Unité des Toxines Bactériennes, UMR CNRS 2001, Institut Pasteur, 75015 Paris, France.
Toxins (Basel). 2020 Nov 13;12(11):716. doi: 10.3390/toxins12110716.
Human botulism is a severe disease characterized by flaccid paralysis and inhibition of certain gland secretions, notably salivary secretions, caused by inhibition of neurotransmitter release. Naturally acquired botulism occurs in three main forms: food-borne botulism by ingestion of preformed botulinum neurotoxin (BoNT) in food, botulism by intestinal colonization (infant botulism and intestinal toxemia botulism in infants above one year and adults), and wound botulism. A rapid laboratory confirmation of botulism is required for the appropriate management of patients. Detection of BoNT in the patient's sera is the most direct way to address the diagnosis of botulism. Based on previous published reports, botulinum toxemia was identified in about 70% of food-borne and wound botulism cases, and only in about 28% of infant botulism cases, in which the diagnosis is mainly confirmed from stool sample investigation. The presence of BoNT in serum depends on the BoNT amount ingested with contaminated food or produced locally in the intestine or wound, and the timeframe between serum sampling and disease onset. BoNT levels in patient's sera are most frequently low, requiring a highly sensitive method of detection. Mouse bioassay is still the most used method of botulism identification from serum samples. However, in vitro methods based on BoNT endopeptidase activity with detection by mass spectrometry or immunoassay have been developed and depending on BoNT type, are more sensitive than the mouse bioassay. These new assays show high specificity for individual BoNT types and allow more accurate differentiation between positive toxin sera from botulism and autoimmune neuropathy patients.
人类肉毒中毒是一种严重的疾病，其特征为弛缓性瘫痪和某些腺体分泌抑制，特别是唾液分泌抑制，这是由于神经递质释放抑制所致。天然获得性肉毒中毒主要有三种形式：食源性肉毒中毒是通过摄入食物中的预先形成的肉毒神经毒素（BoNT）引起的，肉毒中毒是通过肠道定植（婴儿肉毒中毒和 1 岁以上婴儿和成人的肠毒血症肉毒中毒）和创伤性肉毒中毒引起的。为了对患者进行适当的管理，需要快速对肉毒中毒进行实验室确认。检测患者血清中的 BoNT 是解决肉毒中毒诊断的最直接方法。根据以前发表的报告，在食源性和创伤性肉毒中毒病例中，约有 70%的病例检测到肉毒毒素血症，而在婴儿肉毒中毒病例中，只有约 28%的病例检测到肉毒毒素血症，在这些病例中，诊断主要通过粪便样本调查来确认。血清中 BoNT 的存在取决于与污染食物一起摄入的 BoNT 量或在肠道或伤口中局部产生的 BoNT 量，以及血清取样与疾病发作之间的时间框架。患者血清中的 BoNT 水平通常较低，需要使用高度敏感的检测方法。小鼠生物测定仍然是从血清样本中鉴定肉毒中毒的最常用方法。然而，已经开发出基于 BoNT 内切蛋白酶活性的体外方法，并通过质谱或免疫测定进行检测，这些方法根据 BoNT 类型，比小鼠生物测定更敏感。这些新的检测方法对单个 BoNT 类型具有高度特异性，并允许更准确地区分肉毒中毒和自身免疫性神经病患者的阳性毒素血清。
