Botulism Questions & Answers

1. [Guideline] Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021 May 7. 70 (2):1-30. [QxMD MEDLINE Link].

2. Potulska-Chromik A, Zakrzewska-Pniewska B, Szmidt-Sałkowska E, Lewandowski J, Siński M, Przyjałkowski W, et al. Long lasting dysautonomia due to botulinum toxin B poisoning: clinical-laboratory follow up and difficulties in initial diagnosis. BMC Res Notes. 2013 Oct 30. 6:438. [QxMD MEDLINE Link].

3. Chatham-Stephens K, Fleck-Derderian S, Johnson SD, Sobel J, Rao AK, Meaney-Delman D. Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932-2015. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S11-S16. [QxMD MEDLINE Link]. [Full Text].

4. Sobel J. Botulism. Clin Infect Dis. 2005 Oct 15. 41 (8):1167-73. [QxMD MEDLINE Link].

5. Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clinical Characteristics and Ancillary Test Results Among Patients With Botulism-United States, 2002-2015. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S4-S10. [QxMD MEDLINE Link].

6. Sobel J. Diagnosis and treatment of botulism: a century later, clinical suspicion remains the cornerstone. Clin Infect Dis. 2009 Jun 15. 48 (12):1674-5. [QxMD MEDLINE Link].

7. Mallik A, Weir AI. Nerve conduction studies: essentials and pitfalls in practice. J Neurol Neurosurg Psychiatry. 2005 Jun. 76 Suppl 2 (Suppl 2):ii23-31. [QxMD MEDLINE Link].

8. Maselli RA, Bakshi N. AAEM case report 16. Botulism. American Association of Electrodiagnostic Medicine. Muscle Nerve. 2000 Jul. 23 (7):1137-44. [QxMD MEDLINE Link].

9. Botulinum. Stanek, SA; Saunders, D. USAMRIID’s MEDICAL MANAGEMENT OF BIOLOGICAL CASUALTIES HANDBOOK. 9th. FORT DETRICK FREDERICK, MARYLAND: USAMRIID; 2020 Sep. 149-54. [Full Text].

10. Infant Botulism. Centers for Disease Control and Prevention: Botulism in the United States, 1899-1996. Handbook for Epidemiologists, Clinicians, and Laboratory Workers. Centers for Disease Control and Prevention; 1998. 10. [Full Text].

11. Brunt J, van Vliet AH, van den Bos F, Carter AT, Peck MW. Diversity of the Germination Apparatus in Clostridium botulinum Groups I, II, III, and IV. Front Microbiol. 2016. 7:1702. [QxMD MEDLINE Link].

12. Caleo M, Restani L. Exploiting Botulinum Neurotoxins for the Study of Brain Physiology and Pathology. Toxins (Basel). 2018 Apr 25. 10 (5):357-73; abstract ix. [QxMD MEDLINE Link].

13. Yuan J, Inami G, Mohle-Boetani J, Vugia DJ. Recurrent wound botulism among injection drug users in California. Clin Infect Dis. 2011 Apr 1. 52 (7):862-6. [QxMD MEDLINE Link].

14. Badell ML, Rimawi BH, Rao AK, Jamieson DJ, Rasmussen S, Meaney-Delman D. Botulism During Pregnancy and the Postpartum Period: A Systematic Review. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S30-S37. [QxMD MEDLINE Link].

15. Werner SB, Passaro D, McGee J, Schechter R, Vugia DJ. Wound botulism in California, 1951-1998: recent epidemic in heroin injectors. Clin Infect Dis. 2000 Oct. 31 (4):1018-24. [QxMD MEDLINE Link].

16. Botulism: Epidemiological Overview for Clinicians. CDC.gov. Available at https://www.emergency.cdc.gov/agent/botulism/clinicians/epidemiology.asp#:~:text=An%20average%20of%20110%20cases,from%203%20to%2078%20years.. October 6, 2006; Accessed: November 26, 2022.

17. Kiyokawa M, Haning H. A Case Report of Wound Botulism - Rare Disease on the Rise with the Opioid Crisis. Hawaii J Health Soc Welf. 2021 Feb 1. 80 (4):88-91. [QxMD MEDLINE Link].

18. National Botulism Surveillance Summary, 2017. CDC.gov. Available at https://www.cdc.gov/botulism/surv/2017/index.html. January 15, 2020; Accessed: November 27, 2022.

19. Shaffer N, Wainwright RB, Middaugh JP, Tauxe RV. Botulism among Alaska Natives. The role of changing food preparation and consumption practices. West J Med. 1990 Oct. 153 (4):390-3. [QxMD MEDLINE Link].

