A Rare Case of Botulism in an Adult Patient / Un caso raro de botulismo en una paciente adulta

Presentation of botulism in adults is extremely rare and symptoms can be easily confused for symptoms of acute stroke, Guillain-Barre, or myasthenia gravis. The purpose of this clinical case report is to ensure adult botulism will be included in the differential diagnoses for a patient with this presentation so swift and accurate care can be provided to ensure optimal patient outcome. A 41-year-old-female presented with complaints of sudden onset of difficulty speaking. The patient reports a history of intravenous polysubstance abuse and symptoms progressed to bilateral facial weakness, ptosis, and external ophthalmoplegia. With no notable findings from a non-contrast computed tomography and magnetic resonance imaging and given the symptoms, a diagnosis of wound botulism from intravenous drug use was made. Botulism antitoxin was given and the patient was admitted into the intensive care unit for supportive follow-up care. A colony of Clostridium species was discovered in this patient’s arm and the patient showed significant improvement after a few days of care. (AU)

La presentación del botulismo en adultos es extremadamente rara y los síntomas pueden confundirse fácilmente con los síntomas de accidente cerebrovascular agudo, Guillain-Barré o miastenia gravis. El propósito de este informe de caso clínico es garantizar que el botulismo del adulto se incluya en los diagnósticos diferenciales de un paciente con esta presentación, de modo que se pueda brindar una atención rápida y precisa para garantizar un resultado óptimo del paciente. Una mujer de 41 años presentó quejas de aparición repentina de dificultad para hablar. El paciente refiere antecedentes de abuso de múltiples sustancias por vía intravenosa y los síntomas progresaron a debilidad facial bilateral, ptosis y oftalmoplejía externa. Sin hallazgos destacables de la tomografía computarizada sin contraste y la resonancia magnética y ante la sintomatología, se realizó el diagnóstico de botulismo de la herida por uso de drogas intravenosas. Se le administró antitoxina de botulismo y la paciente fue ingresada en la unidad de cuidados intensivos para cuidados de seguimiento de apoyo. Se descubrió una colonia de especies de Clostridium en el brazo de esta paciente, mostrando una mejoría significativa después de unos días de atención. (AU)

Ontogenetic and Experience-Dependent Changes in Defensive Behavior in Captive-Bred Hawaiian Bobtail Squid, Euprymna scolopes.

Cephalopod molluscs are known for their extensive behavioral repertoire and their impressive learning abilities. Their primary defensive behaviors, such as camouflage, have received detailed study, but knowledge is limited to intensive study of relatively few species. A considerable challenge facing cephalopod research is the need to establish new models that can be captive bred, are tractable for range of different experimental procedures, and that will address broad questions in biological research. The Hawaiian Bobtail Squid (Euprymna scolopes) is a small, tropical cephalopod that has a long history of research in the field of microbial symbiosis, but offers great promise as a novel behavioral and neurobiological model. It can be bred in the laboratory through multiple generations, one of the few species of cephalopod that can meet this requirement (which is incorporated in regulations such as EU directive 2010/63/EU). Additionally, laboratory culture makes E. scolopes an ideal model for studying ontogeny- and experience-dependent behaviors. In this study, we show that captive bred juvenile and adult E. scolopes produce robust, repeatable defensive behaviors when placed in an exposed environment and presented with a visual threat. Further, adult and juvenile squid employ different innate defensive behaviors when presented with a size-matched model predator. When a 10-min training procedure was repeated over three consecutive days, defensive behaviors habituated in juvenile squid for at least 5 days after training, but memory did not appear to persist for 14 days. In contrast, adult squid did not show any evidence of long-term habituation memory. Thus we conclude that this species produces a range of quantifiable, modifiable behaviors even in a laboratory environment where ecologically-relevant, complex behavioral sequences may not reliably occur. We suggest that the lack of long-term memory in adult squid may be related to their less escalated initial response to the mimic, and thus indicates less motivation to retain memory and not necessary inability to form memory. This is the first demonstration of age-related differences in defensive behaviors in Euprymna, and the first record of habituation in this experimentally tractable genus of squid.

In Vivo Recording of Neural and Behavioral Correlates of Anesthesia Induction, Reversal, and Euthanasia in Cephalopod Molluscs.

Cephalopod molluscs are among the most behaviorally and neurologically complex invertebrates. As they are now included in research animal welfare regulations in many countries, humane and effective anesthesia is required during invasive procedures. However, currently there is no evidence that agents believed to act as anesthetics produce effects beyond immobility. In this study we demonstrate, for the first time, that two of the most commonly used agents in cephalopod general anesthesia, magnesium chloride and ethanol, are capable of producing strong and reversible blockade of afferent and efferent neural signal; thus they are genuine anesthetics, rather than simply sedating agents that render animals immobile but not insensible. Additionally, we demonstrate that injected magnesium chloride and lidocaine are effective local anesthetic agents. This represents a considerable advance for cephalopod welfare. Using a reversible, minimally invasive recording procedure, we measured activity in the pallial nerve of cuttlefish (Sepia bandensis) and octopus (Abdopus aculeatus, Octopus bocki), during induction and reversal for five putative general anesthetic and two local anesthetic agents. We describe the temporal relationship between loss of behavioral responses (immobility), loss of efferent neural signal (loss of "consciousness") and loss of afferent neural signal (anesthesia) for general anesthesia, and loss of afferent signal for local anesthesia. Both ethanol and magnesium chloride were effective as bath-applied general anesthetics, causing immobility, complete loss of behavioral responsiveness and complete loss of afferent and efferent neural signal. Cold seawater, diethyl ether, and MS-222 (tricaine) were ineffective. Subcutaneous injection of either lidocaine or magnesium chloride blocked behavioral and neural responses to pinch in the injected area, and we conclude that both are effective local anesthetic agents for cephalopods. Lastly, we demonstrate that a standard euthanasia protocol-immersion in isotonic magnesium chloride followed by surgical decerebration-produced no behavioral response and no neural activity during surgical euthanasia. Based on these data, we conclude that both magnesium chloride and ethanol can function as general anesthetic agents, and lidocaine and magnesium chloride can function as local anesthetic agents for cephalopod molluscs.