Endogenous antibody production to botulinum toxin in an adult with intestinal colonization botulism and underlying Crohn's disease.

A patient with obstruction of the terminal ileum from Crohn's disease developed complete paralysis in week 1 of hospitalization. Features initially suggested Guillain-Barre syndrome, but botulinum toxin was identified in serum and stool specimens from week 1 and type A toxin-producing Clostridium botulinum in stool specimens from weeks 3 to 19, confirming botulism due to intestinal colonization. In week 19, the inflamed small bowel was resected, and C. botulinum disappeared from the stool. In week 31, the patient was able to breath without assistance. Testing for an active immune response with neutralizing antibodies to C. botulinum at week 19 was positive; these antibodies remained at a protective level for >1 year. Intestinal colonization botulism, rare in adults, should be considered for patients with descending paralysis, especially those with a preceding alteration in small bowel function. An active immune response to botulinum toxin with production of protective antibodies has not been demonstrated previously in a patient with botulism and may have contributed to this patient's recovery.

Wound botulism in a patient with a tooth abscess: case report and review.

We describe a case of wound botulism associated with a tooth abscess in a 5-year-old boy. We reviewed the literature and reports to the Centers for Disease Control and Prevention (Atlanta) of laboratory-confirmed cases of wound botulism. From 1943 through 1990, 47 cases were reported. Type A botulinus toxin was identified in 32 cases, type B in 13, types A and B in 1, and an unknown type in 1. Botulism was associated with wounds from trauma, use of injectable drugs, and surgery. Sinusitis after use of intranasal cocaine has also been associated with botulism. Treatment for wound botulism includes prompt debridement of the wound for eliminating anaerobic conditions, intensive care, and treatment with antitoxin.

Laboratory diagnosis of botulism complicated by pyridostigmine treatment of the patient. A method for selectively removing interfering substances from clinical specimens.

In August 1974, a case of botulism occurred; home-canned potatoes and peas containing Clostridium botulinum, type A, were strongly incriminated as the vehicle of transmission. C. botulinum, type A, was isolated from a stool specimen of the patient, but the mouse neutralization test for botulinal toxin could not be completed because the stool extract contained a highly toxic, heat-stable substance that rapidly killed mice. Historical and laboratory evidence indicated that the substance was pyridostigmine bromide, a low-molecular-weight drug with which the patient had been treated after her disease was misdiagnosed as myasthenia gravis. A generally applicable method employing dialysis by which toxic SUBSTANCED of low molecular weigth could be selectively removed from specimens without diminishing the potency of botulinal toxin contained in them was developed. Dialysis rendered a pyridostigmine solution, a stool extract from the patient with botulism, and a stool extract from a person taking pyridostigmine virtually nontoxic to mice. Dialysis did not significantly alter the toxicity to mice of crude botulinal toxin; it selectively eliminated all or almost all pyridostigmine toxicity from a pyridostigmine-botulinal toxin mixture without altering the toxicity of the botulinal toxin.