20. Foodborne Botulism. Centers for Disease Control and Prevention: Botulism in the United States, 1899-1996. Handbook for Epidemiologists, Clinicians, and Laboratory Workers. Centers for Disease Control and Prevention; 1998. 8. [Full Text].

21. Lúquez C, Edwards L, Griffin C, Sobel J. Foodborne Botulism Outbreaks in the United States, 2001-2017. Front Microbiol. 2021. 12:713101. [QxMD MEDLINE Link].

22. Mechem CC, Walter FG. Wound botulism. Vet Hum Toxicol. 1994 Jun. 36 (3):233-7. [QxMD MEDLINE Link].

23. Chatham-Stephens K, Fleck-Derderian S, Johnson SD, Sobel J, Rao AK, Meaney-Delman D. Clinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932-2015. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S11-S16. [QxMD MEDLINE Link].

24. MACLENNAN JD. The histotoxic clostridial infections of man. Bacteriol Rev. 1962 Jun. 26 (2 Pt 1-2):177-276. [QxMD MEDLINE Link].

25. Rasetti-Escargueil C, Lemichez E, Popoff MR. Toxemia in Human Naturally Acquired Botulism. Toxins (Basel). 2020 Nov 13. 12 (11):492-4. [QxMD MEDLINE Link].

26. Ghasemi M, Norouzi R, Salari M, Asadi B. Iatrogenic botulism after the therapeutic use of botulinum toxin-A: a case report and review of the literature. Clin Neuropharmacol. 2012 Sep-Oct. 35 (5):254-7. [QxMD MEDLINE Link].

27. Rao AK, Lin NH, Griese SE, Chatham-Stephens K, Badell ML, Sobel J. Clinical Criteria to Trigger Suspicion for Botulism: An Evidence-Based Tool to Facilitate Timely Recognition of Suspected Cases During Sporadic Events and Outbreaks. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S38-S42. [QxMD MEDLINE Link].

28. Hick JL, Barbera JA, Kelen GD. Refining surge capacity: conventional, contingency, and crisis capacity. Disaster Med Public Health Prep. 2009 Jun. 3 (2 Suppl):S59-67. [QxMD MEDLINE Link].

29. Fokke C, van den Berg B, Drenthen J, Walgaard C, van Doorn PA, Jacobs BC. Diagnosis of Guillain-Barré syndrome and validation of Brighton criteria. Brain. 2014 Jan. 137 (Pt 1):33-43. [QxMD MEDLINE Link].

30. Wheeler C, Inami G, Mohle-Boetani J, Vugia D. Sensitivity of mouse bioassay in clinical wound botulism. Clin Infect Dis. 2009 Jun 15. 48 (12):1669-73. [QxMD MEDLINE Link].

31. Rao AK, Lin NH, Jackson KA, Mody RK, Griffin PM. Clinical Characteristics and Ancillary Test Results Among Patients With Botulism-United States, 2002-2015. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S4-S10. [QxMD MEDLINE Link].

32. Rao AK, Lin NH, Griese SE, Chatham-Stephens K, Badell ML, Sobel J. Clinical Criteria to Trigger Suspicion for Botulism: An Evidence-Based Tool to Facilitate Timely Recognition of Suspected Cases During Sporadic Events and Outbreaks. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S38-S42. [QxMD MEDLINE Link].

33. U.S. Department of Health and Human Services. FDA approves first Botulism Antitoxin for use in neutralizing all seven known botulinum nerve toxin serotypes. FDA NEWS RELEASE. 2013 Mar 22. Available at http://wayback.archive-it.org/7993/20161022134538/http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm345128.htm.

34. Arnon SS, Schechter R, Maslanka SE, Jewell NP, Hatheway CL. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006 Feb 2. 354 (5):462-71. [QxMD MEDLINE Link].

35. Tacket CO, Shandera WX, Mann JM, Hargrett NT, Blake PA. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med. 1984 May. 76 (5):794-8. [QxMD MEDLINE Link].

36. BAT® [Botulism Antitoxin Heptavalent (A, B, C, D, E, F, G) - (Equine)] [package insert]. Winnipeg, Canada: Cangene Corporation, a subsidiary of Emergent BioSolutions Inc. 2013. Available at [Full Text].

37. Sheth AN, Wiersma P, Atrubin D, Dubey V, Zink D, Skinner G, et al. International outbreak of severe botulism with prolonged toxemia caused by commercial carrot juice. Clin Infect Dis. 2008 Nov 15. 47 (10):1245-51. [QxMD MEDLINE Link].

38. Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, et al. Safety and Improved Clinical Outcomes in Patients Treated With New Equine-Derived Heptavalent Botulinum Antitoxin. Clin Infect Dis. 2017 Dec 27. 66 (suppl_1):S57-S64. [QxMD MEDLINE Link].

