Abstract
Botulinum neurotoxins (BoNTs) produced by Clostridia species are the most potent identified natural toxins. Classically, the toxic neurological syndrome is characterized by an (afebrile) acute symmetric descending flaccid paralysis. The most know typical clinical syndrome of botulism refers to the foodborne form. All different forms are characterized by the same symptoms, caused by toxin-induced neuromuscular paralysis. The diagnosis of botulism is essentially clinical, as well as the decision to apply the specific antidotal treatment. The role of the laboratory is mandatory to confirm the clinical suspicion in relation to regulatory agencies, to identify the BoNTs involved and the source of intoxication. The laboratory diagnosis of foodborne botulism is based on the detection of BoNTs in clinical specimens/food samples and the isolation of BoNT from stools. Foodborne botulism intoxication is often underdiagnosed; the initial symptoms can be confused with more common clinical conditions (i.e., stroke, myasthenia gravis, Guillain–Barré syndrome—Miller–Fisher variant, Eaton–Lambert syndrome, tick paralysis and shellfish or tetrodotoxin poisoning). The treatment includes procedures for decontamination, antidote administration and, when required, support of respiratory function; few differences are related to the different way of exposure.
Highlights
Botulinum neurotoxins (BoNTs) are the most powerful natural toxins and are mainly related to Clostridia species
The length of the neurons that innervate the cranial muscles is short, with consequent poor tertiary deposit; facial muscles are continuously active, with a prevalence of phasic fibers, high neurotransmitter turnover and rapid internalization of toxin; few receptors are present at postsynaptic facial muscular membrane level that, more quickly, suffer from the lack of acetylcholine
The laboratory confirmation of foodborne botulism is possible with the detection of BoNTs in clinical specimens or food samples and on the isolation of BoNT producing clostridia from stools
Summary
Botulinum neurotoxins (BoNTs) are the most powerful natural toxins and are mainly related to Clostridia species. Botulism of unknown source is mentioned by some authors [3] All this different forms are clinically characterized by the same syndrome, due to the toxin-induced neuromuscular paralysis. C. botulinum capable of producing type B toxin and isolated from an infant botulism case. A first description of nosocomial transmission of C. butyricum type E responsible for two cases of Infant Botulism (IB) has been recently described in two patients came from different geographical area. This experience underlines the importance of apply correct procedures to prevent nosocomial transmission of Clostridium difficile colitis and to reduce spreading of neurotoxins producing clostridia spores [7]. An early clinical diagnosis is crucial to manage appropriately the intoxicated patient with supportive and antidote treatment
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