Arnon S S, Midura T F, Damus K, Wood R M, Chin J
Lancet. 1978 Jun 17;1(8077):1273-7. doi: 10.1016/s0140-6736(78)91264-3.
The spontaneous production of botulinum toxin in the infant gut by ingested Clostridium botulinum organisms is the underlying cause of infant botulism, recognised as an infectious disease only in late 1976. Because of the recognition of the pathophysiology of this disease and because the known potency and action of botulinum toxin can lead to rapid respiratory arrest, it appeared possible that the in-vivo production of botulinum toxin could cause the sudden death of some infants. To test this hypothesis, serum, selected tissues, and bowel contents from 280 dead infants were examined for the presence of C. botulinum toxin and/or organsisms. We found C. botulinum organisms in 10 infants, all of whom died suddenly and unexpectedly. 9 of these deaths were classified by the forensic pathologist as sudden infant death syndrome (S.I.D.S. or crib death). In 2 of these 10 sudden deaths both C. botulinum organisms and botulinum toxin were identified, and from the spleen of 1, C. botulinum organisms were isolated. Faecal specimens from 160 age-matched healthy infants who served as controls in studies of inpatient infant botulism cases were negative for both C. botulinum organisms and toxin, except for one specimen that contained only C. botulinum type A organisms. The 9 S.I.D.S. cases with evidence of C. botulinum infection comprised 4.3% of the 211 S.I.D.S. cases examined over 12 months. These findings suggest that intestinal production of botulinum toxin by C. botulinum is one cause of S.I.D.S. The strikingly similar age-distribution of 62 inpatient infant botulism cases and the 211 S.I.D.S. cases is also consistent with this concept. The possibility that in-vivo production of botulinum toxin may account for a larger proportion of S.I.D.S. cases is discussed.
婴儿摄入肉毒梭菌后，其在婴儿肠道内自发产生肉毒毒素是婴儿肉毒中毒的根本原因，婴儿肉毒中毒直到1976年末才被确认为一种传染病。由于认识到这种疾病的病理生理学，并且由于已知肉毒毒素的效力和作用可导致迅速的呼吸骤停，因此肉毒毒素的体内产生似乎有可能导致一些婴儿猝死。为了验证这一假设，对280名死亡婴儿的血清、选定组织和肠内容物进行了检查，以确定是否存在肉毒梭菌毒素和/或细菌。我们在10名婴儿中发现了肉毒梭菌，所有这些婴儿均突然意外死亡。其中9例死亡被法医病理学家归类为婴儿猝死综合征（S.I.D.S.或摇篮死亡）。在这10例猝死病例中的2例中，同时鉴定出了肉毒梭菌和肉毒毒素，并且从其中1例的脾脏中分离出了肉毒梭菌。作为住院婴儿肉毒中毒病例研究对照的160名年龄匹配的健康婴儿的粪便标本，除了一份仅含有A型肉毒梭菌的标本外，肉毒梭菌和毒素检测均为阴性。在12个月内检查的211例婴儿猝死综合征病例中，9例有肉毒梭菌感染证据的病例占4.3%。这些发现表明，肉毒梭菌在肠道内产生肉毒毒素是婴儿猝死综合征的一个原因。62例住院婴儿肉毒中毒病例和211例婴儿猝死综合征病例惊人相似的年龄分布也与此概念相符。本文还讨论了肉毒毒素体内产生可能占婴儿猝死综合征病例更大比例的可能性。
