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Edwards does not report any relevant financial information.
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For the first time, the CDC has published clinical guidelines for the diagnosis and treatment of botulism.
Agam K. Rao, MD, A medical worker in the CDC’s Highly Consistent Pathogens and Pathology Division and colleagues compiled the recommendations based on data from six systematic reviews of the clinical features of botulism.
“Prior to the publication of these guidelines, there were no comprehensive guidelines for clinical care for the treatment of botulism,” wrote Rao and colleagues in MMWR. “These evidence-based guidelines provide healthcare providers with recommended best practices for diagnosing, monitoring, and treating individual cases or outbreaks of foodborne, wound-borne, and inhaled botulism, and were developed over a multi-year process that included multiple systematic reviews and expert input.”
Healio spoke to Leslie Edwards, MHS, BSN, an epidemiologist and botulism expert for the CDC on the new guidelines.
Healio: Why did it take so long to publish guidelines and why are they published now?
Edwards: These are the first comprehensive guidelines for clinical care for botulism. The guidelines provide doctors with recommended best practices for diagnosing, treating, and monitoring people with most types of botulism. CDC developed the guidelines in a multi-year process that included extensive expert input and six systematic reviews of 100 years of literature. We designed the process to ensure the fullest possible literature review and input from a wide range of scientists with expertise in the clinical treatment of botulism.
Healio: What type of botulism is a clinician most likely to experience in the United States?
Edwards: Foodborne botulism and wound botulism are the two most common types of botulism in adults in the United States. The incidence for each type varies from year to year. When we examine preliminary surveillance data from 2020 and 2021, wound botulism appears to be increasing in people who inject heroin (including black tar heroin) and methamphetamine.
Healio: What are the main risk factors for botulism in the US?
Edwards: The only risk factor for foodborne botulism is consumption of foods that are contaminated with botulinum toxin. This includes eating homemade foods that have not been properly preserved, preserved, or fermented. Foodborne botulism can also occur when certain foods are not adequately refrigerated.
Wound botulism can occur when spores of the bacteria get into a wound and form botulinum toxin. People who inject illegal drugs have a greater chance of developing wound botulism. Wound botulism has also occurred in people after traumatic injuries such as motorcycle accidents or surgery.
Healio: What are the top recommendations that might be most clinically relevant to a practicing ID clinician?
Edwards: Diagnosing botulism depends on high clinical suspicion and a thorough neurological examination. The up-to-dateness of the diagnosis is crucial for a successful treatment, since the patient has to be given botulinum antitoxin as soon as possible. In patients with wound botulism, it can be difficult to distinguish between the clinical presentation of drug use and botulism. Patients with cranial nerve signs and symptoms or descending paralysis should be asked about their food history and drug use in the days leading up to symptoms to aid diagnosis.
Healio: Why is it important not to wait for confirmation from the laboratory before treating a patient suspected of having botulism?
Edwards: Botulism tests are performed in laboratories at the State Department of Health and the CDC. The results can take several days. Delayed administration of antitoxin to a patient with suspected botulism can worsen the patient’s outcome.
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