Townes J M, Cieslak P R, Hatheway C L, Solomon H M, Holloway J T, Baker M P, Keller C F, McCroskey L M, Griffin P M
Centers for Disease Control and Prevention, Foodborne and Diarrheal Diseases Branch, Atlanta, GA 30333, USA.
Ann Intern Med. 1996 Oct 1;125(7):558-63. doi: 10.7326/0003-4819-125-7-199610010-00004.
Although botulism is rare, recognition of a possible case of this illness represents a public health emergency. To prevent more cases, prompt investigation must be done to determine whether illness is linked to commercial product or restaurant. Botulism can masquerade as other illnesses, and seemingly unlikely foods can harbor botulinum toxin.
To confirm the diagnosis and determine the cause and extent of an outbreak of botulism associated with food served at a delicatessen.
Retrospective cohort study of patrons of the delicatessen; laboratory analysis of food, serum samples, and stool samples; and traceback of implicated food.
Community in Georgia.
Patrons of the delicatessen.
Botulinum toxin in food, serum, or stool and Clostridium botulinum in food and stools.
8 of 52 patrons (15%) met the case definition for botulism. In 4 of the 8 patrons, and illness other than botulism was initially diagnosed. Five of the 8 were hospitalized, and 1 died. Stool cultures from 4 patrons yielded type AC. botulinum, and two serum samples contained botulinum toxin. All ill persons ate food from the delicatessen on 1 October 1993. Of the 22 persons who ate at the delicatessen that day, all 8 ill persons but none of the 14 well persons ate a potato stuffed with meat and cheese sauce. An open can of cheese sauce contained type A botulinum toxin and yielded C botulinum on culture. Cheese sauce experimentally inoculated with C botulinum spores became toxic after 8 days at a temperature of 22 degrees C (room temperature).
A commercial, canned cheese caused a botulism outbreak. This product readily becomes toxic when contaminated by C botulinum spores and left at room temperature. Mild botulism caused by unusual vehicles may be misdiagnosed. Botulism should be included in the differential diagnosis of persons with signs or symptoms of acute cranial nerve dysfunction.
尽管肉毒中毒很罕见，但识别可能的病例代表着公共卫生紧急情况。为防止更多病例出现，必须迅速展开调查以确定疾病是否与商业产品或餐厅有关。肉毒中毒可能伪装成其他疾病，看似不太可能的食物也可能含有肉毒杆菌毒素。
确认诊断并确定与熟食店提供的食物相关的肉毒中毒暴发的原因及范围。
对熟食店顾客进行回顾性队列研究；对食物、血清样本和粪便样本进行实验室分析；对涉事食物进行溯源。
佐治亚州的社区。
熟食店的顾客。
食物、血清或粪便中的肉毒杆菌毒素以及食物和粪便中的肉毒梭菌。
52名顾客中有8名（15%）符合肉毒中毒的病例定义。在这8名顾客中，有4名最初被诊断为患有肉毒中毒以外的疾病。8名顾客中有5名住院，1名死亡。4名顾客的粪便培养物检测出A、C型肉毒梭菌，两份血清样本含有肉毒杆菌毒素。所有患病人员均于1993年10月1日食用了熟食店的食物。在当天在熟食店就餐的22人中，所有8名患病人员都吃了夹有肉和奶酪酱的土豆，而14名健康人员中无人食用。一罐开封的奶酪酱含有A型肉毒杆菌毒素，培养后检测出肉毒梭菌。用肉毒梭菌孢子进行实验接种的奶酪酱在22摄氏度（室温）下放置8天后变得有毒。
一种商业罐装奶酪导致了肉毒中毒暴发。该产品被肉毒梭菌孢子污染并置于室温下时很容易产生毒素。由不寻常载体引起的轻度肉毒中毒可能会被误诊。急性颅神经功能障碍体征或症状患者的鉴别诊断应包括肉毒中毒。
