Administration Of Antitoxin Research Articles

Случай тяжелого пищевого ботулизма у ребенка: трудности диагностики и тактика терапии

Practitioners’ alertness of botulism in children decreases due to the rarity of its cases. Early diagnosis is based on clinical symptoms though the clinical manifestations may also escalate rapidly and further lead to misdiagnosis. Patients with suspected botulism require immediate hospitalization due to the high risk for paralysis of respiratory muscles and the need for mechanical ventilation. The timely administration of the antitoxin is crucial. However, maximum allowable time of its administration counting from the onset is still a subject to discussion among physicians. Authors represent a clinical case of late diagnosis of severe foodborne botulism in a 5 y/o pediatric patient with the development of tetraplegia, paralysis of cranial nerves, mechanical ventilation for 148 days, the beginning of motor recovery on the 10th day and antitoxin administration on the 18th day counting from the onset of paralysis that all let to the full motor recovery after 20 months. The difficulties of diagnosis in the acute period and both laboratory and instrumental studies are described. The questions of the duration and the necessity of the administration of botulinum antitoxin in this particular clinical case of late diagnosis are discussed as well.

Neurotropic Effect of Botulinum Toxin and the Potential of Specific Serum Therapy in Botulism (Review)

INTRODUCTION. The outbreak of foodborne botulism that occurred in Russia in June 2024 once again demonstrated the danger of this rather rare but severe infectious disease caused by ingesting botulinum neurotoxin. The only aetiological treatment for botulism is currently the administration of antitoxins against various serotypes of botulinum toxin. However, antitoxins do not provide rapid regression of neurological symptoms, which may raise doubts about the effectiveness of the selected treatment option. It is impossible to assess the potential of specific treatment without understanding the mechanisms of action of botulinum toxin and antitoxin.AIM. This study aimed to systemise information on the mechanism underlying the damaging effect of botulinum neurotoxin, aetiological antitoxin treatment, and the patient recovery process.DISCUSSION. The mechanism underlying the damaging effect of botulinum neurotoxin consists in the destruction of SNARE proteins in presynaptic cholinergic nerve terminals, which disrupts the release of acetylcholine into the synaptic cleft and the transmission of excitation between neurons. The lack of acetylcholine at the neuromuscular junction results in a distinctive form of persistent flaccid paralysis. The specific mechanism of action of botulinum toxin determines the treatment strategy, which includes a set of life-sustaining measures and the earliest possible antiserum administration. If used within 48 hours from the onset of symptoms, botulinum antitoxin binds botulinum toxin circulating in the blood, which stops the progression of paralysis and prevents further disorders in patients. However, botulinum antitoxin cannot neutralise the effect of the toxin that has already bound to nerve receptors, so clinical symptoms may worsen within 12 hours after antiserum administration. Restoration of normal neuronal transmission occurs through the formation of new axonal sprouts and can take a long time.CONCLUSIONS. Antitoxin administration is effective and irreplaceable in the aetiological treatment of botulism. Nevertheless, the duration of recovery depends on the speed of reinnervation and restoration of transmission at the neuromuscular junction.

Case Report: A 5 Yea kan r Old Girl with Diphtheria

Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. It is characterized by the formation of pseudomembranes in the tonsils, pharynx, and/or nasal cavity, which can lead to severe complications such as airway obstruction, myocarditis, and paralysis of the palate muscles. Aims: This study aims to detail the clinical course and treatment of a pediatric diphtheria case, emphasizing the importance of early diagnosis and appropriate therapeutic interventions. Methods: The case of a 5-year-old girl presenting with a 3-day history of fever at K.R.M.T Wongsonegoro Hospital is described. Clinical evaluation, including history, physical examination, and supportive tests, led to a diagnosis of diphtheritic tonsillitis. Findings: The patient exhibited classic symptoms of diphtheria, including sore throat, fever, and the presence of a dirty, greyish-white pseudomembrane on the tonsils. The membrane extended to adjacent structures, causing a condition known as bullneck. The treatment protocol included the administration of diphtheria antitoxin (DAT), antibiotics, antipyretics, corticosteroids, and symptomatic management. Conclusion: Diphtheria remains a serious infectious disease requiring prompt diagnosis and treatment to prevent complications. The case highlights the importance of early intervention, continuous monitoring, and the evaluation of therapeutic efficacy to improve patient outcomes. Implications: This study underscores the necessity of vigilant clinical practices in managing diphtheria cases, particularly in pediatric patients, to reduce morbidity and mortality.

