Botulinum Toxins

  • Naomi E. Aronson


Botulism, a clinical intoxication, was named from botulus (Latin for sausage) after a late 18th century German outbreak caused by blood sausage. Since World War I, outbreaks in the United States have been commonly associated with the home preservation of vegetables and fish. In Europe, home-cured ham and sausage are more frequent vehicles. Clostridium botulinum is an anaerobic organism that is widespread in soil and salt water and freshwater mud. It forms heat-resistant spores. Eight distinct protein toxins from germinating spores have been described; A, B, C1, C2, D, E, F, and G. Regional differences are noted, with type A predominating in the western United States, B in the eastern United States and Europe, and E in the Great Lakes, Alaska, and Southeast Asia areas.


Botulinum Toxin Cervical Dystonia Clostridium Botulinum Biological Weapon Acute Intermittent Porphyria 
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  1. 1.
    Botulinum. In: Medical Management of Biological Casualties Handbook. USAMRIID, Ft. Detrick, MD, 2001, pp. 69–75 and Appendices. Google Scholar
  2. 2.
    Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon. JAMA 2001;285:1059–1070.PubMedCrossRefGoogle Scholar
  3. 3.
    Middlebrooks JL, Franz DR. Botulinum toxins. In: Sidell FR, Takafuji ET, Franz DR, eds. Textbook of Military Medicine: Medical Aspects of Chemical and Biologic Warfare. Borden Institute, Washington, DC, 1997, pp. 643–653.Google Scholar
  4. 4.
    Compton JAF. Botulinum toxin. In: Military Chemical and Biological Agents: Chemical and Toxicological Properties. Telford Press, Caldwell, NJ, 1987, pp. 337–342.Google Scholar
  5. 5.
    Henderson DA. The looming threat of bioterrorism. Science 1999;283:1279–1282.PubMedCrossRefGoogle Scholar
  6. 6.
    Zilinskas RA. Iraq’s biologic weapons. JAMA 1997;278:418–424.PubMedCrossRefGoogle Scholar
  7. 7.
    Franz DR. Defense against toxin weapons. In: Sidell FR, Takafuji ET, Franz DR, eds. Medical Aspects of Chemical and Biologic Warfare (Textbook of Military Medicine Part I). Borden Institute, Washington, DC, 1997, pp. 603–619.Google Scholar
  8. 8.
    CDC. Biologic and chemical terrorism: strategic plan for preparedness and response. MMWR 2000; 49:1–14.Google Scholar
  9. 9.
    Shapiro RL, Hatheway C, Swerdlow DL. Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med 1998;129:221–228.PubMedGoogle Scholar
  10. 10.
    Siegel LS. Destruction of botulinum toxins in food and water. In: Hauschild AH, Dodds KL, eds. Clostridium botulinum: Ecology and Control in Foods. Marcel Dekker, New York, 1993, pp. 323–341.Google Scholar
  11. 11.
    CDC. Botulism in the United States, 1899–1996. In: Handbook for Epidemiologists, Clinicians, and Laboratory Workers. CDC/NCID, Atlanta, GA, 1998,1–42.Google Scholar
  12. 12.
    Hathaway CL. Botulism: the present status of the disease. CUrr Top Microbiol Immunol 1995; 195:55–75.CrossRefGoogle Scholar
  13. 13.
    Hauschild AHW. Epidemiology of human foodborne botulism. In: Hauschild AHW, Dodds KL, eds. Clostridium botulinum: Ecology and Control in Foods. Marcel Dekker, New York, 1993,69–104.Google Scholar
  14. 14.
    Werner SB, Passaro K, McGee J, et al. Wound botulism in California, 1951–1998: recent epidemic in heroin injectors. Clin Infect Dis 2000;31:1018–1024.PubMedCrossRefGoogle Scholar
  15. 15.
    Passaro DS, Werner SB, McGee J, et al. Wound botulism associated with black tar heroin among injecting drug users. JAMA 1998;279:859–863.PubMedCrossRefGoogle Scholar
  16. 16.
    Arnon SS, Midura TF, Damus K. Honey and other environmental risk factors for infant botulism. J Pediatr 1979;94:331–336.PubMedCrossRefGoogle Scholar
  17. 17.
    Spika JS, Shaffer N, Nargett-Bean, et al. Risk factors for infant botulism in the U.S. Am J Dis Child 1989;143:828–832.PubMedGoogle Scholar
  18. 18.
    Chia JK, Clark JB, Ryan CA, Pollack M. Botulism in an adult associated with food-borne intestinal infection with Clostridium botulinum. N Engl J Med 1986;315:239–241.PubMedCrossRefGoogle Scholar
  19. 19.
    Franz DR, Pitt LM, Clayton MA, Hanes MA, Ross KJ. Efficacy of prophylactic and therapeutic adminstration of antitoxin for inhalation botulism. In: Das-Gupta BR, ed. Botulinum and Tetanus Neurotoxins. Neurotransmission and Biomedical Aspects. Plenum Press, New York, 1993, pp. 473–476.Google Scholar
  20. 20.
    Jankovic J, Brin MF. Therapeutic uses of botulinum toxin. N Engl J Med 1991;324:1186–1194.PubMedCrossRefGoogle Scholar
  21. 21.
    Botulinum Toxin Type A Purified Neurotoxin Complex. NDA/BLA 103000,5000. FDA Medical Officer review, 2002.Google Scholar
  22. 22.
    Botulinum Toxin Type B. NDA/BLA 98–1396. FDA Medical Officer review, 1999.Google Scholar
  23. 23.
    Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ. Clinical features of type A and B food-borne botulism. Ann Intern Med 1981;95:442–445.PubMedGoogle Scholar
