Ringe Hannelore, Schuelke Markus, Weber Sven, Dorner Brigitte G, Kirchner Sebastian, Dorner Martin B
Pediatric Intensive Care, and
Department of Neuropediatrics, Charité-Universitätsmedizin Berlin, Berlin, Germany; and.
Pediatrics. 2014 Nov;134(5):e1436-40. doi: 10.1542/peds.2013-3378. Epub 2014 Oct 13.
Infant botulism is an acute life-threatening condition and diagnosis is frequently delayed. Therefore, the best time window to administer specific antibodies, at present the only etiology-based therapy, is often missed, entailing long periods of hospitalization in the PICU. Here we present a 3-month-old boy with infant botulism and respiratory failure, who quickly and favorably responded to thiamine supplementation. From the feces we isolated Clostridium botulinum serotype A2. In addition to producing botulinum neurotoxin A, this strain carried the thiaminase I gene and produced thiaminase I. Accordingly, the child's feces were positive for thiaminase I activity. Because C botulinum group I strains are capable of producing thiaminase I, we speculate that thiamine degradation might further aggravate the paralytic symptoms caused by botulinum neurotoxins in infant botulism. Thus, supportive supplementation with thiamine could be beneficial to speed up recovery and to shorten hospitalization in some patients with infant botulism.
婴儿肉毒中毒是一种危及生命的急性病症，诊断常常延迟。因此，给予特异性抗体（目前唯一基于病因的治疗方法）的最佳时间窗常常错过，这使得患儿需要在儿科重症监护病房（PICU）长时间住院。在此，我们报告一名3个月大患婴儿肉毒中毒并伴有呼吸衰竭的男童，其对补充硫胺素迅速产生良好反应。我们从其粪便中分离出A2型肉毒梭菌。除产生肉毒神经毒素A外，该菌株还携带硫胺素酶I基因并产生硫胺素酶I。相应地，患儿粪便的硫胺素酶I活性呈阳性。由于I群肉毒梭菌能够产生硫胺素酶I，我们推测硫胺素降解可能会进一步加重婴儿肉毒中毒中肉毒神经毒素引起的麻痹症状。因此，对某些婴儿肉毒中毒患者进行硫胺素支持性补充可能有利于加速康复并缩短住院时间。
