In light of this life-threatening complication, all suspected cases of botulism are treated as medical emergencies, and public health officials are usually involved to identify the source and take steps to prevent further cases from occurring.Botulinum toxin A, C, and E cleave the SNAP-25, ultimately leading to paralysis. Diagnosis
For botulism in babies, diagnosis should be made on signs and symptoms. Confirmation of the diagnosis is made by testing of a stool or enema specimen with the mouse bioassay. In people whose history and physical examination suggest botulism, these clues are often not enough to allow a diagnosis. Other diseases such as Guillain–Barré syndrome, stroke, and myasthenia gravis can appear similar to botulism, and special tests may be needed to exclude these other conditions. These tests may include a brain scan, cerebrospinal fluid examination, nerve conduction test (electromyography, or EMG), and an edrophonium chloride (Tensilon) test for myasthenia gravis. A definite diagnosis can be made if botulinum toxin is identified in the food, stomach or intestinal contents, vomit or feces. The toxin is occasionally found in the blood in peracute cases. Botulinum toxin can be detected by a variety of techniques, including enzyme-linked immunosorbent assays (ELISAs), electrochemiluminescent (ECL) tests and mouse inoculation or feeding trials. The toxins can be typed with neutralization tests in mice. In toxicoinfectious botulism, the organism can be cultured from tissues. On egg yolk medium, toxin-producing colonies usually display surface iridescence that extends beyond the colony.
MMF was judged a consequence of a switch to intramuscular injection and the deltoid muscle being the preferred site of both vaccine injection and biopsy in France (while other sites were preferred for biopsy in other countries) and the commencement of HBV vaccination in French adults. Similar lesions could be detected in babies and children upon biopsy of the quadriceps as this is the site of vaccine administration in this group. MMF could also be experimentally reproduced in animals, with regression over time. It has been proposed that in a small portion of the population, vaccination results in persistence of aluminium-compound particles in macrophages in association with myalgia, fatigue, and cognitive dysfunction. A MMF disorder has been compared to autoimmune/inflammatory syndrome induced by adjuvants. A case-controlled study in France found those with MMF were more likely to have received aluminium-containing vaccines. MMF was also associated with fatigue “and related functional limitations", with fatigue more common in the beginning of the malady that led to the biopsy. However, neither myalgia, arthralgia, nor any other symptoms or risk factors were identified as specific to those with MMF.Many of those with MMF had previously been treated for malaria with chloroquine or hydroxychloroquine.As of 2009, with few exceptions, MMF had only been reported in France. == References ==