A Case of Atypical Intestinal Botulism With Rapid Recovery After Delayed Antitoxin Administration

A Case of Atypical Intestinal Botulism With Rapid Recovery After Delayed Antitoxin Administration

Neutralizing anti-diphtheria toxin scFv produced by phage display.

Diphtheria can be prevented by vaccination, but some epidemics occur in several places, and diphtheria's threat is considerable. Administration of diphtheria antitoxin (DAT) produced from hyperimmunized animals is the most common treatment. Recombinant human antibody fragments such as single-chain variable fragments (scFv) produced by phage display library may introduce an interesting approach to overcome the limitations of the traditional antibody therapy. In the present study, B cells of immunized volunteers were used to construct a human single-chain fragment (HuscFv) library. The library was constructed with the maximum combination of heavy and light chains. As an antigen, Diphtheria toxoid (DTd) was used in four-round phage bio-panning to select phage clones that display DTd bound HuscFv from the library. After panning, individual scFv clones were selected. Clones that were able to detect DTd in an initial screening assay were transferred to Escherichia coli HB2151 to express the scFvs and purification was followed by Ni metal ion affinity chromatography. Toxin neutralization test was performed on Vero cells. The reactivity of the soluble scFv with diphtheria toxin were done and affinity calculation based on Beatty method was calculated. The size of the constructed scFv library was calculated to be 1.3×106 members. Following four rounds of selection, 40 antibody clones were isolated which showed positive reactivity with DTd in an ELISA assay. Five clones were able to neutralize DTd in Vero cell assay. These neutralizing clones were used for soluble expression and purification of scFv fragments. Some of these soluble scFv fragments show neutralizing activity ranging from 0.6 to 1.2µg against twofold cytotoxic dose of diphtheria toxin. The affinity constant of the selected scFv antibody was determined almost 107M-1. This study describes the prosperous construction and isolation of scFv from the immune library, which specifically neutralizes diphtheria toxin. The HuscFv produced in this study can be a potential candidate to substitute the animal antibody for treating diphtheria and detecting toxins.

The Diphtheria Disease

This study, ‘The Diphtheria Disease’ explored the historical significance, etiology, symptoms, transmission, and preventive measures related to diphtheria. The study adopted a qualitative meta-analysis approach. The objectives were threefold, which included to ascertain the cause(s) of diphtheria, to investigate potential cures, and to determine the efficacy of treatments. The narrative unfolded through an examination of historical outbreaks, breakthroughs, and contemporary challenges. The study focused on respiratory, cutaneous, nasal, laryngeal, and pharyngeal diphtheria types, detailing symptoms, and transmission modes. Treatment involves diphtheria antitoxin, antibiotics, and supportive care, with emphasis on early intervention and vaccination. The efficacy of the cure was explored, highlighting the importance of timely diagnosis and treatment, antitoxin administration, antibiotic therapy, supportive care, vaccination, isolation, and public health measures. It was found in the study that diphtheria disease was caused by the bacterium Corynebacterium diphtheriae, the antitoxin, derived from the serum of horses could neutralize the circulating diphtheria toxin, and this cure is effective.