39. Lee JH, Lee SI, Chung CJ, Lee JH, Lee SC, Choi SR, et al. The synergistic effect of gentamicin and clindamycin on rocuronium-induced neuromuscular blockade. Korean J Anesthesiol. 2013 Feb. 64 (2):143-51. [QxMD MEDLINE Link].

40. Lawn ND, Fletcher DD, Henderson RD, Wolter TD, Wijdicks EF. Anticipating mechanical ventilation in Guillain-Barré syndrome. Arch Neurol. 2001 Jun. 58 (6):893-8. [QxMD MEDLINE Link].

41. CDC. Botulism | Diagnosis and Treatment. CDC.gov. Available at https://www.cdc.gov/botulism/testing-treatment.html. June 1, 2021; Accessed: November 27, 2022.

42. Sandrock CE, Murin S. Clinical predictors of respiratory failure and long-term outcome in black tar heroin-associated wound botulism. Chest. 2001 Aug. 120 (2):562-6. [QxMD MEDLINE Link].

43. Merz B, Bigalke H, Stoll G, Naumann M. Botulism type B presenting as pure autonomic dysfunction. Clin Auton Res. 2003 Oct. 13 (5):337-8. [QxMD MEDLINE Link].

44. CDC. Botulism | Prevention. CDC.gov. Available at https://www.cdc.gov/botulism/prevention.html#anchor_1491857381171. June 8, 2022; Accessed: November 27, 2022.

45. CDC. Botulism | Home Canned Foods. CDC.gov. Available at https://www.cdc.gov/botulism/consumer.html. June 6, 2019; Accessed: November 27, 2022.

46. Klompas M, Branson R, Eichenwald EC, Greene LR, Howell MD, Lee G, et al. Strategies to prevent ventilator-associated pneumonia in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Aug. 35 (8):915-36. [QxMD MEDLINE Link].

47. Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol. 2010 Apr. 31 (4):319-26. [QxMD MEDLINE Link].

48. Gaspar S, Peralta M, Marques A, Budri A, Gaspar de Matos M. Effectiveness on hospital-acquired pressure ulcers prevention: a systematic review. Int Wound J. 2019 Oct. 16 (5):1087-1102. [QxMD MEDLINE Link].

49. Bell T, O'Grady NP. Prevention of Central Line-Associated Bloodstream Infections. Infect Dis Clin North Am. 2017 Sep. 31 (3):551-559. [QxMD MEDLINE Link].

50. Ostrosky-Zeichner L, Sable C, Sobel J, Alexander BD, Donowitz G, Kan V, et al. Multicenter retrospective development and validation of a clinical prediction rule for nosocomial invasive candidiasis in the intensive care setting. Eur J Clin Microbiol Infect Dis. 2007 Apr. 26 (4):271-6. [QxMD MEDLINE Link].

51. Young PJ, Bagshaw SM, Forbes AB, Nichol AD, Wright SE, Bailey M, et al. Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation: The PEPTIC Randomized Clinical Trial. JAMA. 2020 Feb 18. 323 (7):616-626. [QxMD MEDLINE Link].

William N Bennett, V, MD Staff Physician, Infectious Disease Service, Chair, Antimicrobial Stewardship, Department of Medicine, Wright-Patterson Medical Center; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences School of Medicine

William N Bennett, V, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Joseph M Yabes, Jr, MD, FACP Deputy Director, USAF HIV Medical Evaluation Unit, Associate Program Director, Infectious Disease Fellowhip, Brooke Army Medical Center; Core Faculty, Infectious Disease Fellowship, Chair, Virtual Health Subcommittee, San Antonio Uniformed Services Health Education Consortium (SAUSHEC); Assistant Professor, Department of Medicine, Uniformed Services University of the Health Sciences; Adjunct Assistant Professor, Department of Medicine, University of Texas Health Science Center at San Antonio

Joseph M Yabes, Jr, MD, FACP is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Kirk M Chan-Tack, MD Medical Officer, Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration

Disclosure: Nothing to disclose.

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.

John Bartlett, MD † Professor Emeritus, Johns Hopkins University School of Medicine

John Bartlett, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Pharmacology, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, American Thoracic Society, American Venereal Disease Association, Association of American Physicians, Infectious Diseases Society of America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

The views expressed herein are those of the author(s) and do not reflect the official policy or position of Wright Patterson Medical Center, Brooke Army Medical Center, the Defense Health Agency, Uniformed Services University of the Health Sciences, U.S. Army Medical Department, U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, the DoD, or the U.S. Government.

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