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3例B型婴儿肉毒中毒的临床分析与实验室诊断

[Clinical analysis and laboratory diagnosis of three cases with infantile botulism caused by type B].

作者信息

Ge X S, Sun Q J, Xu X F, Liu S, Huang Y, Gao P Y, Liu Z N, Peng X J, Liu Y, Peng X Y, Wu C D

机构信息

Department of Neurology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China.

Department of Food Science, College of Biochemical Engineering, Beijing Union University, Beijing 100023, China.

出版信息

Zhonghua Er Ke Za Zhi. 2020 Jun 2;58(6):499-502. doi: 10.3760/cma.j.cn112140-20191101-00691.

Abstract

To summarize the clinical characteristics and laboratory diagnostic methods of infant botulism caused by type B. Clinical data of 3 infants with type B botulism who were admitted to Children's Hospital Affiliated to Capital Institute of Pediatrics from May to November 2018 were retrospectively analyzed. Botulinum toxin was detected in fecal samples or fecal enrichment solution of the patients, and was cultured and isolated from fecal samples. The age of onset of the patients (two boys and one girl) was 3, 3 and 8 months old, respectively. Two cases had the onset in May and one case had the onset in November. There were two cases with mixed feeding and one case with breast feeding. One case's family members engaged in meat processing. All of them were previously healthy. All the children presented with acute flaccid paralysis, cranial nerve involvement and difficult defecation. Two cases had secondary urinary tract infection. Electromyograms of two cases showed that action potential amplitude of the motor nerve were lower than those of their peers. After treatments including intravenous human immunoglobulin, respiratory tract management, urethral catheterization, nasal feeding, etc., three cases recovered completely 2 to 4 months later. Type B botulinum toxin was detected in the fecal diluent of one patient, and the TPGYT enrichment solution and cooked meet medium of the feces of 3 patients, respectively. B was identified from the feces of 3 infants after culture, isolation and purification. Combined with typical clinical manifestations including acute flaccid paralysis, cranial nerve involvement symptoms and difficult defecation examination, infant botulism can be clinically diagnosed. The detection of fecal botulinum toxin and the culture and isolation of are helpful for the diagnosis.

摘要

总结B型婴儿肉毒中毒的临床特征及实验室诊断方法。回顾性分析2018年5月至11月首都儿科研究所附属儿童医院收治的3例B型婴儿肉毒中毒患儿的临床资料。在患儿粪便样本或粪便增菌液中检测到肉毒毒素,并从粪便样本中进行培养分离。患儿(2男1女)发病年龄分别为3个月、3个月和8个月。2例于5月发病,1例于11月发病。2例为混合喂养,1例为母乳喂养。1例患儿家庭成员从事肉类加工。既往均健康。所有患儿均出现急性弛缓性麻痹、脑神经受累及排便困难。2例继发尿路感染。2例患儿肌电图显示运动神经动作电位波幅低于同龄人。经静脉用人免疫球蛋白、呼吸道管理、导尿、鼻饲等治疗后,3例患儿2至4个月后完全康复。分别在1例患儿粪便稀释液、3例患儿粪便的TPGYT增菌液及熟肉培养基中检测到B型肉毒毒素。经培养、分离和纯化后,从3例婴儿粪便中鉴定出肉毒杆菌。结合急性弛缓性麻痹、脑神经受累症状及排便困难等典型临床表现,临床上可诊断婴儿肉毒中毒。粪便肉毒毒素检测及肉毒杆菌的培养分离有助于诊断。

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