A rare food poisoning: clostridium botulinum

Botulismus is a gram-positive anaerobic, spore-forming bacterium commonly found in soil. Exotaxins secreted by Clostridium bolulinum bacteria are heat-labile and irreversibly block the release of acetylcholine at the cholinergic ends of presynaptic and autonomic nerves at the neuromuscular junction after ingestion with food. The incubation period of botulismus is between 18-38 hours, and the first finding is blurred vision and diplopia symptoms due to the involvement of the eye muscles. The most important point in its treatment is early diagnosis and rapid administration of antitoxin. In this article, a case who was successfully treated in our intensive care unit with the diagnosis of botulismus poisoning is presented.

A Case of Infant Botulism Caused by Clostridium baratii type F: Evaluation and Experience with Administration of Equine-derived Heptavalent Botulism Antitoxin

A Case of Infant Botulism Caused by Clostridium baratii type F: Evaluation and Experience with Administration of Equine-derived Heptavalent Botulism Antitoxin

Neutrophil extracellular trap (NET) degradation attenuates acute lung injury and protects mice from ricin-induced acute respiratory distress syndrome (ARDS)

Abstract ARDS is a life-threatening respiratory condition associated with pulmonary vascular hyperpermeability and loss of aerated lung tissue. Ricin is a plant-toxin derived from the seeds of Ricinus communis, irreversibly inactivates ribosomes and arrests protein synthesis. Pulmonary exposure to ricin represents a bona fide model for ARDS, is characterized by pulmonary inflammation with massive neutrophil recruitment and severe disruption of the alveolar-capillary barrier leading to pulmonary edema, compromised gas exchange and respiratory failure. We have shown that upon ricin exposure, neutrophil infiltration into lungs, a hallmark of ARDS, mediate proteolysis of junction proteins. Recently, there is an increasing concern about the deleterious effect of NETs in sterile inflammation, such as in ricin case. During NETosis, PAD4 drives histone citrullination and chromatin decondensation. Decondensed chromatin decorated with citrullinated histones (citH3) and cytoplasmic granular enzymes, such as MPO is expelled from the neutrophil. Herein, we show increasing levels of PAD4, citH3 and MPO in the BALF of ricin exposed mice. BALF neutrophils efficiently produced NETs which were associated with MPO and citH3. Immunohistology of lung sections upon ricin exposure demonstrated propagating NETosis. Treatment of ricin exposed mice with recombinant DNase, targeted against NET-associated extracellular DNA, administrated with anti-ricin antibodies, dramatically decreased the level of extracellular DNA and proinflammatory cytokines in the lungs and conferred higher protection levels to mice in comparison to sole administration of antitoxin. This data highlights the potential clinical benefit of NET inhibiting drugs in ARDS.

Urinary catecholamine excretion, cardiovascular variability, and outcomes in tetanus

Severe tetanus is characterized by muscle spasm and cardiovascular system disturbance. The pathophysiology of muscle spasm is relatively well understood and involves inhibition of central inhibitory synapses by tetanus toxin. That of cardiovascular disturbance is less clear, but is believed to relate to disinhibition of the autonomic nervous system. The clinical syndrome of autonomic nervous system dysfunction (ANSD) seen in severe tetanus is characterized principally by changes in heart rate and blood pressure which have been linked to increased circulating catecholamines. Previous studies have described varying relationships between catecholamines and signs of ANSD in tetanus, but are limited by confounders and assays used. In this study, we aimed to perform detailed characterization of the relationship between catecholamines (adrenaline and noradrenaline), cardiovascular parameters (heart rate and blood pressure) and clinical outcomes (ANSD, mechanical ventilation required, and length of intensive care unit stay) in adults with tetanus, as well as examine whether intrathecal antitoxin administration affected subsequent catecholamine excretion. Noradrenaline and adrenaline were measured by ELISA from 24-h urine collections taken on day 5 of hospitalization in 272 patients enrolled in a 2 × 2 factorial-blinded randomized controlled trial in a Vietnamese hospital. Catecholamine results measured from 263 patients were available for analysis. After adjustment for potential confounders (i.e., age, sex, intervention treatment, and medications), there were indications of non-linear relationships between urinary catecholamines and heart rate. Adrenaline and noradrenaline were associated with subsequent development of ANSD, and length of ICU stay.

Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997–2019

Botulism is a low incidence but potentially fatal infectious disease caused by neurotoxins produced mainly by Clostridium botulinum. There are different routes of acquisition, food-borne and infant/intestinal being the most frequent presentation, and antitoxin is the treatment of choice in all cases. In Spain, botulism is under surveillance, and case reporting is mandatory. This retrospective study attempts to provide a more complete picture of the epidemiology of botulism in Spain from 1997 to 2019 and an assessment of the treatment, including the relationship between a delay in antitoxin administration and the length of hospitalization using the Cox proportional hazards test and Kruskal-Wallis test, and an approach to the frequency of adverse events, issues for which no previous national data have been published. Eight of the 44 outbreaks were associated with contaminated commercial foods involving ≤7 cases/outbreak; preserved vegetables were the main source of infection, followed by fish products; early antitoxin administration significantly reduces the hospital stay, and adverse reactions to the antitoxin affect around 3% of treated cases.

Adverse events following the administration of diphtheria antitoxin (Equine Source): An observational study in an Indian tertiary care centre

To assess the clinical safety of diphtheria antitoxin in patients with probable and confirmed diphtheria infection. This was a single-center, observational study which included patients with probable and/or confirmed diphtheria infection. The skin sensitivity test for diphtheria antitoxin was performed in all the patients. The patients who were insensitive/ had ‘no reaction’ to the skin sensitivity test, medically optimal dose of the DAT (10000 IU/10 mL) was administered intravenously. A total of 203 patients were enrolled in this study, and 200 considered for safety assessments (females, n=104). All patients reported negative skin-sensitivity test. A total of 14 adverse events were reported in six patients (two patients reported three events each while remaining four patients reported two events each) either immediately (75%) or within 5-6 hours (12.5%) of administration of diphtheria antitoxin and therefore, these were considered related to the administration of the drug. These 14 adverse events were non-severe and the patients recovered without sequelae. No further adverse events were observed during the rest of the hospitalization period (4-5 days), after discharge from hospital and during follow-up until 15 days after administration of diphtheria antitoxin. There were no deaths and life-threatening serious adverse events observed. The observations from the present study suggest that diphtheria antitoxin has a favorable safety profile and it can be essentially used in children as well as adults without any harm.

A case of fulminant respiratory diphtheria in a 24-year-old Afghan refugee in Austria in May 2022: a case report

PurposeRaising awareness of respiratory diphtheria and for the importance of early antitoxin administration.MethodsReport of a case of fulminant, imported respiratory diphtheria in an otherwise healthy 24-year-old Afghan refugee in Austria in May 2022.ResultThis was the first case of respiratory diphtheria in Austria since 1993. Diphtheria antitoxin was administered at an already progressed disease stage. This delay contributed to a fulminant disease course with multiorgan failure and death.ConclusionIn high-income countries with low case numbers, awareness of respiratory diphtheria and for the importance of early antitoxin administration must be raised.

Human versus equine intramuscular antitoxin, with or without human intrathecal antitoxin, for the treatment of adults with tetanus: a 2 × 2 factorial randomised controlled trial

