Department of Gastroenterology and Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
Department of Poisoning and Treatment, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
J Emerg Med. 2021 Jun;60(6):760-763. doi: 10.1016/j.jemermed.2020.12.006. Epub 2021 Jan 29.
Botulinum toxin is a neurotoxin generated during the growth of Clostridium botulinum and can lead to a rare but life-threatening disease with neurologic symptoms. Relatively little is known about the many types of botulinum toxins in China. The clinical symptoms of the different types of botulism toxin-induced illnesses appear after an incubation period and vary greatly by the serotype and degree of exposure to the toxin.
We describe 4 patients who consumed vacuum-packaged salted fish and ham and then presented with severe gastrointestinal symptoms, resulting in vomiting and one death. Blood serum and urine samples tested by the botulinum neurotoxin Endopep-MS assay were positive for botulinum toxin types A, B, and E. The patient who consumed the largest amount of fish and ham died after 36 h, and the other patients were treated with botulism antitoxin after being diagnosed with a botulinum toxin-induced illness and recovered after 1 month. These cases illustrate the importance of early diagnosis and early treatment of botulism type E, in particular, because of the risk of respiratory failure and treatment delays, which can result in increased mortality and poorer overall outcomes. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Our cases illustrate the importance of early diagnosis and especially the treatment of illnesses related to botulism type E because of the risk of respiratory failure and because treatment delays can result in increased mortality and worsened overall outcomes.
肉毒杆菌毒素是在肉毒梭菌生长过程中产生的一种神经毒素，可导致一种罕见但危及生命的神经系统疾病。目前对中国存在的多种类型的肉毒毒素知之甚少。不同类型的肉毒中毒的临床症状在潜伏期后出现，并因血清型和接触毒素的程度而异。
我们描述了 4 名食用真空包装咸鱼和火腿的患者，随后出现严重的胃肠道症状，导致呕吐和 1 例死亡。肉毒神经毒素 Endopep-MS 检测的血清和尿液样本检测出 A、B 和 E 型肉毒毒素。摄入鱼和火腿最多的患者在 36 小时后死亡，其他患者在诊断为肉毒毒素中毒后接受了肉毒毒素抗毒素治疗，1 个月后康复。这些病例说明了早期诊断和治疗 E 型肉毒中毒的重要性，特别是因为存在呼吸衰竭和治疗延误的风险，这可能导致死亡率增加和整体预后较差。
为什么急诊医生应该了解这一点？：我们的病例说明了早期诊断和特别是治疗与 E 型肉毒中毒相关的疾病的重要性，因为存在呼吸衰竭的风险，并且治疗延误可能导致死亡率增加和整体预后恶化。
