我国首例由丁酸梭菌引起婴儿E型肉毒中毒实验室诊断研究

目的对一起疑似婴儿肉毒中毒进行实验室诊断研究。方法对1例疑似婴儿肉毒中毒病例的粪便、食用过的食品和生活环境涂抹共计30份标本/样品进行梭菌分离鉴定及肉毒毒素检测,对分离菌株进行产毒试验。结果将患儿粪便标本培养物上清液腹腔注射小鼠后可致小鼠出现典型肉毒毒素中毒表现(竖毛、呼吸困难并出现典型的蜂腰、四肢麻痹),继而死亡,且培养物上清液经胰酶处理后毒性增强,表现为小鼠出现中毒及死亡时间较未处理组明显缩短。但培养物上清液经100℃加热处理后再次染毒动物,小鼠未出现中毒和死亡。混合型肉毒毒素诊断血清及单价抗E型肉毒毒素诊断血清可对小鼠起到保护作用。从患儿的粪便标本中分离到G~+芽胞杆菌,该菌在哥伦比亚血平板上呈不规则半透明扁平菌落,边缘根状生长,并携带E型肉毒毒素产毒基因,16S rRNA将其鉴定为丁酸梭菌,产毒试验结果显示该菌株可产E型肉毒毒素。结论该起婴儿中毒事件是由感染产E型肉毒毒素的丁酸梭菌引起。     

Distinct characters of Clostridium botulinum type A strains and their toxin associated with infant botulism in Japan

Four strains of Clostridium botulinum type A having been associated with infant botulism in Japan, and another strain isolated from honey not associated with infant botulism, were found to be hemagglutinin (HA) negative. These strains do not produce L (Mr 500 kDa) nor LL toxin (Mr 900 kDa) but M toxin (Mr 300 kDa) only. No marked difference was found between the HA-positive and HA-negative strains in other biochemical properties, but the HA-negative strains tended to colonize more easily in the intestines of infant mice than did HA-positive strains. The toxin of HA-positive strains and that of HA-negative strains differed in the antigenicity of part of the toxic component and that of the nontoxic component, and in the molecular size of the toxic component.