Hatheway C L, McCroskey L M
Division of Bacterial Diseases, Centers for Disease Control, Atlanta, Georgia 30333.
J Clin Microbiol. 1987 Dec;25(12):2334-8. doi: 10.1128/jcm.25.12.2334-2338.1987.
In the 12-year period 1975 to 1987, feces from 336 infants were examined for botulinal neurotoxin and Clostridium botulinum. All the infants had illnesses which prompted their physicians to consider infant botulism in the diagnosis. Stool specimens from 113 of the infants yielded organisms that produced botulinal neurotoxins assumed to be responsible for the illness. The types of botulinal toxin in the confirmed cases were distributed as follows: 38 A, 69 B, 2 atypical B, 1 E, 1 F, 1 A + B, and 1 B + F. The type A and B toxins in a single infant were produced by two different strains of organism, and the type B and F toxins in another infant were produced by a single strain. The physiological characteristics of all the isolated toxigenic organisms except two were consistent with those of group I (proteolytic) C. botulinum. The toxigenic isolate from the infant with type E botulism was identified as C. butyricum, and that from the infant with type F botulism was identified as C. barati. Toxin of the same type as produced by the isolated organisms was identified in feces of 98 of 111 culture-positive infants. Botulinal toxin was identified in the serum of 9 of 67 culture-positive infants (8 of 22 infants with type A organisms; 1 of 43 infants with type B organisms; neither of 2 infants with A + B or atypical type B organisms). Botulinal toxin was not detected in feces (206 infants) or in serum (114 infants) of the culture-negative infants. The culture-positive infants had clinical features and a course of illness consistent with those of infant botulism. Most of the culture-negative infants probably had illnesses other than botulism, but specimens might have been obtained late in some infants' illnesses, when the organism had disappeared.
在1975年至1987年的12年期间，对336名婴儿的粪便进行了肉毒杆菌神经毒素和肉毒梭菌检测。所有婴儿均患有疾病，促使其医生在诊断中考虑婴儿肉毒中毒。113名婴儿的粪便标本培养出了产生肉毒杆菌神经毒素的微生物，这些毒素被认为是导致疾病的原因。确诊病例中肉毒毒素的类型分布如下：A型38例，B型69例，非典型B型2例，E型1例，F型1例，A + B型1例，B + F型1例。一名婴儿体内的A型和B型毒素由两种不同的微生物菌株产生，另一名婴儿体内的B型和F型毒素由单一菌株产生。除两株外，所有分离出的产毒微生物的生理特征与I组（蛋白水解型）肉毒梭菌一致。E型肉毒中毒婴儿的产毒分离株被鉴定为丁酸梭菌，F型肉毒中毒婴儿的产毒分离株被鉴定为巴氏梭菌。在111例培养阳性婴儿中，98例婴儿的粪便中鉴定出与分离出的微生物产生的相同类型的毒素。67例培养阳性婴儿中有9例在血清中检测到肉毒杆菌毒素（22例A型微生物婴儿中有8例；43例B型微生物婴儿中有1例；2例A + B型或非典型B型微生物婴儿均未检测到）。培养阴性婴儿的粪便（206例）或血清（114例）中未检测到肉毒杆菌毒素。培养阳性婴儿的临床特征和病程与婴儿肉毒中毒一致。大多数培养阴性婴儿可能患有除肉毒中毒以外的其他疾病，但有些婴儿可能在疾病后期采集标本，此时微生物已经消失。
