Botulinum antitoxin

Botulinum antitoxin Neutralizatien ef the lethal effects of botulinum toxins A, B and E in mice SOOlUmI- eftypeA 5001U mM ef Type B 50IU ml- ef Type E... 

Antitoxin An antibody formed in response to and capable of neutralizing a biological poison, an animal serum containing antitoxins, or a solution of antibodies (e.g., diphtheria antitoxin and botulinum antitoxin) derived from the serum of animal immunized with specific antigens. Antitoxins are used to confer passive immunity and for treatment. 

Passive immunity can be provided by equine botulinum antitoxin or by specific human hyperimmune globulin, while endogenous immunity can be induced by immunization with botulinum toxoid... 

Botulism. While there is a licensed trivalent equine botulinum antitoxin available through the CDC, its administration is unlikely to reverse the disease in children who are symptomatic (Henretig, Cieslak, ... 

Botulinum toxin is extremely poisonous to humans. Coats, gloves, face shields, and protective cabinets are recommended for handling botulism specimens. Ideally, laboratory personnel should be vaccinated with C. botulinum antitoxin. Universal precautions should be used when caring for patients suspected of botulism. Isolation is not necessary but droplet precautions should be instituted (Arnon et al., 2001). 

The mainstays of botulism therapy include ventilatory support as well as the administration of botulinum antitoxin. Botulinum antitoxin is a trivalent, equine antitoxin that provides antibodies to botulinum toxin Types A, B, and E. It acts only against unbound toxin and therefore its efficacy is greatest early in the patient s clinical course. Cathartics and enemas have also been recommended for elimination of botulinum toxin from the GI tract. Antibiotics are not recommended except for the treatment of secondary infectious complications... 

Infantile Botulism—Ingestion ot botulism spores, often in honey, produces flaccid paralysis, poor feeding and suck reflexes, floppy baby syndrome. Wound Botulism—Contamination of wounds with C. botulinum spores can produce systemic symptoms. THERAPY Ventilatory support (often for weeks) Trivalent botulinum antitoxin Enemas and cathartics... 

Oberst, F., Crook, J., Cresthull, P., House, M. (1967).Evaluation of botulinum antitoxin, supportive therapy, and artificial respiration in monkeys with experimental botulism. Clin. Pharmacol. Ther. 9 209-14. 

Botulinum antitoxin Neutralization of the lethal effects of botulinum 500 lU/ml type A... 

Because the antitoxin is a horse serum product, the most likely adverse reactions inclnde hypersensitivity reactions, such as anaphylaxis, serum sickness, and urticaria. Unfortunately, the literature does not contain much information on botulinum antitoxin safety. From 1967 to 1977, when doses were larger than today, the frequency of hypersensitivity reactions was approximately 9%. Dnring that time, 2% of recipients developed anaphylaxis within lOmin of receiving the antitoxin. In... 

Patients experiencing any of these reactions should not receive equine botulinum antitoxin. Instead, they should receive desensitization through administration of 0.01-0.1 mL of antitoxin subcutaneously, doubling the previous dose every 20min, until they can tolerate 1.0-2.0 mL without any marked reaction (28). If available, although unlikely in an outbreak situation, an experience allergist should perform the desensitization. 

Botulinum toxins Toxin aerosolized or added to food or virater. Exposed to food orvirater. Exposed surfaces may be contaminated vifith toxin. Toxic dose 0.01 mcg/kg for Inhalation and 70 meg for Ingestion. Hours to a few days See p 136. Symmetric, descending flaccid paralysis with Initial bulbar palsies (ptosis, diplopia, dysarthria, dysphagia) progressing to diaphragmatic muscle weakness and respiratory arrest. Dry mouth and blurred vision due to toxin blockade of muscarinic receptors. Toxin cannot penetrate intact skin but is absorbed across mucous membranes or wounds. Treatment botulinum antitoxin (see p 420). 

II. Indications. Botulinum antitoxin is used to treat clinical botulism (see page 136) to prevent progression of neurologic manifestations. It is generally not recommended for treatment of infant botulism however, open-label clinical trials have been under way in California with human-derived botulism immune globulin (BIG) and have been extended nationwide. For information, call the California Department of Health Services at (510) 231-7600. 

A. Parenteral. Biivalent botulinum antitoxin or botulism antitoxin bivalent (equine) (7500 lU type A, 5500 lU type B), and monovalent botulinum antitoxin (8500 lU type E) available through the Centers for Disease Control (CDC), telephone (404) 639-3356 (weekdays) or (404) 639-2888 (after hours) or contact your local health department (for reporting and to facilitate access to antitoxin). To obtain or detennine the availability of BIG for suspected infant botulism, call (510) 231-7600. 

Foodbome botulism is treated with a licensed trivalent equine antitoxin (serotypes A, B, and E) that is available only from the CDC. There is no other approved therapy for airborne botulism, although animal studies show that botulinum antitoxin can be very effective if given before the manifestation of clinical signs of disease. Mechanical ventilation is invariably necessary due to paralysis of respiratory muscles, if antitoxin is not given before the onset of clinical signs (Shapiro et al., 1997). 

Trivalent botulinum antitoxin (A,B,E) Horse antibotulism serum (globulin) Botulinum Vaccine... 

The botulinum antitoxin neutralizes toxin that has not yet bound to nerve terminals but does not reverse toxin that is already attached. If given within the first 24 hours of onset of symptoms, the antitoxin will decrease the severity of the disease and improve survival. Older patients and those who already have chronic diseases are more likely to succumb to the toxin. 

A botulinum antitoxin is available and can be obtained from stores held in regional centres and the HPA Centre for Infections as well as Porton Down. The decision to use antitoxin therapy will usually be made by a senior infectious diseases clinician and should rely on clinical or historical features rather than laboratory test results. Surgical debridement and antibiotic therapy may be indicated for suspected wound botulism. Respiratory failure may require endotracheal intubation and mechanical ventilation with subsequent monitoring and treatment in a critical care environment. 

No antibiotic therapy is currently recommended. Treatment should be with botulinum antitoxin... 

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