Perl T M, Bédard L, Kosatsky T, Hockin J C, Todd E C, Remis R S
Bureau régional des maladies infectieuses, Montreal, PQ, Canada.
N Engl J Med. 1990 Jun 21;322(25):1775-80. doi: 10.1056/NEJM199006213222504.
In Canada in late 1987 there was an outbreak of an acute illness characterized by gastrointestinal symptoms and unusual neurologic abnormalities among persons who had eaten cultivated mussels. Health departments in Canada solicited reports of this newly recognized illness. A case was defined as the occurrence of gastrointestinal symptoms within 24 hours or of neurologic symptoms within 48 hours of the ingestion of mussels. From the more than 250 reports received, 107 patients met the case definition. The most common symptoms were vomiting (in 76 percent of the patients), abdominal cramps (50 percent), diarrhea (42 percent), headache, often described as incapacitating (43 percent), and loss of short-term memory (25 percent). Nineteen patients were hospitalized, of whom 12 required intensive care because of seizures, coma, profuse respiratory secretions, or unstable blood pressure. Male sex and increasing age were associated independently with the risks of hospitalization and memory loss. Three patients died. Mussels associated with this illness were traced to cultivation beds in three river estuaries on the eastern coast of Prince Edward Island. Domoic acid, which can act as an excitatory neurotransmitter, was identified in mussels left uneaten by the patients and in mussels sampled from these estuaries. The source of the domoic acid appears to have been a form of marine vegetation, Nitzschia pungens, also identified in these waters in late 1987. The contaminated mussels from Prince Edward Island were removed from the market, and no new cases have occurred since December 1987. We conclude that the cause of this outbreak of a novel and severe intoxication was the ingestion of mussels contaminated by domoic acid, a potent excitatory neurotransmitter.
1987年末在加拿大，食用养殖贻贝的人群中爆发了一种急性疾病，其特征为胃肠道症状和异常的神经学异常。加拿大卫生部门征集了关于这种新发现疾病的报告。病例定义为在食用贻贝后24小时内出现胃肠道症状或48小时内出现神经学症状。从收到的250多份报告中，107名患者符合病例定义。最常见的症状是呕吐（76%的患者）、腹部绞痛（50%）、腹泻（42%）、常被描述为使人衰弱的头痛（43%）以及短期记忆丧失（25%）。19名患者住院治疗，其中12名因癫痫发作、昏迷、大量呼吸道分泌物或血压不稳定而需要重症监护。男性和年龄增长分别独立与住院风险和记忆丧失风险相关。3名患者死亡。与此次疾病相关的贻贝追溯到爱德华王子岛东海岸三个河口的养殖区。在患者未食用的贻贝以及从这些河口采集的贻贝样本中发现了能作为兴奋性神经递质的软骨藻酸。软骨藻酸的来源似乎是一种海洋植物——尖刺菱形藻，1987年末在这些水域中也发现了这种植物。来自爱德华王子岛的受污染贻贝被撤出市场，自1987年12月以来未出现新的病例。我们得出结论，这次新型严重中毒事件的原因是食用了被软骨藻酸污染的贻贝，软骨藻酸是一种强效兴奋性神经递质。
