胃内注射肉毒杆菌神经毒素后发生的医源性肉毒中毒——一次重大疫情。
Iatrogenic botulism after intragastric botulinum neurotoxin injections - a major outbreak.
作者信息
Goerttler Tsepo, Dorner Martin B, van der Linden Christina, Kienitz Ricardo, Petrik Stephan, Blechinger Stephan, Spickschen Jonah, Betz Iris R, Hinrichs Carl, Steindl David, Weber Frederike, Musacchio Thomas, Wunderlich Gilbert, Rueger Maria Adele, Barbe Michael T, Dafsari Haidar, Demir Seda, Lapa Sriramya, Zeiner Pia S, Strzelczyk Adam, Tinnemann Peter, Kleine Christian, Totzeck Andreas, Klebe Stephan, Mikolajewska Agata, Dorner Brigitte G, Fertl Elisabeth, Grefkes-Hermann Christian, Fink Gereon, Kleinschnitz Christoph, Hagenacker Tim
机构信息
Department of Neurology and Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, Hufelandstr. 55, 45147, Essen, Germany.
National Consultant Laboratory for Neurotoxin-producing Clostridia (Botulism, Tetanus), ZBS3, Centre for Biological Threats and Special Pathogens, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany.
出版信息
Neurol Res Pract. 2024 Oct 29;6(1):52. doi: 10.1186/s42466-024-00350-3.
BACKGROUND
Intragastric botulinum neurotoxin injections (IBNI) are offered off-label in the private medical sector in a few European countries as a safe and effective weight-loss measure. In February and March 2023, an outbreak of iatrogenic botulism occurred in several European countries following IBNI treatment in Turkey. This case series describes the clinical features of severe iatrogenic botulism after IBNI.
METHODS
We retrospectively summarize the clinical course and emergency department and intensive care unit interventions in ten cases of severe iatrogenic botulism that occurred after receiving IBNI in this sudden outbreak in Austria and Germany.
RESULTS
Seven out of ten cases initially showed characteristic symptoms of botulism with diplopia, dysphagia, dysarthria, dysarthrophonia, and descending paralysis. All patients were hospitalized, six in an intensive care unit and partially requiring mechanical ventilation. All patients recovered and were discharged without relevant permanent deficits.
CONCLUSION
Our study highlights ten clinical cases in this iatrogenic botulism outbreak, representing the largest reported outbreak worldwide. Clinicians should be aware of the risks associated with medical procedures involving botulinum neurotoxins and ensure measures to minimize the risk of iatrogenic botulism.
背景
在一些欧洲国家的私立医疗部门，胃内注射肉毒杆菌神经毒素（IBNI）作为一种安全有效的减肥措施被用于非标签用途。2023年2月和3月，在土耳其接受IBNI治疗后，几个欧洲国家发生了医源性肉毒中毒疫情。本病例系列描述了IBNI后严重医源性肉毒中毒的临床特征。
方法
我们回顾性总结了在奥地利和德国此次突然爆发的疫情中，10例接受IBNI后发生严重医源性肉毒中毒病例的临床病程以及急诊科和重症监护病房的干预措施。
结果
10例病例中有7例最初表现出肉毒中毒的典型症状，包括复视、吞咽困难、构音障碍、发声障碍和下行性麻痹。所有患者均住院治疗，6例入住重症监护病房，部分患者需要机械通气。所有患者均康复出院，无相关永久性缺陷。
结论
我们的研究突出了此次医源性肉毒中毒疫情中的10例临床病例，这是全球报告的最大规模疫情。临床医生应意识到涉及肉毒杆菌神经毒素的医疗程序相关风险，并确保采取措施将医源性肉毒中毒风险降至最低。
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