SummaryBackgroundIntramuscular antitoxin is recommended in tetanus treatment, but there are few data comparing human and equine preparations. Tetanus toxin acts within the CNS, where there is limited penetration of peripherally administered antitoxin; thus, intrathecal antitoxin administration might improve clinical outcomes compared with intramuscular injection.MethodsIn a 2 × 2 factorial trial, all patients aged 16 years or older with a clinical diagnosis of generalised tetanus admitted to the intensive care unit of the Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam, were eligible for study entry. Participants were randomly assigned first to 3000 IU human or 21 000 U equine intramuscular antitoxin, then to either 500 IU intrathecal human antitoxin or sham procedure. Interventions were delivered by independent clinicians, with attending clinicians and study staff masked to treatment allocations. The primary outcome was requirement for mechanical ventilation. The analysis was done in the intention-to-treat population. The study is registered at ClinicalTrials.gov, NCT02999815; recruitment is completed.Findings272 adults were randomly assigned to interventions between Jan 8, 2017, and Sept 29, 2019, and followed up until May, 2020. In the intrathecal allocation, 136 individuals were randomly assigned to sham procedure and 136 to antitoxin; in the intramuscular allocation, 109 individuals were randomly assigned to equine antitoxin and 109 to human antitoxin. 54 patients received antitoxin at a previous hospital, excluding them from the intramuscular antitoxin groups. Mechanical ventilation was given to 56 (43%) of 130 patients allocated to intrathecal antitoxin and 65 (50%) of 131 allocated to sham procedure (relative risk [RR] 0·87, 95% CI 0·66–1·13; p=0·29). For the intramuscular allocation, 48 (45%) of 107 patients allocated to human antitoxin received mechanical ventilation compared with 48 (44%) of 108 patients allocated to equine antitoxin (RR 1·01, 95% CI 0·75–1·36, p=0·95). No clinically relevant difference in adverse events was reported. 22 (16%) of 136 individuals allocated to the intrathecal group and 22 (11%) of 136 allocated to the sham procedure experienced adverse events related or possibly related to the intervention. 16 (15%) of 108 individuals allocated to equine intramuscular antitoxin and 17 (16%) of 109 allocated to human antitoxin experienced adverse events related or possibly related to the intervention. There were no intervention-related deaths.InterpretationWe found no advantage of intramuscular human antitoxin over intramuscular equine antitoxin in tetanus treatment. Intrathecal antitoxin administration was safe, but did not provide overall benefit in addition to intramuscular antitoxin administration.FundingThe Wellcome Trust.

A survey of veterinarians' practices, recommendations and perceptions associated with the prevention of tetanus in horses in Australia.

Identify veterinarians' practices, recommendations and perceptions when preventing tetanus in horses in Australia. Graduated members of Equine Veterinarians Australia participated in an online survey about the prevention of tetanus in horses in Australia. Of 77 respondents (response rate ~ 8%), 50 (65%) reported that they had attended collectively 145-152 cases of tetanus in horses in Australia (1.1 cases of tetanus observed/10 veterinarian-years since qualification). The estimated case fatality rate (CFR) was at least 79%. Puncture wounds were most frequently suspected as the entry point (32%; n=47). Five respondents (7%) reported cases of localised tetanus. Three respondents reported generalised tetanus within 2 weeks of tetanus antitoxin (TAT) administration. Respondents did not report any cases of tetanus in horses which had been vaccinated according to manufacturer's recommendations. All respondents recommended vaccination, but over 50% (N=45) stated 'lack of veterinary recommendation' as often or sometimes a reason why clients did not vaccinate horses. Opinions varied on the use of TAT for peri-exposure prophylaxis; 67% of respondents dosed TAT independent of body weight, with the rest dosing according to body weight. Cases of Theiler's disease related to the use of TAT were not reported in Australia by respondents. The caseload of equine tetanus appears relatively low among equine veterinarians in Australia. Consistent with the literature, estimated CFR was high. Respondents' recommendations and perceptions about tetanus vaccination were generally consistent but varied regarding TAT usage. Evidence for TAT usage is limited and we recommend studies of TAT efficacy in horses.

