Department of Infectious Disease, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
Clin Toxicol (Phila). 2010 Nov;48(9):867-79. doi: 10.3109/15563650.2010.535003.
Botulism is a neuroparalytic illness caused by botulinum toxin, a product of the Clostridium botulinum bacteria and characteristically presents as an acute, symmetrical, descending flaccid paralysis. Albeit it is the most poisonous substance known, which even poses a major threat as biological weapons, purified and highly diluted botulinum toxin can be used to treat a wide variety of conditions associated with muscular hyperactivity, glandular hypersecretions and pain. There are six clinical presentations associated with current occurring botulism, each results from absorption of botulinum toxin into the bloodstream.
The aim of this review is to summarize the current knowledge on the microbiology, epidemiology, vaccine research and clinical management of human botulism.
Early diagnosis and management rely on history and physical examination. Delay in treatment may allow progression of paralysis, protracted hospitalization and deaths of long-term mechanical ventilation and intensive care unit care. The clinicians must take this disease into consideration of a possible outbreak. Awaiting laboratory confirmation is an egregious error, while awareness of the clinical sign and symptoms of botulism is critical for early diagnosis. Rapid management and followed public health surveillance may greatly alleviate disease severity and decrease mortality rates.
肉毒中毒是由肉毒梭菌产生的肉毒毒素引起的神经麻痹性疾病，其特征为急性、对称、下行性弛缓性瘫痪。尽管它是已知的最毒物质，甚至作为生物武器构成重大威胁，但纯化和高度稀释的肉毒毒素可用于治疗与肌肉过度活动、腺体过度分泌和疼痛相关的多种疾病。目前与肉毒中毒相关的有六种临床表现，每种临床表现均源于肉毒毒素被吸收到血液中。
本综述旨在总结人类肉毒中毒的微生物学、流行病学、疫苗研究和临床管理的最新知识。
早期诊断和管理依赖于病史和体格检查。治疗的延误可能导致瘫痪进展、延长住院时间以及需要长期机械通气和重症监护治疗。临床医生必须考虑到可能发生的爆发。等待实验室确认是一个严重的错误，而对肉毒中毒的临床体征和症状的认识对于早期诊断至关重要。快速管理和后续的公共卫生监测可以极大地减轻疾病的严重程度并降低死亡率。
