Extracorporeal adsorption as a new approach to treatment of botulism

Botulism is a paralytic disease caused by a toxin produced by the bacterium Clostridium botulinum. Outbreaks of the illness take place with a mortalit y rate of 10%, and the potential terrorist use of the toxin has become a se rious concern. The current treatment includes administration of antitoxin, which can cause serious allergic reactions. Recently, we have successfully treated a 64 year old woman with the illness with IMMUSORBA TR350 (Asahi Me dical, Tokyo, Japan), an extracorporeal adsorptive column containing polyvi nylalcoholtryptophan as an adsorptive agent, which has been widely used in Japan to treat myasthenia gravis and Guillain-Barre syndrome. Initially, th e patient developed ocular muscle weakness and a variant of the Guillain-Ba rre syndrome was suspected. After extracorporeal treatment, her neurologic symptoms remarkably improved. After a series of treatments, botulinum toxin type B was isolated in the food she had eaten, establishing the diagnosis. An in vitro study revealed that the adsorptive column removed botulinum to xin to a significant extent. Our recent findings suggest that treatment wit h the adsorptive column TR350 can be a feasible option for botulism, which is a rare but potentially lethal disease.