Diphtheria in Children- A Clinical Profile of Cases during an Outbreak in Kerala, India

Introduction: Diphtheria is an acute potentially fatal infectious disease caused by the toxigenic strains of Corynebacterium diphtheriae. Acute respiratory obstruction, toxic myocarditis and neurologic weakness are the most important complications of diphtheria. The clinical presentation and severity of diphtheria vary in immunized and non-immunized children. Early diagnosis and prompt treatment including administration of diphtheria antitoxin and antibiotics minimize mortality. Aim: To observe the changing trends in the clinical presentation of diphtheria during the 2016 outbreak and its association with immunization status and antitoxin administration. Materials and Methods: This Longitudinal prospective study conducted among children admitted to Government Medical College, Kozhikode, Kerala, a tertiary care centre with a diagnosis of diphtheria during January 2016 to December 2016. Details of socio-demographic data, clinical presentation, investigations, immunization status, treatment and complications were collected using a semi-structured performa. These children were managed by an interim guideline provided by the state authorities. They were followed-up for 3 months. The data was analyzed using Statistical Package for Social Sciences (SPSS), version 18.0. Results: Among 76 children, 62(82%) were from Malappuram and Kozhikode districts, which have relatively low immunization coverage. Most admissions were in July 2016. Majority (58, 76.3%) of children belonged to Muslim community. The mean age was 8.1 years with male to female ratio 1.53:1. Most of the children (47, 62%) were unimmunized or partially immunized. Cultures were positive for C. diphtheriae in 20 children. Complications were noted in 36 children, which included asymptomatic myocarditis in 31, symptomatic myocarditis in one, palatal palsy in nine, loss of accommodation in four and distal weakness in five. Only one child who received antitoxin within 72 hours of disease onset developed neurological complications. Complications were common in children who received less than minimum three doses of diphtheria vaccines compared to those who received three or more doses (54% vs. 44%). There was no mortality. Conclusion: There was an upward shift in age of affected children. Neurological complications were significantly less in those who received antitoxin within 72 hours of disease onset. Regular monitoring helped to detect asymptomatic myocarditis. The outbreak highlighted the need to improve awareness about diphtheria and better vaccination coverage, especially in older children.

Microbiological and Clinical Aspects of Diphtheria-Confirmed Cases from Capital City of Indonesia, Jakarta, and Surrounding Areas in 2017

Background: The World Health Organization reported Indonesia as one of the countries with the most prevalent cases of diphtheria worldwide. The microbiological aspects of diphtheria-inducing bacteria are of great significance in tracing disease transmission and case management. However, clinical aspects are critical for updating clinical features and case management in the field, which may sometimes differ from theoretical foundations. Objectives: This study aimed to identify the microbiological and clinical aspects, including molecular typing and case fatality rates, in diphtheria-confirmed cases from the capital city of Indonesia, Jakarta, and surrounding areas in 2017. Methods: The microbiological aspect of 40 diphtheria-confirmed cases were obtained by re-identify diphtheria-inducing bacteria isolated from the samples, while the clinical aspects of the cases were obtained from the medical records and epidemiological data. The chi-square test was used to examine the correlation between fatal cases and myocarditis and diphtheria antitoxin administration delay. In this study, P ≤ 0.05 was set as the significance level. Results: All 40 diphtheria confirmed cases were induced by toxigenic Corynebacterium diphtheriae with two biotypes, namely intermedius (60.0%) and mitis (40.0%). There are six sequence types of bacteria with two main sequence types, ie, ST534 (46.4%) and ST377 (35.7%). The proportions of cases that had a fever and sore throat were 72.5% and 77.5%, respectively; however, the prevalence rates of the cases with pseudomembrane and bull neck were 100% and 47%, respectively. Most cases were administered a combination of penicillin or erythromycin with other antibiotics (40%), and 22.5% of the cases only received penicillin. Myocarditis was noticed in three fatal cases, and their relationship was statistically significant (P = 0.000). All five fatal cases (12.5% of cases) received diphtheria antitoxin (DAT) lately or had not received it yet. Conclusions: Toxigenic C. diphtheriae with two biotypes (namely mitis and intermedius) and two main sequence types (ie, ST534 and ST377) was the causative agent of diphtheria-confirmed cases from Jakarta and surrounding areas in 2017. It was also concluded that those fatal cases were correlated with myocarditis complications.

