{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:34:22Z","timestamp":1791923662860,"version":"4.3.4"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,6,21]],"date-time":"2018-06-21T00:00:00Z","timestamp":1529539200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Basic Clin Pharma Tox"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Iatrogenic botulism resulting from the substantial increase in use of botulinum neurotoxin type A (Bo\n                    <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\n                    \u2010A) treatment is rarely reported. We aimed to describe a large iatrogenic botulism outbreak in Egypt in June\u2013July 2017. Nine patients developed botulism after receiving intramuscular injections of Bo\n                    <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\n                    \u2010A (dose: 200\u2013300 IU) to treat cerebral palsy (N = 7), spastic dystonia (N = 1) and hyperhidrosis (N = 1). Detailed findings were available in five of nine cases. Patients were admitted to the hospital 5\u201010 days after the Bo\n                    <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\n                    \u2010A injection. Complaints included muscle weakness in the upper and lower limbs (N = 5), dysphagia (N = 5), dizziness (N = 2), dyspnoea (N = 2), dysphonia (N = 2), dysarthria (N = 2), fatigue (N = 1), diplopia (N = 1) and blurred vision (N = 1). Physical examination showed bilateral ptosis (N = 5), diminished gag reflex (N = 2), ophthalmoparesis (N = 1), facial paresis (N = 1) and tongue weakness (N = 1). Diagnosis was based on the patients' history and presentation and did not require any confirmatory test. On hospital admission, patients received supportive care and trivalent botulism type A\/B\/E antitoxin (250\u2013500 IU) was started. No patient required mechanical ventilation. Immediate reversal of the most severe features was observed while varying degrees of peripheral muscular weakness persisted. Full recovery required 6\u201312 weeks. Cases were promptly reported to the Egyptian health authorities, and epidemiological investigations revealed that the outbreak was related to a recently imported highly concentrated unlicensed Bo\n                    <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\n                    \u2010A preparation sold as Neuroxin\n                    <jats:sup>\u00ae<\/jats:sup>\n                    . Immediate withdrawal from the market was ordered. In conclusion, iatrogenic botulism outbreak due to counterfeit botulism toxin may result in life\u2010threatening features. The early administration of botulism antitoxin in addition to supportive care is life\u2010saving. Clinicians should remain mindful of the risk of systemic botulism with Bo\n                    <jats:styled-content style=\"fixed-case\">NT<\/jats:styled-content>\n                    \u2010A therapy.\n                  <\/jats:p>","DOI":"10.1111\/bcpt.13048","type":"journal-article","created":{"date-parts":[[2018,5,22]],"date-time":"2018-05-22T10:46:20Z","timestamp":1526985980000},"page":"622-627","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Iatrogenic Botulism Outbreak in Egypt due to a Counterfeit Botulinum Toxin A Preparation \u2013 A Descriptive Series of Patient Features and Outcome"],"prefix":"10.1111","volume":"123","author":[{"given":"Eman Abdel Monaem Abdel","family":"Rashid","sequence":"first","affiliation":[{"name":"Department of Pharmacology Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nashwa Mohamed","family":"El\u2010Mahdy","sequence":"additional","affiliation":[{"name":"National Egypt Center of Environmental and Toxicological Research (NECTR) Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huda Shehata","family":"Kharoub","sequence":"additional","affiliation":[{"name":"National Egypt Center of Environmental and Toxicological Research (NECTR) Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Salah","family":"Gouda","sequence":"additional","affiliation":[{"name":"National Egypt Center of Environmental and Toxicological Research (NECTR) Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naglaa Ahmed","family":"ElNabarawy","sequence":"additional","affiliation":[{"name":"National Egypt Center of Environmental and Toxicological Research (NECTR) Faculty of Medicine Cairo University 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