Long S S, Gajewski J L, Brown L W, Gilligan P H
Pediatrics. 1985 May;75(5):935-41.
Forty-four cases of botulism occurred in infants in Southeastern Pennsylvania between 1976 and 1983. Forty-three were caused by Clostridium botulinum type B. Progressive weakness necessitated ventilatory support in 39 infants. Complications during hospitalization included otitis media in 13 patients and aspiration pneumonia in 11. Eight infants developed the syndrome of inappropriate secretion of antidiuretic hormone and two developed adult respiratory distress syndrome. One infant died of progressive bradycardia despite adequate control of ventilation. Manifestations of autonomic nervous system dysfunction recognized on admission to the hospital were constipation, distention of the urinary bladder, and decreased salivation and tearing. During hospitalization, some infants had unexpected fluctuations of skin color, blood pressure, and heart rate. Infants' strength improved despite persistent intestinal elaboration of toxin. C botulinum was isolated from seven of nine home or work environments sampled. All 44 infants were white and were receiving breast milk at the time of onset of symptoms. The majority had first feedings of nonhuman food substances within 4 weeks prior to onset of symptoms. Delineation of fecal flora in seven infants revealed predominance of enterobacteriaceae. Perturbations of intestinal flora during infancy, especially at weaning, may cause transient permissiveness to colonization by C botulinum.
1976年至1983年间,宾夕法尼亚州东南部有44例婴儿肉毒中毒病例。其中43例由B型肉毒杆菌引起。39名婴儿因进行性肌无力需要通气支持。住院期间的并发症包括13例中耳炎和11例吸入性肺炎。8名婴儿出现抗利尿激素分泌异常综合征,2名婴儿出现成人呼吸窘迫综合征。尽管通气得到充分控制,但仍有1名婴儿死于进行性心动过缓。入院时发现的自主神经系统功能障碍表现为便秘、膀胱扩张、唾液分泌减少和流泪减少。住院期间,一些婴儿出现了意想不到的肤色、血压和心率波动。尽管肠道持续产生毒素,但婴儿的肌力仍有所改善。在采集样本的9个家庭或工作环境中,有7个环境分离出了肉毒杆菌。所有44名婴儿均为白人,发病时均在接受母乳喂养。大多数婴儿在症状出现前4周内首次喂食了非人类食物物质。对7名婴儿粪便菌群的分析显示肠杆菌科占优势。婴儿期肠道菌群的扰动,尤其是在断奶时,可能会导致肉毒杆菌短暂性定植。