肉毒中毒
医学
孢子
排泄
医学微生物学
生理学
微生物学
儿科
生物
内科学
病毒学
作者
Keigo Kihara,Yuta Kajiyama,Yasuyoshi Kimura,Shuhei Okazaki,Naoya Esa,Ryosuke Nobe,Kentaro Shimizu,Kiyoshi Ohno,Daisuke Motooka,Tomohiro Matsumura,Takeshi Shimazu,Shota Nakamura,Yukako Fujinaga,Hideki Mochizuki
标识
DOI:10.1016/j.jiac.2023.08.009
摘要
We report a case of an 80-year-old woman with botulism from 2020 in Osaka, Japan. The patient complained of dysarthria and dizziness. On the same day, the patient developed respiratory failure, and was intubated and placed on mechanical ventilation. Subsequently, ophthalmoparesis and quadriparesis progressed rapidly. Ten days after onset, the patient failed to respond to any external stimulation. Blood tests showed anemia, and computed tomography revealed undiagnosed cervical cancer. Initially, diagnosis of neuromuscular junction disorder and acute motor neuropathy, including paraneoplastic syndrome, were considered. However, intravenous immunoglobulin therapy and plasma exchange were ineffective. A fecal sample on day 30 showed a large number of C. botulinum spores. On day 34, a mouse bioassay revealed botulinum toxin type A in the patient’s serum; therefore, a botulinum antitoxin was administered. Later, the patient’s muscle strength was gradually improved. However, severe muscle paralysis persisted, and the patient died of cachexia owing to cervical cancer on day 196. The etiology of this case was unknown because no contaminated food was identified during an inspection of the patient’s home. Fecal 16S rRNA gene sequencing revealed dysbiosis of the intestinal microbiota with abundant Enterococcus species. Long-lasting excretion of substantial botulinum spores even on day 30 indicated colonization of C. botulinum in the intestinal tract. This case suggests that C. botulinum colonization with co-existing intestinal dysbiosis may be associated with severe and prolonged symptoms of botulism.
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