Wang L J, Li K C, Qian S Y, Gao H M, Liu J, Li Z, Jia X L, Fan C N, Wang Q
Pediatric Intensive Care Unit, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2024 Mar 2;62(3):218-222. doi: 10.3760/cma.j.cn112140-20230908-00169.
To summarize the clinical characteristics and prognosis of severe infant botulism and evaluate the therapeutic effect of botulinum antitoxin in the pediatric intensive care unit (PICU). The clinical data of 8 cases diagnosed with infantile botulism were retrospectively analyzed in the PICU of Beijing Children's Hospital from October 2019 to August 2023. Data of basic demographic information, clinical manifestations, laboratory tests, treatment and prognosis of each child were collected and analyzed using descriptive statistical methods. Eight laboratory-confirmed cases of infant botulism were included in this study, all of which were male infants with an age of 6.0 (3.3,6.8) months. Three of the children were from Inner Mongolia Autonomous Region, 2 of them were from Hebei, and the other 3 were from Beijing, Shandong and Xinjiang Uyghur Autonomous Region, respectively. All the patients were previously healthy. In 4 of these cases, the possible cause was the ingestion of either honey and its products or sealed pickled food by the mother or child before the onset of the disease. The first symptom was poor milk intake (4 cases), followed by shallow shortness of breath (7 cases), limb weakness (7 cases) and so on. The typical signs were bilateral dilated pupils (8 cases) and decreased limb muscle strength (8 cases). The main subtype was type B (7 cases), and only 1 case was classified as type A. Six of the children were treated with antitoxin therapy for a duration of 24 (19, 49) d. Seven of them had invasive mechanical ventilation. All the patients survived upon discharge with a follow-up period of 29 d to 3 years and 8 months. Six patients had fully recovered, and 2 recently discharged patients were gradually recovering. For infants with suspected contact or ingestion of botulinum and presented with bilateral pupillary paralysis, muscle weakness and clear consciousness, the stool should be collected for diagnostic testing using a mouse bioassay as soon as possible. Type B was the most common type. The antitoxin treatment was effectiveness and the prognosis was well.
总结重症婴儿肉毒中毒的临床特征及预后，并评估肉毒抗毒素在儿科重症监护病房（PICU）的治疗效果。回顾性分析2019年10月至2023年8月在北京儿童医院PICU确诊的8例婴儿肉毒中毒患儿的临床资料。收集每个患儿的基本人口学信息、临床表现、实验室检查、治疗及预后等数据，并采用描述性统计方法进行分析。本研究纳入8例实验室确诊的婴儿肉毒中毒病例，均为男性婴儿，年龄为6.0（3.3，6.8）个月。其中3例患儿来自内蒙古自治区，2例来自河北，另外3例分别来自北京、山东和新疆维吾尔自治区。所有患儿既往健康。其中4例病例的可能病因是母亲或患儿在发病前摄入了蜂蜜及其制品或密封腌制食品。首发症状为吃奶差（4例），其次为呼吸浅促（7例）、肢体无力（7例）等。典型体征为双侧瞳孔散大（8例）和肢体肌力减弱（8例）。主要亚型为B型（7例），仅1例为A型。6例患儿接受了抗毒素治疗，疗程为24（19，49）天。7例患儿接受了有创机械通气。所有患儿出院时均存活，随访时间为29天至3年8个月。6例患儿已完全康复，2例近期出院患儿正在逐渐康复。对于疑似接触或摄入肉毒杆菌且出现双侧瞳孔麻痹、肌无力且意识清醒的婴儿，应尽快采集粪便进行小鼠生物试验诊断检测。B型是最常见的类型。抗毒素治疗有效，预后良好。
