A review on iatrogenic botulism

• Published in: Hong Kong journal of emergency medicine Vol. 27; no. 6; pp. 356 - 367
• Main Authors: Fung, Hin Tat, Chan, Ka Man, Lam, Shing Kit Tommy
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.11.2020; Sage Publications Ltd
• Subjects: Antitoxin; Antitoxins; botulinum; Botulinum toxin; Botulism; cosmetic; Cosmetics; Iatrogenesis; toxin; Antitoxin; botulinum; cosmetic; toxin
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/1024907920934901

Background: With the flourishing application of botulinum toxin cosmetically and therapeutically is the emergence of iatrogenic botulism, a new type of botulism in addition to the traditional ones. Objectives: We aim at a comprehensive review of the clinical characteristics of iatrogenic botulism. Methods: The available publications are retrieved and studied. Results: Botulinum toxin blocks cholinergic transmission in the neuromuscular junctions and autonomic ganglia. The blockade can spread from the site of tissue injection to adjacent or sometimes far off structures, resulting in inadvertent disabling or even lethal effects. On literature review, weakness and dysphagia are the commonest complications of iatrogenic botulism, whereas ophthalmological and oropharyngeal symptoms are more prevalent in the cosmetic group and dyspnea in the therapeutic group. Antitoxin therapy is required in about 20% of the patients. Diagnosis of iatrogenic botulism is primarily clinical and should not be confused with the neurological diagnoses possessing similar clinical manifestations. Vigilance to the drug formulation, dosage, and administration during botulinum toxin injection are part of the preventive measures in minimizing the occurrence of iatrogenic botulism. Conclusion: While overlapping with the traditional types of botulism, iatrogenic botulism carries its unique clinical characteristics.