Deangelis Tracy M, Shen Liang
Mount Sinai School of Medicine, New York, NY, USA.
Mt Sinai J Med. 2009 Oct;76(5):442-7. doi: 10.1002/msj.20132.
In the fall of 2007, the Minnesota Department of Health was notified of 11 cases of an unexplained neurological illness, all linked to a pork processing plant, Quality Pork Processors, Inc., in Austin, MN. The cluster of workers had been experiencing similar symptoms, including fatigue, pain, numbness, and tingling in their extremities as well as weakness. The symptoms were described as more sensory than motor, and all patients had evidence of polyradiculoneuropathy with signs of nerve root irritation. An epidemiological investigation revealed that the only commonality between cases was their exposure to a pork brain extraction procedure involving compressed air. As relatives of the cases remained asymptomatic and all cultures for known pathogens were negative, the etiology of the syndrome seemed not to be infectious. Clinically, the syndrome was most akin to chronic inflammatory demyelinating polyneuropathy. Laboratory tests corroborated the clinical findings, revealing inflammation of peripheral nerves and nerve roots; however, these cases also had features clinically distinct from chronic inflammatory demyelinating polyneuropathy as well as laboratory testing revealing a novel immunoglobulin G immunostaining pattern. This suggested that the observed inflammation was the result of 1 or more unidentified antigens. This syndrome was ultimately dubbed progressive inflammatory neuropathy and was theorized to be an autoimmune reaction to aerosolized porcine neural tissue. Since the investigation's outset, 18 cases of progressive inflammatory neuropathy have been identified at the Minnesota pork processing plant, with 5 similar cases at an Indiana plant and 1 case at a Nebraskan plant. The plants in which cases have been identified have since stopped the use of compressed air in removing pork brains. All cases have stabilized or improved, with some requiring immunosuppressive and analgesic treatment. The study of progressive inflammatory neuropathy is ongoing, and the details of this investigation highlight the value of epidemiological principles in the identification and containment of outbreaks while researchers attempt to uncover the unique pathophysiology and potential etiology of the illness. Mt Sinai J Med 76:442-447, 2009. (c) 2009 Mount Sinai School of Medicine.
2007年秋季，明尼苏达州卫生部接到通报，有11例不明原因的神经疾病，所有病例均与明尼苏达州奥斯汀市的一家猪肉加工厂——优质猪肉加工公司有关。这群工人一直出现类似症状，包括疲劳、疼痛、麻木、四肢刺痛以及虚弱感。症状被描述为感觉症状多于运动症状，所有患者都有多发神经根神经病的证据以及神经根刺激迹象。一项流行病学调查显示，病例之间唯一的共同点是他们都接触了一种涉及压缩空气的猪脑提取程序。由于病例的亲属仍无症状，且所有已知病原体培养结果均为阴性，该综合征的病因似乎并非传染性的。临床上，该综合征最类似于慢性炎症性脱髓鞘性多发性神经病。实验室检查证实了临床发现，显示外周神经和神经根有炎症；然而，这些病例在临床上也有与慢性炎症性脱髓鞘性多发性神经病不同的特征，实验室检查还显示出一种新的免疫球蛋白G免疫染色模式。这表明观察到的炎症是一种或多种未识别抗原的结果。这种综合征最终被称为进行性炎症性神经病，据推测是对雾化猪神经组织的自身免疫反应。自调查开始以来，明尼苏达州的猪肉加工厂已确诊18例进行性炎症性神经病，印第安纳州的一家工厂有5例类似病例，内布拉斯加州的一家工厂有1例。此后，已发现病例的工厂已停止在去除猪脑时使用压缩空气。所有病例病情已稳定或好转，一些病例需要免疫抑制和止痛治疗。对进行性炎症性神经病的研究仍在继续，本次调查的细节凸显了流行病学原理在识别和控制疫情中的价值，同时研究人员试图揭示该疾病独特的病理生理学和潜在病因。《西奈山医学杂志》76:442 - 447，2009年。(c) 2009年西奈山医学院。
