Botulism antitoxins

Antibodies Derived from Horse Antisera Botulism antitoxin, diphtheria antitoxin, scorpion venom antisera, snake venom antisera, spider anti-venins, and tetanus antitoxin. 

Botulism antitoxin Horse Specificity against toxins of t5 pe A, B or E Clostridium botulinum... 

Botulism Botulism antitoxin, equine Consult the CDC.3 Treatment and prophylaxis of botulism. Available from the CDC.3 Ten to 20 percent incidence of serum reactions. 

Botulism antitoxin, which binds and neutralizes toxin, is used in me treatment of botulism. 

Hatheway, C.H., Snyder, J.D., Seals, J.E., Edell, T.A., Lewis, G.E. (1984). Antitoxin levels in botulism patients treated with bivalent equine botulism antitoxin to toxin types A, B, and E. J. Infect. Dis. 150 407-12. 

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. 

The patients are treated with botulism antitoxin and supportive care. All require endotracheal intubation and... 

Botulism is usually not transmissable from one person to another. A supply of antitoxin against botulism is maintained by the Center for Disease Control and Prevention located in Atlanta, Georgia. Such antitoxin is effective against the severity of symptoms if administered early in the course of disease, and most patients eventually recover after weeks to months of supportive care. 

Drugs There is an antitoxin stored at the CDC. To arrange to use this antitoxin, call your state health department (or CDC at 404-639-2206 or 404-639-3753 workdays, or call weekends or evenings at 404-639-2888). This chemotherapy (antitoxin) available from CDC is a licensed trivalent equine antitoxin for serotypes A, B, and E. There is no reversal of botulism disease with this drug, but the antitoxin does usually prevent further nerve damage. The U.S. Department of Defense (DOD) has a heptavalent equine despeciated antitoxin for serotypes A - G (IND). DOD also has pentavalent toxoid (vaccine) for serotypes A - E (IND). The currently recommended schedule is for use at zero, two, and twelve weeks with a one year booster. This vaccine is supposed to induce solidly protective antitoxin levels in greater that 90 percent of those vaccinated after one year. Contact USAMRIID, (U.S. Army Medical Research Institute of Infectious Diseases), Fort Detrick, Maryland. Tel. 301-619-2833. 

Botulism (adjunctive therapy to antitoxin), gas gangrene and tetanus (adjunctive therapy to human tetanus immune globulin)... 

Botulism A (Clostridium bofulinum toxin) Bacteria— food (particularly improperly canned foods), wound, and infantile 1-5 days No Standa d Descending muscle paralysis, ptosis (drooping upper eyelids), blurred vision/ diplopia Fatal about 4-6 days nonfatal several months Aggressive resp support, supportive care trivalent and heptavalent antitoxin... 

Reliable antidotes for botulism are not available. In some cases, anticholinesterase drugs may improve muscle strength, albeit temporarily. Guanidine and 4-aminopyri-dine also have limited usefulness. Management depends primarily on supportive measures, such as administering antitoxin and maintaining respiration. 

Injected forms of antibodies which have been generated in another body or animal can be isolated, purified, and administered as standard human immune serum globulin (ISG), and ISG plus preparation, or as an animal antiserum or antitoxin. Some serums which are available are those for rabies, snake and insect bites, botulism, and tetanus. Temporary immunity of up to six months to hepatitis can be imparted by one "gamma globulin" shot. More permanent active immunity is available to health care workers. 

For example, in October and November 1987, eight cases of botulism occurred, two in New York and six in Israel. All the victims had eaten Kapchunka, air-dried, salted whitefish, which had been prepared in New York, and then some had been transported by individuals to Israel. All the patients developed the symptoms of botulism within 36 hours, and one died. Some were treated with antitoxin and two received breathing assistance. 

Cases of botulism are rare, and there is an antidote available (known as an antitoxin). Refrigeration of food and the use of preservatives such as sodium nitrite clearly have reduced the likelihood of contamination, but cases still occur despite this. 

The history of the development of antitoxins in combating bacterial infection dates back to the early beginnings of organized bacteriology. Belrring was tile first to show that animals that were immune to diphtheria contained, in their serum, factors which were capable of neutralizing the poisonous effect of the toxins derived from the diphtheria bacillus. While this work was earned out in 1890, prior to many of the great discoveries of mass immunization, and much later the antibiotics, there yet remains a place for antitoxins in medical treatment or prophylaxis for some diseases, such as tetanus and botulism,... 

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... 

The administration of heterologous antitoxin was one of the first therapeutic approaches developed for botuhsm patients and remains the most effective when initiated in the early stages of intoxication. The primary limitation of antitoxin treatment was established in some of the earhest published reports on experimental botuhsm. One of these reports evaluated the pathogenesis of oral intoxication and the efficacy of antitoxin therapy in monkeys (Back and Wood, 1928). Antitoxin treatment was not effective when administered after symptoms of botulism were already apparent, despite the fact that circulating toxin could still be detected in many of the animals. 

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