Botulism Reference Service for Canada, Microbiology Research Division, Bureau of Microbial Hazards, Food Directorate, Health Products and Food Branch, Ottawa, ON K1A 0K9, Canada.
National Reference Centre for Botulism, Microbiological Foodborne Hazard Unit, Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità, viale Regina Elena, 29900161 Rome, Italy.
Toxins (Basel). 2020 Jan 24;12(2):81. doi: 10.3390/toxins12020081.
Intoxication with botulinum neurotoxin can occur through various routes. Foodborne botulism results after consumption of food in which botulinum neurotoxin-producing clostridia (i.e., or strains of type E or type F) have replicated and produced botulinum neurotoxin. Infection of a wound with and in situ production of botulinum neurotoxin leads to wound botulism. Colonization of the intestine by neurotoxigenic clostridia, with consequent production of botulinum toxin in the intestine, leads to intestinal toxemia botulism. When this occurs in an infant, it is referred to as infant botulism, whereas in adults or children over 1 year of age, it is intestinal colonization botulism. Predisposing factors for intestinal colonization in children or adults include previous bowel or gastric surgery, anatomical bowel abnormalities, Crohn's disease, inflammatory bowel disease, antimicrobial therapy, or foodborne botulism. Intestinal colonization botulism is confirmed by detection of botulinum toxin in serum and/or stool, or isolation of neurotoxigenic clostridia from the stool, without finding a toxic food. Shedding of neurotoxigenic clostridia in the stool may occur for a period of several weeks. Adult intestinal botulism occurs as isolated cases, and may go undiagnosed, contributing to the low reported incidence of this rare disease.
肉毒中毒可通过多种途径发生。食源性肉毒中毒是由于摄入了产毒梭菌（即 A 型或 E 型或 F 型菌株）已复制并产生肉毒神经毒素的食物而引起的。创伤感染 A 型和原位产生肉毒神经毒素可导致创伤性肉毒中毒。神经毒素产生的梭菌定植于肠道，随后在肠道中产生肉毒毒素，导致肠毒血症性肉毒中毒。当这种情况发生在婴儿身上时，称为婴儿肉毒中毒，而在成人或 1 岁以上的儿童中，称为肠定植性肉毒中毒。儿童或成人肠定植的易感因素包括先前的肠道或胃部手术、解剖肠道异常、克罗恩病、炎症性肠病、抗菌治疗或食源性肉毒中毒。通过检测血清和/或粪便中的肉毒毒素，或从粪便中分离出产毒梭菌，而未发现有毒食物，可确认肠定植性肉毒中毒。神经毒素产生的梭菌在粪便中脱落可持续数周。成人肠性肉毒中毒为孤立性病例，可能未被诊断，导致这种罕见疾病报告发病率低。
