St Louis M E, Peck S H, Bowering D, Morgan G B, Blatherwick J, Banerjee S, Kettyls G D, Black W A, Milling M E, Hauschild A H
Enteric Diseases Branch, Centers for Disease Control, Atlanta, Georgia.
Ann Intern Med. 1988 Mar;108(3):363-8. doi: 10.7326/0003-4819-108-3-363.
Diagnosis of botulism in two teenaged sisters in Montreal led to the identification of 36 previously unrecognized cases of type B botulism in persons who had eaten at a restaurant in Vancouver, British Columbia, during the preceding 6 weeks. A case-control study implicated a new vehicle for botulism, commercial chopped garlic in soybean oil (P less than 10(-4)). Relatively mild and slowly progressive illness, dispersion of patients over at least eight provinces and states in three countries, and a previously unsuspected vehicle had contributed to prolonged misdiagnoses, including myasthenia gravis (six patients), psychiatric disorders (four), stroke (three), and others. Ethnic background influenced severity of illness: 60% of Chinese patients but only 4% of others needed mechanical ventilation (P less than 10(-3]. Trypsinization of serum was needed to show toxemia in one patient. Electromyography results with high-frequency repetitive stimulation corroborated the diagnosis of botulism up to 2 months after onset. Although botulism is a life-threatening disease, misdiagnosis may be common and large outbreaks can escape recognition completely.
对蒙特利尔两名青少年姐妹肉毒中毒的诊断，使得确认了不列颠哥伦比亚省温哥华一家餐馆在过去6周内用餐的人群中有36例先前未被识别的B型肉毒中毒病例。一项病例对照研究表明肉毒中毒有了一种新的传播媒介，即大豆油中的商用蒜末（P小于10的负4次方）。病情相对较轻且进展缓慢，患者分布在三个国家的至少八个省和州，以及一种先前未被怀疑的传播媒介，这些因素导致了长期误诊，包括重症肌无力（6例患者）、精神障碍（4例）、中风（3例）及其他疾病。种族背景影响病情严重程度：60%的华裔患者需要机械通气，而其他患者中只有4%需要（P小于10的负3次方）。有一名患者需要对血清进行胰蛋白酶处理才能显示毒血症。高频重复刺激的肌电图结果在发病后长达2个月都能证实肉毒中毒的诊断。尽管肉毒中毒是一种危及生命的疾病，但误诊可能很常见，大规模暴发可能完全未被识别。