Neutralizing Concentrations of Anti-Botulinum Toxin Antibodies Positively Correlate with Mouse Neutralization Assay Results in a Guinea Pig Model.

Botulinum neurotoxins (BoNT) are some of the most toxic proteins known and can induce respiratory failure requiring long-term intensive care. Treatment of botulism includes the administration of antitoxins. Monoclonal antibodies (mAbs) hold considerable promise as BoNT therapeutics and prophylactics, due to their potency and safety. A three-mAb combination has been developed that specifically neutralizes BoNT serotype A (BoNT/A), and a separate three mAb combination has been developed that specifically neutralizes BoNT serotype B (BoNT/B). A six mAb cocktail, designated G03-52-01, has been developed that combines the anti-BoNT/A and anti-BoNT/B mAbs. The pharmacokinetics and neutralizing antibody concentration (NAC) of G03-52-01 has been determined in guinea pigs, and these parameters were correlated with protection against an inhalation challenge of BoNT/A1 or BoNT/B1. Previously, it was shown that each antibody demonstrated a dose-dependent mAb serum concentration and reached maximum circulating concentrations within 48 h after intramuscular (IM) or intraperitoneal (IP) injection and that a single IM injection of G03-52-01 administered 48 h pre-exposure protected guinea pigs against an inhalation challenge of up to 93 LD50s of BoNT/A1 and 116 LD50s of BoNT/B1. The data presented here advance our understanding of the relationship of the neutralizing NAC to the measured circulating antibody concentration and provide additional support that a single IM or intravenous (IV) administration of G03-52-01 will provide pre-exposure prophylaxis against botulism from an aerosol exposure of BoNT/A and BoNT/B.

Current status and development trend of botulinum antitoxin

Botulism is a rare, potentially fatal disease caused by botulinum toxin, a strongest biotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only specific treatment for botulism. Early administration of botulinum antitoxin is essential for the therapeutic effect of botulism. At present, almost all the approved botulinum antitoxins are equine plasma derived products, which have the potential risk of adverse reactions, including allergic reactions. This paper summarizes the current status of production technique, quality control and clinical application of botulinum antitoxin both at home and abroad, and introduce the application prospect of botulinum antitoxin.

Outbreak of foodborne botulism in Alexandria, Egypt: modulating indications for administration of heptavalent botulinum antitoxin

In October 2019, ninety-four patients were admitted into Alexandria Poison Center (APC) with a history of ingestion of Feseekh (salted fish). In an attempt to allocate the resources, not all patients were given HBAT (botulism antitoxin heptavalent (A, B, C, D, E, F, G) equine immediately. The current study aimed to portray the clinical characteristics of the cases, explore the possible relation between these characteristics and necessity of HBAT administration, explore the reliability of mouse lethal test, and establish a clinical guide for management including preservation of resources. The current prospective study included 94 patients who were admitted to Alexandria Poison Center (APC) in the period from the 29th of September to the 27th of October 2019. The patients' data were recorded using a checklist that includes: personal data, past medical history, clinical assessment, investigations, treatment, and the outcome. The checklist was carried out to assess and follow up each patient. Hospitalized patients were categorized according to symptoms consistent with botulism. The equine HBAT, made by Emergent BioSolutions Canada Inc. (formerly Cangene Corporation), was used in the treatment. HBAT was given to thirty-four patients (36.2%) only out of the total admission. However, eighty-two (87.2%) of patients were completely cured, whereas ten patients (10.6%) were discharged with mild neurological sequels and death occurred only in two cases (2.2%). Sixty cases (63.8%) with suspected foodborne botulism could be managed by supportive treatment only with no need for HBAT, while patients with evident neurological signs received HBAT immediately.