Initial recovery and rebound of type f intestinal colonization botulism after administration of investigational heptavalent botulinum antitoxin.

Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Clinical Infectious Diseases (Impact Factor: 9.42). 09/2011; 53(9):e125-8. DOI: 10.1093/cid/cir550
Source: PubMed

ABSTRACT Investigational heptavalent botulinum antitoxin (HBAT) is now the primary antitoxin for US noninfant botulism patients. HBAT consists of equine Fab/F(ab')2 IgG fragments, which are cleared from circulation faster than whole immunoglobulins. Rebound botulism after antitoxin administration is not previously documented but occurred in our patient 10 days after HBAT administration.

  • [Show abstract] [Hide abstract]
    ABSTRACT: During an 11-year period (1967 through 1977) CDC monitored reactions of hypersensitivity to botulinal antitoxin of equine origin. Of 268 persons given botulinal antitoxin, 24 (9.0 percent) had nonfatal acute (5.3 percent) or delayed (3.7 percent) hypersensitivity reactions to a skin test or therapeutic dose. The over-all rate of reaction did not differ with the age or sex of the recipient or with the type (AB or ABE) of antitoxin administered. Serum sickness occurred significantly more frequently in persons who received more than 40 ml of serum antitoxin (p < 0.02). The over-all reaction, rate was higher than that associated with other equine serum products and probably cannot be substantially reduced. This risk, however, would be substantially reduced if not eliminated by using botulinal immune globulin obtained from hyperimmunized human donors.
    The American Journal of Medicine 11/1980; 69(4):567-70. · 5.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Clostridium botulinum neurotoxin types A, B, and E cause most cases of the paralytic disease botulism. Little is known about the epidemiology, clinical features, or microbiology of botulism type F. Cases of adult type F botulism were identified by review of data collected by CDC's National Botulism Surveillance System between 1981 and 2002. A case was either an individual whose serum or stool demonstrated type F toxin or whose stool culture yielded an organism producing toxin type F. A detailed review of cases' medical charts and laboratory data from CDC and local health departments was performed. Between 1981 and 2002, 1,269 cases of botulism among adults and infants were reported to CDC; 13 (1%) were adult type F. The median age of type F cases was 54 years; 7 (54%) were female. None were part of outbreaks. A toxigenic Clostridium baratii was identified in 9 (69%) of 13 cases. Among 11 cases for which clinical data were available, all required mechanical ventilation for a median duration of 17 days (range, 10 to 84); 8 (73%) were intubated within 24 hours of symptom onset. All patients had nearly complete or complete quadriplegia at the nadir of neurologic dysfunction, which occurred on average on day 5. On average by day 8, improvement in neuromuscular function was noted. The median duration of acute hospitalization was 31 days (range, 20 to 60). No deaths were reported. In only one case was a possible foodborne etiology identified. Toxigenic C baratii are the sole documented causes of type F botulism in the United States since 1981. These cases are characterized by a fulminant course with rapid progression to respiratory failure and paralysis, making early recognition and intervention critical to appropriate management.
    Neurology 01/2006; 65(11):1694-700. · 8.30 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Fast disappearance of F(ab')2 antivenoms from the plasma compartment [Sevcik et al., 2004. Modelling Tityus scorpion venom and antivenom pharmacokinetics. Evidence of active immunoglobulin G's F(ab')2 extrusion mechanism from blood to tissues. Toxicon 44, 731-734; Vazquez et al., 2005. Pharmacokinetics of a F(ab')2 scorpion antivenom in healthy human volunteers. Toxicon 46, 797-805] suggests a quick time course to reach its final distribution volume. An equation was developed to describe how the volume occupied by a drug in the body grows with time. As discussed in the paper this equation is free of some shortcomings of an equation developed for the same purpose by Niazi [1976. Volume of distribution as a function of time. J. Pharm. Sci. 65, 452-454]. Fluorescence microscopy showed that the rapid initial decay in plasmatic F(ab')2 concentration may be related to uptake of F(ab')2 by vascular endothelium which, in combination with accumulation in the vascular wall connective tissue, may produce an intermediate plateau in F(ab')2 V(sl)(t), which reached its final value after 10 h. The V(sl)(t) equation predicts that the plasma concentration half-time of decay has little use to estimate how a drug distributes through the body to exert its action, and predicts that, in some instances, intermediate plateaus in the time course of V(sl)(t) exist. Data from the literature showed that the kinetic considerations for V(sl)(t) also apply to clevidipine, digoxin, digitoxin, lidocaine and thiopentone.
    Toxicon 11/2007; 50(5):653-65. · 2.58 Impact Factor