Clinical Characteristics And Treatment Of Patients With Clostridium Botulinum Food Poisoning

ObjectiveBotulinum neurotoxin is a toxin secreted by Clostridium botulinum in anaerobic environment,and is currently known as the natural virulence of one of the strongest biological toxins.Botulism is a fatal neuromuscular potential of flaccid paralysis caused by botulinum neurotoxin,mainly involving the prejunctional membrane.The clinical symptoms of patients show multiple skeletal muscle paralysis,no fever consciousness disorders during the course of disease.Common clinical types of poisoning cases are food-borne botulism,traumatic botulism and infant botulism.Clostridium botulinum food poisoning is the most common form of botulism.In recent years,with the population flow,faster circulation of goods,food distribution channels and other factors,the Clostridium botulinum food poisoning patients gradually show multi-province,multi-regional,group,sudden and so on.This research mainly aims at poisoning patients who were diagnosed and hospitalized in our hospital.Those clinical characteristics,laboratory examination and treatment after the first hospitalization,and after treatment indicators are analyzed and summarized.It is to explore the clinical features of poisoning patients in our hospital and the experience in the diagnosis and treatment of patients,in order to improve the level of diagnosis and treatment of medical institutions at all levels of Clostridium botulinum food poisoning and detection rate.According to two Clostridium botulinum food poisoning patients remaining sample analysis results in 2016 in our hospital,detection method,integrated a number of laboratories,to gradually explore for patients with clinically suspected botulism detection method which is needed in the laboratory,for the future to carry out the preliminary inspection,final confirmed cases of suspected botulism as references.ContentAccording to Clostridium botulinum food poisoning diagnostic criteria in the 14 thedition of "Practical Internal Medicine" and "Diagnosis and Treatment of Acute Poisoning and Critical Care Medicine",the inclusion and exclusion criteria are established,and the general situation of all the patients are collected,including the name,age,sex,origin,ethnicity,incidence season and year of the disease,the cause of poisoning,whether the group is diagnosed,misdiagnosis or not,latent period,incidence to the first visit time,admission time,hospitalization time,poisoning severity score(PSS),toxin type identification,clinical symptoms and signs,the average amount of antitoxins use,admission the first blood routine,liver function,kidney function and myocardial enzymes,analysis of vital signs and arterial blood gas analysis before and after treatment.MethodsAccording to PSS,the clinical symptoms and signs of patients,all patients are divided into mild poisoning group,moderate poisoning group,and severe poisoning group.The general information and epidemiological characteristics of the patients were analyzed,including disease classification,latent period,area distribution,seasonal distribution,annual distribution,cause of poisoning,misdiagnosis and misdiagnosis departments and toxin types.Mild poisoning group,moderate poisoning group,severe poisoning group patients' age and sex,latent period,onset to the first treatment time,the average amount of antitoxins use,hospitalization time and PSS,first admission to the blood routine,myocardial enzymes,blood biochemical indexes(liver and kidney function),before and after the treatment group and the different condition of vital signs arterial blood gas analysis are compared.The pathogenesis and treatment experience are summarized.Statistical methods: statistical analysis and statistical inputting data use SPSS 23.0 statistical software.Measurement data with the mean±standard deviation to be description.If the datas meet the conditions for comparison between groups,it will be using ANOVA analysis,otherwise nonparametric test,finally the whole groups will compare with each other.The count data are expressed in terms of frequency and rate,and the comparison between groups is either Chi-square test or Fisher's exact probability method.Results1.In the study,there were 53 cases of Clostridium botulinum food poisoning patients.According to the clinical symptoms and PSS,there are 33 cases of mild poisoning group,13 cases of moderate poisoning group,7 cases of severe poisoning group.General information has some characteristics: a female predominance,age distribution of large span,the group incidence of disease,the family as a unit.Patients are mainly concentrated in Hebei,Beijing and Henan provinces.Summer and autumn are the main onset season,and homemade fermentation products are still the first cause of poisoning.The average latent period is 51 hours.The majority of patients with botulism are the mild poisoning and the type A toxin poisoning.The moderate poisoning group and severe poisoning group patients with the number of botulinum antitoxins are significantly more than the mild poisoning group.Some patients were misdiagnosed,and the mainly misdiagnosed diseases include myasthenia gravis,Guillain-Barre syndrome(GBS),acute gastroenteritis and so on.2.Among the botulism patients included in this study,the highest frequencies of clinical symptoms are dizziness,weakness,blurred vision.Lacking special symptoms of the first symptoms,some patients to the first doctor's diagnosis brings a lot of interference,and the final diagnosis depends on multi-disciplinary cooperation.3.Different degree of poisoning patients admitted to hospital for the first time,the WBC,N,and ALB were significantly difference.The results showed that WBC,N and ALB in patients with severe poisoning group are significantly difference than those of mild poisoning group.4.Different degrees of poisoning patients,in addition to PCO2,before treatment the patients' vital signs and arterial blood gas analysis index have difference.The R,HR,pH,FiO2,PO2 And SaO2 in severe group are more significantly difference than those in the mild poisoning group.There is significant difference in PO2 among the groups after treatment.5.For the detection of two suspected cases of Clostridium botulinum food poisoning patients' residual sample,the rapid detection of botulinum toxin colloidal gold showed the positive detection of botulinum toxin.The mouse biological test are divided into detection test,confirmatory test,stereotyped test.The detection test result is initially suspected there may be botulinum toxin in the sample,and the confirmatory test to further clarify the presence of botulinum toxin in the sample.The setting test shows that toxin for A type.The trivalent mixed antitoxin and monovalent A botulinumantitoxins have protective effects on mice.The results to guide our clinical antitoxin using.Finally,the clinical suspected botulism patients diagnosed in our hospital.6.The suspected Clostridium botulinum food poisoning pathogen nucleic acid detection technology includes PCR,fluorescence quantitative PCR and whole gene sequencing technology.From the different perspective of molecular biology,the three detection again confirmed that the pathogenic bacteria of Clostridium botulinum,serotype A.Conclusions1.Clostridium botulinum food poisoning course in low incidence areas is still sporadic.The provinces and cities around Beijing have a small scale group and popular trend in recent years,and the number of cases showed an upward trend year by year.2.Patients with early symptoms and signs of Clostridium botulinum food poisoning are lack of specificity,which brings to the first doctor a lot of confusion.Some patients' first diagnosis exist misdiagnosis and delayed treatment,so the relevant departments need to strengthen the understanding of the botulism,less misdiagnosis as possible.3.The laboratory examination of the first admission of patients with Clostridium botulinum food poisoning has some reference value for the follow-up evaluation.4.PSS and arterial blood gas analysis could be effective for patients with Clostridium botulinum food poisoning real-time assessment,disease monitoring,which is easy to grasp the dynamic condition of patients.5.For suspected botulism cases,point-of-care testing(POCT)can give physicians a preliminary judgment,it is necessary to application in the clinical.Although it is time-consuming,the mouse biological test is still the standard test of botulinum test,which could not be replaced by other means of detection.Clostridium Botulinum nucleic acid detection technology and clinical application needs further exploration.