Treating rosacea with botulism toxin: Protocol for a systematic review and meta-analysis.

BACKGROUND: Rosacea is a chronic inflammatory disease usually associated with persistent erythema and periodic flushing. This disease is difficult to treat, and the outcomes are often unsatisfactory and prone to recurrence. In recent years, botulinum toxin has been used as a new treatment for rosacea; however, its efficacy and safety remain under discussion. Although a systematic review of the effectiveness and safety of botulinum toxin has been previously conducted by other researchers, our systematic review and meta-analysis evaluate the efficacy of botulinum toxin from a more comprehensive and detailed perspective to provide evidence for clinicians. METHODS: Any study using botulinum toxin for the treatment of rosacea was considered for the analysis. RESULTS: A total of 22 studies were included, 9 of which were randomized controlled trials involving 720 subjects. After treatment, all studies showed varying degrees of improvement in patient signs and symptoms along with reduced Clinician's Erythema Assessment (CEA) scores. The improvement was maintained for several months, and the adverse effects were mild and self-limiting. CONCLUSION: Botulinum toxin may be an effective treatment for patients with rosacea; however, further clinical evidence is needed to confirm its long-term efficacy and side effects. The study was preregistered with Prospero (CRD42022358911).

Botulismo alimentar: relato de caso de uma doença rara, grave e de relevância para a saúde pública / Foodborne botulism: case report of a rare, serious disease of public health relevance

Este resumo apresenta o relato de um caso de Botulismo ocorrido em maio de 2021 no Hospital do Servidor Público Municipal (HSPM) em São Paulo. O objetivo principal é sensibilizar os profissionais de saúde para considerar o Botulismo como uma possível causa de síndrome neuroparalítica aguda, apesar de sua raridade. Destaca-se a importância do diagnóstico precoce e do tratamento com antitoxina, juntamente com cuidados intensivos, para reduzir a mortalidade. O estudo é observacional e descritivo, relatando o caso de uma paciente hospitalizada com Botulismo de origem alimentar entre maio e agosto de 2021. Diante de uma síndrome neuroparalítica aguda, a suspeita de Botulismo e uma revisão da epidemiologia da doença são cruciais. Destaca-se a importância da antitoxina e dos cuidados intensivos no tratamento para reduzir a mortalidade. Complicações pós-infecção, como sequelas motoras, são comuns em pacientes de Botulismo, tornando essencial uma abordagem multidisciplinar de reabilitação física para uma recuperação eficaz. A Vigilância Epidemiológica e Sanitária desempenham um papel vital na prevenção e controle do Botulismo, incluindo a coleta e transporte oportunos de amostras, busca ativa de casos suspeitos e orientação à população sobre medidas preventivas. A qualidade dos dados notificados é fundamental para a eficácia dessas ações. Em vista da alta letalidade do Botulismo, destaca-se a importância de alertar os profissionais de saúde para identificar casos suspeitos, bem como treiná-los na integração com as unidades de Vigilância Sanitária e Epidemiológica. Isso permite uma identificação precoce e tratamento oportuno de casos suspeitos, contribuindo para a saúde pública. Palavras-chave: Botulismo. Neurotoxina botulínica. Intoxicação alimentar.

Benign food-borne type B botulism presenting as unilateral internal ophthalmoplegia: a case report.

BACKGROUND: Food-borne botulism is a rare neuromuscular junction disorder due to the effect of toxins released from Clostridium botulinum ingested by eating improperly stored food. Its classic manifestation is a rapidly evolving descending symmetrical flaccid paralysis with dysautonomia. CASE PRESENTATION: We have described a case of type B food-borne botulism with a benign clinical course characterized by an initially unilateral tonic mydriatic pupil. An extensive neurophysiological evaluation inclusive of pilocarpine eye drop(s) test, facial and limbs nerve stimulation and sudomotor tests, was decisively leading the diagnostic process. CONCLUSIONS: The importance of what has been described here lies in underlining that it is always advisable to consider food-borne botulinum intoxication, even in the case of unilateral/asymmetrical internal ophthalmoplegia without generalized progressive involvement of the voluntary muscles.

When your cat takes you to the ICU: Miller Fisher/ Guillain-Barré-overlap-syndrome caused by Pasteurella multocida infection resembling wound botulism.

BACKGROUND: Pasteurella multocida can cause serious soft tissue infections and, less commonly, septic arthritis, osteomyelitis, and sepsis especially in immunocompromised hosts. P. multocida can cause meningitis or meningoencephalitis, occasionally with the formation of abscesses, but is rarely the cause of other neurological diseases. Miller Fisher Syndrome (MFS) is a parainfectious autoimmune disorder presenting with ophthalmoplegia, ataxia and areflexia. CASE PRESENTATION: We present the case of a 59-year-old immunocompetent patient who developed an atypical Miller Fisher/ Guillain-Barré-overlap-syndrome associated with a phlegmon caused by P. multocida, an associated bacteremia and sepsis leading to long intensive care treatment. Initial differential diagnosis was wound botulism. Patient was treated by antibiotics, wound cleansing with VAC pump and intravenous immunoglobulins. CONCLUSION: With this case we were able to show that a P. multocida infection can trigger atypical Miller Fisher/ Guillain-Barré-overlap-syndrome and that this is an important differential diagnosis of wound botulism.

