Wenham T N
Emerg Med J. 2008 Jan;25(1):55-6. doi: 10.1136/emj.2007.049775.
Botulism is a rare, naturally occurring disease that may also be caused by deliberate or accidental exposure to the toxins of Clostridium botulinum. The three types of naturally occurring disease are food-borne, wound and intestinal colonisation botulism, dependent on the route of ingress of the toxins. Food related botulism remains rare in the UK, but wound botulism is increasing, particularly associated with intravenous drug use. It presents with an afebrile, descending, symmetrical, flaccid paralysis of motor and autonomic but not sensory nerves. Respiratory failure can occur rapidly with little prior ventilatory deterioration. Management includes respiratory support, specific antitoxin and surgical debridement and antibiotics for cases of wound botulism. We report a case of wound botulism and discuss the presenting features that should alert the emergency physician to the diagnosis of wound botulism.
肉毒中毒是一种罕见的自然发生的疾病，也可能由故意或意外接触肉毒杆菌毒素引起。自然发生的三种疾病类型是食源性、伤口性和肠道定植性肉毒中毒，这取决于毒素的进入途径。在英国，与食物相关的肉毒中毒仍然很少见，但伤口性肉毒中毒正在增加，特别是与静脉注射吸毒有关。它表现为无发热、下行性、对称性、运动和自主神经而非感觉神经的弛缓性麻痹。呼吸衰竭可能迅速发生，之前几乎没有通气功能恶化。治疗包括呼吸支持、特异性抗毒素、手术清创以及针对伤口性肉毒中毒病例使用抗生素。我们报告一例伤口性肉毒中毒病例，并讨论应提醒急诊医生诊断伤口性肉毒中毒的临床表现。
