a Epidemic Intelligence Service, Centers for Disease Control and Prevention , Atlanta , GA , USA.
b Division of Environmental Hazards and Health Effects , National Center for Environmental Health, Centers for Disease Control and Prevention , Atlanta , GA , USA.
Clin Toxicol (Phila). 2019 Jan;57(1):10-18. doi: 10.1080/15563650.2018.1485927. Epub 2018 Jul 10.
In April 2015, a multistate outbreak of illness linked to synthetic cannabinoid (SC) use was unprecedented in magnitude and severity. We identified Mississippi cases in near-real time, collected information on cases to characterize the outbreak, and identified the causative SC.
A case was defined as any patient of a Mississippi healthcare facility who was suspected of SC use and presenting with ≥2 of the following symptoms: sweating, severe agitation, or psychosis during April 2-May 3, 2015. Clinicians reported cases to the Mississippi Poison Control Center (MPCC). We used MPCC data to identify cases at the University of Mississippi Medical Center (UMMC) to characterize in further detail, including demographics and clinical findings. Biologic samples were tested for known and unknown SCs by liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF/MS).
Clinicians reported 721 cases (11 deaths) statewide; 119 (17%) were UMMC patients with detailed data for further analysis. Twelve (10%) were admitted to an intensive care unit and 2 (2%) died. Aggression (32%), hypertension (33%), and tachycardia (42%) were common. SCs were identified in serum from 39/56 patients (70%); 33/39 patients (85%) tested positive for MAB-CHMINACA (N-(1-amino-3,3-dimethyl-1-oxobutan-2-yl)-1-(cyclohexylmethyl)-1H-indazole-3-carboxamide) or its metabolites. Compared to all patients tested for SCs, those positive for MAB-CHMINACA were more likely to have altered mental status on examination (OR = 3.3, p = .05).
SC use can cause severe health effects. MAB-CHMINACA was the most commonly detected SC in this outbreak. As new SCs are created, new strategies to optimize surveillance and patient care are needed to address this evolving public health threat.
2015 年 4 月，一起与合成大麻素（SC）使用有关的多州暴发疾病的规模和严重程度前所未有。我们实时发现了密西西比州的病例，收集了病例信息以对暴发进行特征描述，并确定了致病 SC。
病例定义为 2015 年 4 月 2 日至 5 月 3 日期间，任何在密西西比州医疗机构就诊的疑似 SC 使用且出现以下 2 种以上症状的患者：出汗、严重激越或精神病。临床医生向密西西比毒物控制中心（MPCC）报告病例。我们使用 MPCC 数据在密西西比大学医学中心（UMMC）识别病例，以进一步详细描述特征，包括人口统计学和临床发现。通过液相色谱四极杆飞行时间质谱法（LC-QTOF/MS）对生物样本进行了已知和未知 SC 的检测。
临床医生报告全州范围内有 721 例病例（11 例死亡）；119 例（17%）为 UMMC 患者，有详细数据进行进一步分析。12 例（10%）患者收入重症监护病房，2 例（2%）死亡。激越（32%）、高血压（33%）和心动过速（42%）较为常见。从 56 例患者中的 39 例（70%）血清中鉴定出 SC；39 例患者中的 33 例（85%）检测到 MAB-CHMINACA（N-（1-氨基-3,3-二甲基-1-氧代丁-2-基）-1-（环己基甲基）-1H-吲哚-3-甲酰胺）或其代谢物阳性。与所有接受 SC 检测的患者相比，MAB-CHMINACA 阳性患者检查时精神状态改变的可能性更大（OR=3.3，p=0.05）。
SC 使用会引起严重的健康影响。在此次暴发中，MAB-CHMINACA 是最常检测到的 SC。随着新的 SC 的出现，需要制定新的策略来优化监测和患者护理，以应对这一不断演变的公共卫生威胁。
