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Antitoxin and Immune Globulin Therapy in Botulism

Description

Clostridium botulinum produces neurotoxins which are responsible for the clinical manifestations. Seven toxins have been identified, with a single strain usually producing one toxin type. A patient with botulism should be administered antibody to the toxin.


Physiologic Group of C. botulinum

Toxins Produced

I

A, B, F

II

B, E, F

III

C, D

IV

G

 

Antitoxin is produced in horses and is available in the Unites States through the Centers for Disease Control and state health departments. One product is directed against toxins A and B, while a second targets A, B and E.

 

Antitoxin E activity is indicated if the patient:

(1) was exposed in Alaska

(2) consumed preserved fish or fish eggs

(3) consumed seal or walrus

(4) consumed whale

(5) consumed beaver tail

 

Hypersensitivity to the equine antisera occurs in 9-20% of recipients. Patients should undergo skin testing prior to administration. Patients showing a reaction should undergo desensitization prior to full dose administration.

 

Botulism occurring in infants < 12 months of age is treated with immune globulin. Antitoxin is generally not recommended for use in infants. The Immune globulin may be obtained from the Infant Botulism Prevention Program, Health and Human Services, California (510-540-2646).


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