Botulinum Toxin A (Btx-A) Injection: A Rare and Complicated Pediatric Case from Kurdistan, Iraq
Nizar Bakir Yahya1, Hevan Adel Al-Atroushy2, Stefano Maiandi3 and Federica Buzzi4*
1MBChB, FIBMS and Assistant Professor, College of Medicine, Department of Pediatric,
University of Duhok, Duhok, Iraq
2Pediatrician FIBMS, Pediatric Intensive Care Unit, Hevi Pediatric Teaching Hospital Duhok, KR, Iraq
3MsN, Professional Development and Research, Directorate of Health Professions, ASST of Lodi
4RN, Head of pediatric and neonatal intensive care clinical training, E.U. Project
MADAD, Italian Association for Solidarity among Peoples, Duhok, KR, Iraq
Nurse, Hematology and Bone Marrow Transplantation Unit and Pediatric
Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan
*Corresponding Author: Federica Buzzi, RN, Head of pediatric and neonatal
intensive care clinical training, E.U. Project MADAD, Italian Association for Solidarity among Peoples, Duhok, KR, Iraq.
December 13, 2021; Published: March 25, 2022
Botulinum neurotoxin is the most potent poison known to humans. The active form of the Clostridium botulinum spore produces a neurotoxin that causes paralysis. Many botulism presentations are subtle and difficult to diagnose. However, botulinum can also have therapeutic uses, and the indications are different, including the reduction of muscle spasticity in pediatric patients. The therapeutic use of botulinum toxin can cause several complications, including the possibility of developing botulism.
Treatment of botulism consists of administration of antitoxins, hospitalization, close monitoring, and respiratory support as needed. The mortality rate of patients who develop botulism has dramatically decreased in developing countries but not in low-middle income countries because resources are severely limited. We report the first case of botulism after botulinum injection in a patient with hypoxic ischemic encephalopathy. The diagnosis was very complicated and late given the scarce resources present in Kurdistan, Iraq. The patient required advanced and long-lasting care.
The child was hospitalized for 92 days, 56 of which the patient was on mechanical ventilation. The patient was treated without any antidote as it was not present, and he had no further neurological sequelae following the event.
Keywords: Botulinum Toxin; Injection; Pediatric; Complicated
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