EXPERIENCE WITH THE USE OF AN INVESTIGATIONAL F(AB')(2) HEPTAVALENT BOTULISM IMMUNE GLOBULIN OF EQUINE ORIGIN DURING AN OUTBREAK OF TYPE-E BOTULISM IN EGYPT

During an outbreak of type E foodborne botulism in Cairo in 1991, an i nvestigational equine F(ab')(2) ''despeciated'' heptavalent botulism i mmune globulin (dBIG) was provided to the Egyptian Ministry of Health by the U.S. Army, Of 54 patients known to have been treated with antit oxins, 4 received commercially available trivalent antitoxins, 45 rece ived dBIG, and 5 received both commercial antitoxin and dBIG, Physicia ns recorded side effects in 10 (22%) of 45 patients who received dBIG; in nine cases, reactions were considered ''mild,'' and in one case th ey were believed to be serum sickness. In contrast, possible serum sic kness during hospitalization was recorded for two of four patients who were receiving commercial antitoxins, No complications of therapy wer e noted for any patient who was receiving both antitoxin types. In a s eparate study, 31 patients were contacted about their reactions to the antitoxin by telephone after discharge from the hospital, Seven (54%) of 13 patients attributed symptoms that they experienced while they w ere hospitalized to receipt of dBIG, while four (44%) of nine patients who indicated that they had received commercial antitoxins and one (2 0%) of five who received both commercial antitoxin and dBIG reported s ide effects before discharge, Data on the efficacy of the antitoxins w ere not obtained. In our experience, equine dBIG was at least as safe as commercially available antitoxins in treating type E foodborne botu lism.