Botulism confirmed in three cases linked to Florida clinic

Dec 7, 2004 (CIDRAP News) – Florida officials said today that botulism has been confirmed in three of four suspected cases linked with a Florida clinic that reportedly gave injections with anti-wrinkle preparations containing botulinum toxin, but whether the cases stemmed from such injections remained unknown.

"Tests conducted at the Centers for Disease control and Prevention (CDC) in Atlanta have detected botulism toxin type A in the blood from three individuals," the Florida Department of Health (FDH) said in a news release. "Only the toxin, not Clostridium botulinum bacteria, has been identified in these patients. Pretreatment specimens were unavailable for testing for one individual."

Four people linked with Advanced Integrated Medical Center in Fort Lauderdale, Fla., were hospitalized last week with suspected botulism. Two patients, Bach McComb and Alma "AJ" Hall, worked at the center and were hospitalized in New Jersey while visiting there, according to newspaper accounts. The other two patients, Eric S. Kaplan and his wife, Bonnie, told a treating physician they had gone to the center for anti-wrinkle injections, according to reports.

Botulinum toxin is produced by C botulinum and causes muscle paralysis. In drugs such as Botox, tiny amounts of the toxin are used to smooth facial wrinkles and treat certain muscle disorders. Most botulism cases result from contaminated food or wound contamination.

The FDH statement said, "It is not possible to determine from the tests conducted by the CDC if the botulism toxin detected in these patients was derived from a commercial preparation or some other source. The source of the botulism toxin type A in these individuals remains under investigation."

The FDH statement indicated that the four patients, who were on mechanical ventilators last week, remained seriously ill today. "The severity of illness noted in the affected individuals continues to significantly challenge their ability to fully participate in a detailed investigation of possible causes of their illness," the statement said.

The department said it is working with the Food and Drug Administration to determine whether "pharmaceuticals" found at Advanced Integrated Medical Center contributed to the illness cases.

The statement noted that the typical botulinum toxin doses contained in approved drugs, when used appropriately for their intended purpose, have not been linked with severe illnesses like those in the four patients.

A Dec 4 report in Fort Lauderdale's South Florida Sun-Sentinel said authorities were investigating the possibility that the illness cases were related to the use of "an unapproved Botox-like wrinkle injection."

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