群体性食源性肉毒杆菌中毒的临床特征  

Clinical features of foodborne botulism associated with one local outbreak

作　　者：柴晨 范蕾[2] 王磊[1] 温宇英 彭操 程向东 吕美霞 唐泽海 Chai Chen;Fan Lei;Wang Lei;Wen Yuying;Peng Cao;Cheng Xiangdong;Lv Meixia;Tang Zehai

机构地区：[1]华中科技大学同济医学院附属协和医院急诊科,武汉430022 [2]新疆维吾尔自治区人民医院急诊科,乌鲁木齐830001 [3]华中科技大学公共卫生学院流行病与卫生统计学系,武汉430030

出　　处：《中华急诊医学杂志》2020年第10期1322-1327,共6页Chinese Journal of Emergency Medicine

摘　　要：目的分析群体性食源性肉毒杆菌中毒的流行病学数据及临床资料,总结食源性肉毒中毒的影响因素、临床特征,减少误诊。方法流行病学调查一起24人进食自制豆腐乳,导致14例群体性食源性肉毒杆菌中毒事件,分析中毒的影响因素。研究14例肉毒中毒患者的临床表现、实验室数据、影像学资料、治疗及预后。结果中毒患者均为A型肉毒中毒,误诊2例,饮白酒者的中毒发病率RR值为0.183(P=0.009)。中毒潜伏期中位数为2.0(1.0~3.0)d,10例复视、4例视物模糊为首发症状,9例继而吞咽困难、语言障碍等;4例进展为呼吸困难、胸闷等。中毒患者都意识清楚、无感觉异常、无发热、无腹泻腹痛等,实验室检测及颅脑CT/MRI无特征性异常。注射肉毒抗毒素治疗,8.0(7.0~8.5)d后好转出院,6月后随访,9例患者仍有轻微视物模糊。结论食源性肉毒杆菌中毒的典型临床表现是对称性下行性弛缓性瘫痪,饮白酒降低食源性肉毒中毒发病率,尽早使用肉毒抗毒素治疗有效。Objective Analyze the epidemiological data and the clinical data of local foodborne botulism,summarize the influencing factors and clinical characteristics of the foodborne botulism,mitigate future misdiagnosis.Methods An epidemiological investigation was conducted to a local outbreak with botulism,which involved 24 individuals consuming homemade bean curd and 14 cases with foodborne botulism through analyzing the influencing factors of the poisoning.For 14 patients with botulism,their clinical manifestations,first laboratory test and imaging data,treatment and prognosis,were documented and explored.Results All 14 cases were diagnosed as type A foodborne botulism,of which 2 were misdiagnosed.The incidence of the foodborne botulism was reduced by 81.7%in alcoholic drinkers(P=0.009).The median incubation period of the 14 patients with botulism was 2.0(1.0~3.0)days.The initial clinical symptom of 10 patients was diplopia,while that of the other 4 patients was blurred vision.Nine patients subsequently suffered from paralysis of oropharyngeal muscles,leading to dysphagia,speech impairment,etc.Four patients progressed to dyspnea and chest tightness due to respiratory muscle involvement.All of the patients had clear consciousness without sensory abnormalities,no fever and abdominal symptoms such as diarrhea and abdominal pain.There were no obvious abnormal findings in 14 patients with laboratory tests and cranial CT/MRI assessment.14 patients with the poisoning were relieved after injection of botulinum antitoxin for 8.0(7.0~8.5)days.Follow-up of all the patients 6 months later found that 9 patients still had slight blurred vision.Conclusions The typical clinical manifestation of foodborne botulism was symmetric descending flaccid paralysis.Drinking liquor could reduce the incidence of foodborne botulism.Botulinum antitoxin was effective in the treatment of botulism and should be used as early as possible.

关 键 词：肉毒杆菌毒素 急性中毒 群体性中毒 食源性中毒 临床特征 中毒影响因素 误诊 饮酒 肉毒抗毒素 弛缓性瘫痪 

分 类 号：R595.7[医药卫生—内科学]