Hellmich Dorothea, Wartenberg Katja E, Zierz Stephan, Mueller Tobias J
Neurointensive Care Unit, Department of Neurology, University Hospital Halle (Saale), Ernst-Grube-Strasse 40, D-06097, Halle (Saale), Germany.
J Med Case Rep. 2018 Jan 4;12(1):1. doi: 10.1186/s13256-017-1523-9.
Foodborne botulism is a life-threatening, rapidly progressive disease. It has an incidence of less than 10 cases per year in Germany and mostly affects several previously healthy people at the same time. The only specific treatment is the administration of botulism antitoxin. According to the German guidelines administration of antitoxin is recommended only in the first 24 hours after oral ingestion of the toxin.
A 47-year-old white woman and her 51-year-old white husband presented with paralysis of multiple cranial nerves and rapidly descending paralysis approximately 72 hours after ingestion of home-canned beans. The disease was complicated by autonomic changes like hypertension, febrile temperatures, and a paralytic ileus. The diagnosis was confirmed by identification of botulinum neurotoxin type A in the serum of the woman. In accordance with the German guidelines, antitoxin was not given due to the prolonged time interval at diagnosis. Both patients had a long intensive care unit course requiring ventilation for approximately 5 months. Finally they recovered completely.
A full recovery from foodborne botulism is possible even in patients with intensive care lasting several months. There are only case reports indicating that administration of antitoxin may shorten the course of the disease, even if given later than 24 hours after intoxication. Due to the rarity of the disease and its rapid course there are no randomized controlled trials. Thus, evidence of the superiority of this treatment is lacking. However, the prevailing view according to the German guidelines to administer antitoxin only within 24 hours after ingestion of the toxin should be questioned in the case of progression of the disease with proof of remaining toxin in the blood.
食源性肉毒中毒是一种危及生命、进展迅速的疾病。在德国，其发病率每年不到10例，且大多同时影响数名此前健康的人。唯一的特效治疗方法是注射肉毒抗毒素。根据德国指南，仅在口服毒素后的头24小时内推荐使用抗毒素。
一名47岁的白人女性及其51岁的白人丈夫在食用自家罐装豆子约72小时后出现多组颅神经麻痹和迅速下行性麻痹。该疾病并发了自主神经改变，如高血压、发热和麻痹性肠梗阻。通过在该女性血清中检测出A型肉毒神经毒素确诊。按照德国指南，由于诊断时时间间隔延长，未给予抗毒素。两名患者在重症监护病房都经历了漫长的病程，需要通气约5个月。最终他们完全康复。
即使是经历数月重症监护的食源性肉毒中毒患者也有可能完全康复。仅有病例报告表明，即使在中毒24小时后给予抗毒素，也可能缩短病程。由于该疾病罕见且病程迅速，尚无随机对照试验。因此，缺乏这种治疗方法优越性的证据。然而，在疾病进展且血液中仍有毒素证据的情况下，按照德国指南仅在摄入毒素后24小时内给予抗毒素的主流观点应受到质疑。
