An Yaqing, Lv Baopu, Zheng Tuokang, Gong Yu, Hou Jianhang, Tian Heyule, Chen Fangyu, Wei Bokai, Lu Jiajia, Yun Yiming, Yang Penglong, Zhang Muchao, Hu Zeqing, Wu Yang, Gao Hengbo, Tian Yingping, Yao Dongqi
Emergency Department, the Second Hospital of Hebei Medical University, Shijiazhuang, China.
Emergency Department, the Pingxiang County People's Hospital, Xingtai, China.
Clin Toxicol (Phila). 2025 May;63(5):337-342. doi: 10.1080/15563650.2025.2491662. Epub 2025 Apr 28.
Improper use of botulinum neurotoxin may result in poisoning. This study aimed to investigate the causes, characteristics, and risk factors of iatrogenic botulism incidents in China.
Patients diagnosed with iatrogenic botulism who presented to the emergency department of the Second Hospital of Hebei Medical University between June and July 2024 were included. We assessed baseline demographics, clinical symptoms, disease grade, and botulinum toxin type A-related variables. Multivariate regression analysis was used to identify independent risk factors influencing the 30-day prognosis.
A total of 195 patients were included in the study, with a median age of 38 years (IQR: 33-47 years) and a male-to-female ratio of 1:38. Blurred vision was the most common early feature (82.1%), followed by dizziness and ptosis (75.9%), fatigue (65.1%), and dysarthria (63.1%). The most frequently observed complications were acute gastroenteritis (9.7%), followed by aspiration pneumonia (7.2%). Fifty-one patients experienced severe poisoning with early ocular, facial, limb muscle, and respiratory muscle involvement. Thirty-two patients (16.4%) required mechanical ventilation. The median latent period was 3 days (IQR: 2-4 days), with a median interval of 7 h (IQR: 4-10 h) observed between symptom onset and antitoxin administration. The median duration of hospitalization was 6 days (IQR: 4-8 days). Adverse reactions to the antitoxin included serum sickness in 11 patients and allergic reactions in 20 patients. Based on the presence or absence of clinical signs 30 days post-discharge, we categorized the cohort into good and poor prognostic groups; 87 patients (44.6%) had a poor prognosis. Independent risk factors for a poor prognosis included a latent period ≤3 days, increased time from onset of features to antitoxin treatment, longer hospital duration, disease severity, and need for mechanical ventilation.
Iatrogenic botulism frequently leads to severe outcomes due to delayed diagnosis and intervention. We identified a disease severity grading system alongside additional risk factors to predict patient prognosis.
Our study underscores the critical importance of early recognition and timely treatment of iatrogenic botulism. Clinicians should implement prompt treatment to mitigate disease progression.
肉毒杆菌神经毒素使用不当可能导致中毒。本研究旨在调查中国医源性肉毒中毒事件的原因、特征和危险因素。
纳入2024年6月至7月在河北医科大学第二医院急诊科就诊并被诊断为医源性肉毒中毒的患者。我们评估了基线人口统计学特征、临床症状、疾病分级和A型肉毒毒素相关变量。采用多因素回归分析确定影响30天预后的独立危险因素。
本研究共纳入195例患者，中位年龄为38岁（四分位间距：33 - 47岁），男女比例为1:38。视力模糊是最常见的早期症状（82.1%），其次是头晕和上睑下垂（75.9%）、疲劳（65.1%）和构音障碍（63.1%）。最常观察到的并发症是急性胃肠炎（9.7%），其次是吸入性肺炎（7.2%）。51例患者发生严重中毒，早期出现眼部、面部、肢体肌肉和呼吸肌受累。32例患者（16.4%）需要机械通气。中位潜伏期为3天（四分位间距：2 - 4天），症状出现至给予抗毒素之间的中位间隔时间为7小时（四分位间距：4 - 10小时）。中位住院时间为6天（四分位间距：4 - 8天）。抗毒素的不良反应包括11例血清病和20例过敏反应。根据出院后30天是否存在临床体征，我们将队列分为预后良好和预后不良组；87例患者（44.6%）预后不良。预后不良的独立危险因素包括潜伏期≤3天、症状出现至抗毒素治疗的时间延长、住院时间延长、疾病严重程度以及需要机械通气。
由于诊断和干预延迟，医源性肉毒中毒常导致严重后果。我们确定了一种疾病严重程度分级系统以及其他危险因素来预测患者预后。
我们的研究强调了早期识别和及时治疗医源性肉毒中毒的至关重要性。临床医生应实施及时治疗以减轻疾病进展。
