Werner S B, Passaro D, McGee J, Schechter R, Vugia D J
Division of Communicable Disease Control, California Department of Health Services, Berkeley, CA 94704, USA.
Clin Infect Dis. 2000 Oct;31(4):1018-24. doi: 10.1086/318134. Epub 2000 Oct 25.
California has reported most of the world's wound botulism (WB) cases and nearly three-fourths of the cases reported in the United States. We reviewed the clinical, epidemiologic, and laboratory features of WB. From the first case in 1951, through 1998, a total of 127 cases were identified-93 in the last 5 years. The dramatic increase has been due to an epidemic (of WB) in people who inject black tar heroin. Whereas early cases of WB occurred after gross trauma, all but 1 of the last 102 cases occurred in drug users, primarily those who inject drugs subcutaneously ("skin poppers"). Cases are occurring disproportionately in Hispanics and women. Misdiagnosis and diagnostic delays of up to 64 days have occurred. This unprecedented, ongoing epidemic is now being reported in other states. We discuss the clinical and laboratory features that distinguish botulism from conditions that can mimic it, the relative yield of various diagnostic laboratory tests for botulism, and its treatment.
加利福尼亚州报告了世界上大部分的创伤性肉毒中毒（WB）病例，以及美国报告病例的近四分之三。我们回顾了WB的临床、流行病学和实验室特征。从1951年的首例病例到1998年，共确诊127例病例，其中过去5年有93例。病例数的急剧增加是由于注射黑色焦油海洛因人群中爆发了（WB）疫情。早期的WB病例发生在严重创伤后，而过去102例病例中除1例之外，均发生在吸毒者中，主要是那些皮下注射毒品的人（“皮肤注射者”）。病例在西班牙裔和女性中不成比例地发生。曾出现误诊和长达64天的诊断延误。现在其他州也报告了这种前所未有的、仍在持续的疫情。我们讨论了将肉毒中毒与可能与之相似的病症区分开来的临床和实验室特征、肉毒中毒各种诊断实验室检测的相对阳性率及其治疗方法。
