Griffin P M, Hatheway C L, Rosenbaum R B, Sokolow R
Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
J Infect Dis. 1997 Mar;175(3):633-7. doi: 10.1093/infdis/175.3.633.
A patient with obstruction of the terminal ileum from Crohn's disease developed complete paralysis in week 1 of hospitalization. Features initially suggested Guillain-Barre syndrome, but botulinum toxin was identified in serum and stool specimens from week 1 and type A toxin-producing Clostridium botulinum in stool specimens from weeks 3 to 19, confirming botulism due to intestinal colonization. In week 19, the inflamed small bowel was resected, and C. botulinum disappeared from the stool. In week 31, the patient was able to breath without assistance. Testing for an active immune response with neutralizing antibodies to C. botulinum at week 19 was positive; these antibodies remained at a protective level for >1 year. Intestinal colonization botulism, rare in adults, should be considered for patients with descending paralysis, especially those with a preceding alteration in small bowel function. An active immune response to botulinum toxin with production of protective antibodies has not been demonstrated previously in a patient with botulism and may have contributed to this patient's recovery.
一名因克罗恩病导致回肠末端梗阻的患者在住院第1周出现完全性瘫痪。最初的症状提示吉兰-巴雷综合征，但在第1周的血清和粪便标本中检测到肉毒杆菌毒素，在第3至19周的粪便标本中检测到产A型毒素的肉毒梭菌，证实为肠道定植所致的肉毒中毒。第19周，切除发炎的小肠，肉毒梭菌从粪便中消失。第31周，患者能够自主呼吸。在第19周检测到针对肉毒梭菌的具有中和抗体的活跃免疫反应呈阳性；这些抗体在>1年的时间里维持在保护水平。肠道定植型肉毒中毒在成人中罕见，对于出现下行性瘫痪的患者应予以考虑，尤其是那些小肠功能先前有改变的患者。此前在肉毒中毒患者中尚未证实对肉毒杆菌毒素产生具有保护性抗体的活跃免疫反应，而这可能促成了该患者的康复。