Neurophysiological patterns of acute and post-acute foodborne botulism.

INTRODUCTION/AIMS: Neurophysiological patterns in patients with foodborne botulism are rarely described after the acute phase. We report data from a large Italian outbreak of botulism, with patients evaluated at different timepoints after poisoning. METHODS: Eighteen male patients (mean age 47 ± 8.4 y) underwent 22 clinical and neurophysiological evaluations (4 patients were re-evaluated). The resting compound muscle action potential (CMAP) amplitude, postexercise CMAP amplitude, CMAP change after high-frequency (50 Hz) repetitive nerve stimulation (HFRNS), and motor unit action potentials (MUAPs) were assessed in the acute (4-8 days after poisoning; 5 patients), early post-acute (32-39 days after poisoning; 5 patients), and late post-acute (66-80 days after poisoning; 12 patients) phases. RESULTS: In the acute, early post-acute, and late post-acute phases, respectively, reduced CMAP amplitudes were found in 100%, 20%, and 17% of patients; abnormal postexercise CMAP facilitation was observed in 100%, 40%, and 0% of patients; and pathological incremental responses to HFRNS were found in 80%, 50%, and 8% of patients. Baseline CMAP amplitudes, postexercise CMAP facilitation, and CMAP increases in response to HFRNS differed significantly between the acute and post-acute phases. Small MUAPs were found in 100% of patients in the acute and early post-acute phases and in 50% of patients in the late post-acute phase. DISCUSSION: The neurophysiological findings of foodborne botulism vary considerably according to the evaluation time point. In the post-acute phase, different neurophysiological techniques must be applied to support a diagnosis of botulism.

Foodborne botulism presenting as small bowel obstruction: a case report.

BACKGROUND: Small bowel obstruction is one of the leading reasons for accessing to the Emergency Department. Food poisoning from Clostridium botulinum has emerged as a very rare potential cause of small bowel obstruction. The relevance of this case report regards the subtle onset of pathognomonic neurological symptoms, which can delay diagnosis and subsequent life-saving treatment. CASE PRESENTATION: A 24-year-old man came to our Emergency Department complaining of abdominal pain, fever and sporadic self-limiting episodes of diplopia, starting 4 days earlier. Clinical presentation and radiological imaging suggested a case of small bowel obstruction. Non-operative management was adopted, which was followed by worsening of neurological signs. On specifically questioning the patient, we discovered that his parents had experienced similar, but milder symptoms. The patient also recalled eating home-made preserves some days earlier. A clinical diagnosis of foodborne botulism was established and antitoxin was promptly administered with rapid clinical resolution. CONCLUSIONS: Though very rare, botulism can mimic small bowel obstruction, and could be associated with a rapid clinical deterioration if misdiagnosed. An accurate family history, frequent clinical reassessments and involvement of different specialists can guide to identify this unexpected diagnosis.

[Botulism: A case report and literature review]. / Botulisme : à propos d'un cas et revue de la littérature.

INTRODUCTION: Botulism is a rare syndrome resulting from the action of a neurotoxin produced by Clostridium botulinum, that it is potentially life threatening if diagnosis is delayed. CASE REPORT: We report a 26-year-old woman who presented an acute onset of bilateral cranial neuropathies associated with an anticholinergic syndrome in the absence fever leading to consider and confirm the diagnosis of botulism. At the end of follow-up, 7 weeks later, the outcome was favorable with an almost complete neurologic recovery. CONCLUSION: Although botulism is uncommon, better awareness of its manifestations and high clinical suspicion should shorten diagnostic delay that makes the use of specific antitoxin ineffective. An acute onset of a bilateral oculomotor palsy, a fixed pupillary dilation and descending weakness in the absence of fever is typical of botulism. Outcome is usually favorable with a slow but full neurological recovery.

Hospital-acquired intestinal toxemia botulism in a newly diagnosed adult colon cancer patient.

This manuscript reports a case of intestinal toxemia botulism in an adult with recently diagnosed metastatic colon cancer in whom botulism symptoms began 23 days after hospital admission. Representing the rarest form of botulism presentation in clinical practice, this infectious disease may have developed due to a cluster of predisposing factors that favored Clostridium botulinum colonization and the endogenous production of neurotoxins, among which are previous use of broad-spectrum antibiotics and colon changes related to the development of the neoplasia. This case highlights the importance of considering intestinal toxemia botulism in the differential diagnosis of a patient presenting with symmetrical descending flaccid paralysis, since immediate treatment with botulinum antitoxin may improve clinical outcomes.

Brote de botulismo por consumo de alubias / Outbreak of botulism due to consumption of beans

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