Diagnosis and treatment of botulism after botulinum toxin type A injections: report of 9 cases

Abstract

Objective To explore the diagnostic criteria of botulism after botulinum toxin type A (BT/A) injection and observe the therapeutic effect of botulinum antitoxin. Methods From August 2018 to June 2020, 9 patients suffering from botulism after BT/A injection admitted to our department were enrolled in this study. They all received blood laboratory examinations, electrophysiological examination, ophthalmological examination and so on, and then, were treated with botulinum antitoxin (type A). Results Toxic granules in the neutrophils were found in the peripheral blood smears of these patients. The results of electrophysiological examination showed that there were prolongation of motor nerve conduction velocity (MCV) in 1 patient, prolongation of trigeminal somatosensory evoked potential (TSEP) in 1 patient, attenuation of repetitive nerve stimulation (RNS) in 2 patients and prolongation of visual evoked potential (VEP) in 1 patient. In ophthalmological examination, the double view was positive in 2 cases, and the eyelid plate gland was less in 2 cases. Nine patients were treated with botulinum antitoxin and recovered well after that. Conclusion Combined with clinical manifestations, comprehensive blood laboratory examinations, electrophysiological examination and ophthalmological examination are helpful for the early diagnosis and elimination of botulism. Patients with confirmed botulinum should be treated with botulinum antitoxin as soon as possible.

Keywords

• botulinum a toxin
• poisoning
• botulinum antitoxin