study was conducted to analyze the clinical characteristics of and treatment strategies for botulism among patients receiving cosmetic injection of botulinum toxin (BoNT).A total of 86 botulism patients caused by cosmetic injection of BoNT were enrolled in our study. All of the patients were diagnosed according to their history of cosmetic BoNT injection, clinical symptoms and signs, and other auxiliary examinations (including those on renal and liver functions, blood index detection, and chest X-ray). Read More

Tierarztl Prax Ausg G Grosstiere Nutztiere 2018 Aug 24;46(4):213-220. Epub 2018 Aug 24.

Objective: To evaluate the perceptions of Bavarian bovine practitioners in regard to ailments that could potentially be associated with chronic infections.

Material And Methods: A questionnaire-based survey consisting of two parts was conducted via telephone. The questionnaire contained five main inclusion criteria and seven further criteria for inclusion in the second, special part of the study. Read More

Curr Microbiol 2018 Nov 17;75(11):1506-1515. Epub 2018 Aug 17.

Institute of Biochemistry, University Hospital of Leipzig, Leipzig, Germany.

Clostridium species cause several local and systemic diseases. Conventional identification of these microorganisms is in part laborious, not always reliable, time consuming or does not always distinguish different species, i.e. Read More

Anaerobe 2018 Dec 16;54:72-74. Epub 2018 Aug 16.

National Reference Center for the Botulism, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.

This report describes an outbreak of botulism occurred among a free-living population of mallards (Anas platyrhynchos) and geese (Anser anser) in an urban park. Mortality rate among investigated population was 86,8% (118 dead out of 136). Twenty-seven carcasses were collected for macroscopic examination and screened for microbiological, virological, toxicological investigations. Read More

Dis Model Mech 2018 09 27;11(9). Epub 2018 Sep 27.

Department of Biotechnology, Israel Institute for Biological Research, Ness Ziona 7410001, Israel

Botulinum neurotoxin (BoNT) serotypes A, B and E are responsible for most cases of human botulism. The only approved therapy for botulism is antitoxin treatment administered to patients after symptom onset. However, a recent meta-analysis of antitoxin efficacy in human botulism cases over the past century concluded that a statistically significant reduction in mortality is associated with the use of type E and type A antitoxin, but not with type B antitoxin. Read More

Przegl Epidemiol 2018 ;72(2):149-155

National Institute of Public Health - National Institute of Hygiene in Warsaw, Department of Epidemiology of Infectious Diseases and Surveillance

Objectives: The main aim of the study is to assess the epidemiological situation of foodborne botulism in Poland in 2016 compared to previous years.

Materials And Methods: In this assessment we reviewed national surveillance data on foodborne botulism cases published in the annual bulletin “Infectious diseases and poisonings in Poland in 2016” and in previous publications, as well as unpublished data retrieved from botulism case reports for 2016 sent from Sanitary-Epidemiological Stations to the Department of Epidemiology NIPH-NIH.

Results: In 2016, a total of 26 foodborne botulism cases (including 18 laboratory confirmed) were reported and the annual incidence rate (0. Read More

Anaerobe 2018 Dec 1;54:19-22. Epub 2018 Aug 1.

Veterinary School, Universidade Federal de Minas Gerais (UFMG), Av. Antônio Carlos, 6627, Belo Horizonte, MG, CEP 31.270-901, Brazil.

Rabbits and guinea pigs are used in the official control and validation of clostridial vaccines, but it is unknown whether the antitoxin titers obtained in these animals corroborate with the humoral response in bovine. The objective of the study was to compare the humoral antibody response of guinea pig and rabbits to those obtained in cattle vaccinated with a commercial vaccine containing Clostridium perfringens epsilon and beta, and Clostridium botulinum types C and D toxoids. This study revealed the same level of humoral response in rabbits and cattle for all four toxoids tested, including C. Read More

Toxins (Basel) 2018 Aug 1;10(8). Epub 2018 Aug 1.

Institute of Cell Biochemistry, OE 4310, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany.

In the recent past, about 40 botulinum neurotoxin (BoNT) subtypes belonging to serotypes A, B, E, and F pathogenic to humans were identified among hundreds of independent isolates. BoNTs are the etiological factors of botulism and represent potential bioweapons; however, they are also recognized pharmaceuticals for the efficient counteraction of hyperactive nerve terminals in a variety of human diseases. The detailed biochemical characterization of subtypes as the basis for development of suitable countermeasures and possible novel therapeutic applications is lagging behind the increase in new subtypes. Read More

Pract Neurol 2018 Dec 30;18(6):501-504. Epub 2018 Jul 30.

Department of Neurology, Mater Misericordiae University Hospital, Dublin, Ireland.

A 42-year-old man, returning to Europe after a 2-month stay in China, reported cough and runny nose. Five days later, he developed neck discomfort and rapidly evolving weakness, spreading from his arms to the facial, bulbar and neck muscles, and then the legs. He developed dysphagia and breathlessness, and was intubated in the emergency department. Read More

Toxins (Basel) 2018 Jul 24;10(8). Epub 2018 Jul 24.

Department of Biomedical Sciences, University of Padova and Institute for Neuroscience of the National Research Council, Via Ugo Bassi n. 58/B, 35121 Padova, Italy.

Cesare Montecucco is a member of the board of various leading scientific journals. His research focus is on the regeneration of the peripheral nervous system and on the mechanisms of action of toxins and related diseases, including tetanus, botulism, anthrax and Helicobacter pylori-associated diseases. In this interview, we talked to Cesare Montecucco about his career, learning and culture. Read More

Clin Auton Res 2018 Jul 18. Epub 2018 Jul 18.

Department of Neurology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.

Autonomic dysfunction is common in neuro-critical care patients and may compromise the function of various organs. Among the many diseases causing or being associated with autonomic dysfunction are traumatic brain injury, cerebrovascular diseases, epilepsy, Guillain-Barré syndrome (GBS), alcohol withdrawal syndrome, botulism and tetanus, among many others. Autonomic dysfunction may afflict various organs and may involve hyper- or hypo-activity of the sympathetic or parasympathetic system. Read More

Arch Dis Child 2018 Sep 14;103(9):907-909. Epub 2018 Jul 14.

University of Cambridge School of Clinical Medicine, Cambridge, UK.

Harm Reduct J 2018 07 11;15(1):36. Epub 2018 Jul 11.

Health Protection Scotland, NHS National Services Scotland, Meridian Court, 5 Cadogan Street, Glasgow, Scotland.

Background: People who inject drugs (PWID) are at an increased risk of wound botulism, a potentially fatal acute paralytic illness. During the first 6 months of 2015, a large outbreak of wound botulism was confirmed among PWID in Scotland, which resulted in the largest outbreak in Europe to date.

Methods: A multidisciplinary Incident Management Team (IMT) was convened to conduct an outbreak investigation, which consisted of enhanced surveillance of cases in order to characterise risk factors and identify potential sources of infection. Read More