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肉毒桿菌毒素中毒之眼部表徵－六病例報告
Ocular Manifestations of Botulism-Six Cases Report
摘要
肉毒桿菌毒素主要作用在膽鹼導性神經纖維(Cholinergic fibers)，阻斷神經肌肉傳導而造成全身症狀。本文報告六例肉毒桿菌毒素中毒之眼部症候。六位患者均表現出不等程度的自主神經功能異常的症狀如口乾，嘔吐，淚液分泌減少等症狀且合併有神經肌肉接合處功能障礙症狀如吞嚥困難、全身無力疲倦，呼吸困難等；眼部的症狀有視力模糊、眼瞼下垂、瞳孔擴大併對光反應緩慢等。六病例均接受肉毒桿菌抗毒素治療，其中一例因中毒較深，有呼吸衰竭症狀而接受呼吸器治療。病例的血清送檢，利用生物體中和法證實其中二例之血清有B型肉毒桿菌毒素毒在。二個月後追蹤檢查均已無臨床症狀。此病例在眼科因屬罕見，故提出報告。
關鍵字
無資料並列摘要
Botulism is an acute form of poisoning that results from ingestion of neurotoxin produced by clostridium botulinum. Botulinum toxins exert their major effect by blocking neuromuscular transmission in cholinergic fibers. We presented six cases with clinical manifesttion of botulism. The symptoms of severe naused and vomiting, marked dryness of the mouth and tongue, feelings of weakness and lassitude occurred after ingestion of improperly processed home preserved foods. The ocular symptoms and signs noted upon examination are blurred vision, photophobia, dilated fixed pupils with sluggishly pupillary reaction, ptosis and decreased lacrimation. The diagnosis is confirmed by mouse bioassay neutralization test. Afterward, diagnosis is further facilitated with EMG performance. All cases received trivalent antitoxin and the use of mechanical respiratory aids for one patient. The clinical symptoms were absent at two months later.