  24. 24.
    Beller M, Gessner B, Wainwright R, Barrett D. Botulism in Alaska: A Guide for Physicians and Health Care Providers. Alaska Department of Health and Social Services, Anchorage, AK, 1994, pp. 1–28.Google Scholar
  25. 25.
    Caya JG. Clostridium botulinum and the ophthalmologist: a review of botulism; including biological warfare ramifications of botulinum toxin. Surv Ophthalmol 2001;46:25–34.PubMedCrossRefGoogle Scholar
  26. 26.
    Tacket CO, Mann JM, Hargrett NT, Blake PA. Equine antitoxin use and other factors that predict outcome in type A foodborne botulism. Am J Med 1984;76:794–798.PubMedCrossRefGoogle Scholar
  27. 27.
    Cherington M. Botulism: ten year experience. Arch Neurol 1974;30:432–437.PubMedCrossRefGoogle Scholar
  28. 28.
    Pickett JB. AAEE Case Report #16: botulism. Muscle Nerve 1988;11:1201–1205.PubMedCrossRefGoogle Scholar
  29. 29.
    Woodruff BA, Griffin PM, McCroskey LM, et al. Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States 1975–1988. J Infect Dis 1992;166:1281–1286.PubMedCrossRefGoogle Scholar
  30. 30.
    Wainwright RB, Heyward WL, Middaugh JP, Hatheway CL, Harpster AP, Bender TR. Food-borne Botulism in Alaska, 1947–85: Epidemiology and clinical findings. J Infect Dis 1988;157:1158–1162.PubMedCrossRefGoogle Scholar
  31. 31.
    Mann JM, Martin S, Hoffman R, Marazzo S. Patient recovery from type A botulism: morbidity assessment following a large outbreak. Am J Public Health 1981;71:266–269.PubMedCrossRefGoogle Scholar
  32. 32.
    Wilcox P, Andolfatto G, Fairbarn MS, Pardy RL. Long-term follow-up of symptoms, pulmonary function, respiratory muscle strength and exercise performance after botulism. Am Rev Respir Dis 1989;139:157–163.PubMedCrossRefGoogle Scholar
  33. 33.
    Schmidt-Nowara WW, Samet JM, Rosario PA. Early and late pulmonary complications of botulism. Arch Intern Med 1983;143:451–456.PubMedCrossRefGoogle Scholar
  34. 34.
    Campbell WW, Swift TR. Differential diagnosis of acute weakness. South Med J 1981;74:1371–1375.PubMedCrossRefGoogle Scholar
  35. 35.
    LoVecchio F, Jacobson S. Approach to generalized weakness and peripheral neuromuscular disease. Emerg Med Clin North Am 1997;3:605–623.CrossRefGoogle Scholar
  36. 36.
    Miller JM. Agents of bioterrorism: preparing for bioterrorism at the community health care level. Infect Dis Clin North Am 2001;15:1132:1148–1150.Google Scholar
  37. 37.
    CDC website: (Laboratory Testing section).Google Scholar
  38. 38.
    Madsen JM. Toxins as weapons of mass destruction. Clin Lab Med 2001;21:593–605.PubMedGoogle Scholar
  39. 39.
    Henchal EA, Teska JD, Ludwig GV, Shoemaker DR, Ezzell JN. Current laboratory methods for biological threat agent identification. Clin Lab Med 2001;21:661–675.PubMedGoogle Scholar
  40. 40.
    Solomon HM, Lilly T. Clostridium botulinum. In: Jackson GH, Merker RI, Bandler R, eds. Bacteriological Analytical Manual Online ( FDA Center for Food Safety and Applied Nutrition, Washington, DC, 2001.Google Scholar
  41. 41.
    Mann JM, Hatheway CL, Gardiner TM. Laboratory diagnosis in a large outbreak of type A botulism. Am J Epidemiol 1982;115:598–605.PubMedGoogle Scholar
  42. 42.
    Hatheway CH, Snyder JD, Seal JE, Edell TA, Lewis GE. Antitoxin levels in botulism patients treated with trivalent equine botulism antitoxin to toxin types A, B, and E. J Infect Dis 1984;150:407–412.PubMedCrossRefGoogle Scholar
  43. 43.
    Black RE, Gunn RA. Hypersensitivity reactions associated with botulinal antitoxin. Am J Med 1980;69:567–570.PubMedCrossRefGoogle Scholar
  44. 44.
    Hibbs RG, Weber JT, Corwin A, et al. Experience with the use of an investigational F(ab)2 heptavalent botulism immune globulin of equine origin during an outbreak of type E botulism in Egypt. Clin Infect Dis 1996;23:337–340.PubMedCrossRefGoogle Scholar
  45. 45.
    California Department of Health Services website.
  46. 46.
    Nowakowski A, Wang C, Powers DB, et al. Potent neutralization of botulinum neurotoxin by recombinant oligoclonal antibody. Proc natl Acad Sic USA 2002;99:11,346–11,350.Google Scholar
  47. 47.
    American Academy of Pediatrics. Chemical-biologic terrorism and its impact on children: a subject review. Pediatrics 2000;105:662–670.CrossRefGoogle Scholar
  48. 48.
    Siegel LS. Human immune response to botulinum pentavalent (ABCDE) toxoid determined by a neutralization test and by an enzyme-linked immunosorbent assay. J Clin Microbiol 1988;26:2351–2356.PubMedGoogle Scholar
  49. 49.
    Byrne M, Smith LA. Development of vaccines for prevention of botulism. Biochimie 2000;82:955–966.PubMedCrossRefGoogle Scholar

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© Humana Press Inc., Totowa, NJ 2004

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  • Naomi E. Aronson

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