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BRAIN and NERVE Volume 63, Issue 9 （September 2011）

BRAIN and NERVE 63巻9号（2011年9月発行）

Japanese English

総説

食餌性ボツリヌス症 Food-Borne Botulism 中村優子 ¹ , 澤田幹雄 ¹ , 池口邦彦 ¹ , 中野今治 ¹ Yuko Nakamura ¹ , Mikio Sawada ¹ , Kunihiko Ikeguchi ¹ , Imaharu Nakano ¹ ¹自治医科大学神経内科 ¹Department of Neurology,Jichi Medical University キーワード： food-borne botulism , type A toxin , adult colonization botulism , adult intestinal botulism , electrophysiologic test Keyword: food-borne botulism , type A toxin , adult colonization botulism , adult intestinal botulism , electrophysiologic test pp.979-985

発行日 2011年9月1日 Published Date 2011/9/1

DOI https://doi.org/10.11477/mf.1416101004

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参考文献 Reference

はじめに

　ボツリヌス症はグラム陽性嫌気性桿菌であるボツリヌス菌Clostridium botulinumの産生する毒素によって四肢麻痺を生じる疾患であり，その病型としては食餌性ボツリヌス症，乳児ボツリヌス症，そう傷性ボツリヌス症および成人腸管定着ボツリヌス症がある。食餌性ボツリヌス症はボツリヌス菌が産生した毒素が食物とともに摂取され，腸管から吸収されて発症する生体外毒素型の食中毒の一種であり，他の病型は感染型中毒である。ボツリヌス症を診療する機会は稀であるが，遭遇した場合には迅速かつ的確に診断し治療を開始する必要がある。ボツリヌス症のうち主に食餌性ボツリヌス症について，自験例を提示しながら概説する。

Abstract

　Botulism is a neuroparalytic disease caused by neurotoxins produced by Clostridium botulinum.　Food-borne botulism is a kind of exotoxin-caused food intoxication.　Although this disease is rarely reported in Japan now, it is a cause of great concern because of its high mortality rate, and botulism cases should be treated as a public health emergency.　Botulism classically presents as acute symmetrical descending flaccid paralysis.　Its diagnosis is based on the detection of botulinum toxins in the patient's serum or stool specimens.　Electrophysiologic tests of such patients show reduced compound muscle action potentials (CMAPs), low amplitudes and short durations of motor unit potentials (MUPs), and mild waning in repetitive low-frequency stimulations.　Single fiber electromyography (EMG) is particularly useful for the diagnosis of botulism.

　We report a case of food-borne botulism that we had encountered.　An 83-year-old man with rapidly progressive diplopia, dysphagia, and tetraplegia was hospitalized; he required intensive care, including artificial ventilatory support.　Electrophysiologic tests yielded findings compatible with botulism.　We made a clinical diagnosis of food-borne botulism and administered antitoxin on the seventh disease day.　The patient's motor symptoms started ameliorating several days after the antitoxin injection.　Subsequently, botulinum toxin type A was detected in the patient's serum specimen by using a bioassay, and the type A gene and silent B gene were detected in his serum specimen by using polymerase chain reaction (PCR).　C. botulinum was also obtained from stool culture on the 17th and 50th disease days.

　Botulism is a curable disease if treated early.　Although it is a rare condition,it should always be considered in the differential diagnosis of patients with rapid onset of cranial nerve and limb muscle palsies.