Gottlieb Sami L, Kretsinger Katrina, Tarkhashvili Nato, Chakvetadze Neli, Chokheli Maia, Chubinidze Marina, Michael Hoekstra R, Jhorjholiani Ekaterina, Mirtskhulava Merab, Moistsrapishvili Maia, Sikharulidze Merab, Zardiashvili Tamar, Imnadze Paata, Sobel Jeremy
Epidemic Intelligence Service, Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Clin Infect Dis. 2007 Jul 15;45(2):174-80. doi: 10.1086/518890. Epub 2007 Jun 5.
The acute paralytic syndrome of botulism has been well-described; however, little is known about its long-term consequences.
We conducted a case-control study in the Republic of Georgia to evaluate the health of patients > or =6 months after they had experienced an episode of botulism. Case patients were selected on the basis of who had had a clinical diagnosis of foodborne botulism reported to the national surveillance system from 1998 through 2003. Three control subjects were randomly selected from each patient's community.
We located 217 patients who had had botulism from surveillance records, with a median time since onset of illness of 4.3 years. The median age was 37 years, and 49% of the patients were female, similar to the control subjects. Most of the patients (68%) had acquired botulism from home-conserved vegetables (probably containing toxin type B), 15% had been hospitalized for >1 month, and 25% had required mechanical ventilation. Six patients died. Of the remaining 211 patients, 68% reported having worse health at the time of the interview than 6 years before the interview, compared with 17% of 656 control subjects (matched odds ratio, 17.6; 95% confidence interval, 10.9-28.4). Overall, 49% of the patients reported their current health as "fair" or "poor," versus 25% of the control subjects (odds ratio, 5.0; 95% confidence interval, 3.2-7.6). Patients were more likely than control subjects to report fatigue, weakness, dizziness, dry mouth, and difficulty lifting objects (P<.05, for each). Patients were more likely than control subjects to report difficulty breathing caused by moderate exertion (P<.001) but not by minimal exertion or at rest. Patients were also more likely to report being limited in vigorous activities, walking 3 blocks, and climbing 3 flights of stairs (P<.05, for each). Finally, patients reported feeling significantly worse than control subjects for 6 of 11 questions regarding psychosocial well-being (P<.05, for each). In a multivariable model involving patients who had had botulism, mechanical ventilation during acute illness, older age, and region of residence independently predicted worse health.
Several years after acute botulism, patients reported significant health, functional, and psychosocial limitations that are likely to be consequences of the illness.
肉毒中毒的急性麻痹综合征已有详尽描述；然而，对其长期后果却知之甚少。
我们在格鲁吉亚共和国开展了一项病例对照研究，以评估肉毒中毒发作6个月及以上患者的健康状况。病例患者是根据1998年至2003年向国家监测系统报告的食源性肉毒中毒临床诊断病例选取的。从每位患者所在社区随机选取3名对照对象。
我们从监测记录中找出217例曾患肉毒中毒的患者，发病至调查时的中位时间为4.3年。中位年龄为37岁，49%的患者为女性，与对照对象相似。大多数患者（68%）因食用家庭腌制蔬菜（可能含有B型毒素）而感染肉毒中毒，15%的患者住院时间超过1个月，25%的患者需要机械通气。6例患者死亡。在其余211例患者中，68%报告在访谈时的健康状况比访谈前6年更差，而656名对照对象中这一比例为17%（匹配比值比为17.6；95%置信区间为10.9 - 28.4）。总体而言，49%的患者将其当前健康状况报告为“一般”或“较差”，而对照对象中这一比例为25%（比值比为5.0；95%置信区间为3.2 - 7.6）。患者比对照对象更有可能报告疲劳、虚弱、头晕、口干及提物困难（每项P<0.05）。患者比对照对象更有可能报告因适度运动而导致呼吸困难（P<0.001），但因轻微运动或休息时不会出现呼吸困难。患者也更有可能报告在剧烈活动、行走3个街区及爬3层楼梯方面受限（每项P<0.05）。最后，在关于心理社会幸福感的11个问题中，患者在6个问题上报告感觉比对照对象明显更差（每项P<0.05）。在一个涉及曾患肉毒中毒患者的多变量模型中，急性病期间的机械通气、年龄较大及居住地区独立预测了更差的健康状况。
急性肉毒中毒数年之后，患者报告了明显的健康、功能及心理社会方面的限制，这些很可能是该病的后果。
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