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They do a lot of tests and scans but they still have not found the cause of the paralysis, in the end the doctors let the patient have an electromechanical examination in the Neurology department, he just got sick.
Dr. Nguyen Trung Nguyen, Director of the Poison Control Center, Bach Mai Hospital, said that on August 18, the Poison Control Center of the Bach Mai Hospital received two married patients, at the age of almost 70, in a state of paralysis.
According to family members, in July, the grandparents bought Pate Minh Chay. When they got to the second bottle, they noticed a different smell than the previous one. The last meal they ate was at the end of July, after a day or two they both had a sore throat, droopy eyelids, slurred speech, trouble swallowing, weak arms, weak feet, and shortness of breath …
To accurately diagnose the condition of two critically ill patients, doctors must perform many tests and imaging.
“However, the results do not explain the muscle weakness and paralysis. We sent the patients for an electromechanical examination in the Department of Neurology, the male patients are not healthy enough to comply with the test at all times. Two hours”, Dr. Nguyen said.
Dr. Nguyen Trung Nguyen, Director of the Poison Control Center, Bach Mai Hospital. Image: Thanh Duong.
Electromechanical results indicated that the patient had characteristic symptoms of botulinum intoxication, including a decrease in bilateral cylindrical nerve motor amplitude, a decrease of more than 10% in the successive repeated stimulation test, muscle cell damage and neuromuscular junction but no sensory disturbances.
Vegetarian pate samples were eaten in vials from two patients and sent to the National Institute of Food Safety and Hygiene and the Central Institute of Hygiene and Epidemiology, both of which detected bacteria. Clostridium botulinum. The patient’s fecal cultures also detected this bacteria.
“These factors are similar to the characteristics of botulinum poisoning that appear in the literature, together with the results of food microbiology tests, intoxication tests, confirm patients with botulinum poisoning,” said Dr. Nguyen. .
Due to the intense and prolonged nature of the poisoning, two patients had the underlying disease, so the risk of death was very high.
In Vietnam, there is no specific antidote. Thanks to the intervention and assistance of the Ministry of Health, Drug Administration, Financial Planning Department, World Health Organization (WHO), Ramathibodit Poison Control Center in Bangkok, Thailand, and the Board of Directors of Bach Hospital Mai. On the afternoon of August 29, two vials of antidote (heptavalent antitoxin botulism) were rushed from Thailand to be used to detox two patients immediately afterward.
The price of two bottles of antidote is about 16,000 USD, fully funded by WHO, the patient does not have to pay the cost. With this antidote, the female patient has improved significantly, she can sit, open her eyes, open her mouth, and her voice has improved, the male patient hopes to reduce the time of severe paralysis, reduce the time of mechanical ventilation and recovery. health and therefore reducing complications and also the risk of death.
In addition to the two patients receiving inpatient treatment, the Center has received more than 10 other patients for examination after eating Minh Chay’s pate over the past three days. They come in mild conditions, mainly with muscle weakness, fatigue, not being able to do much exercise and are being evaluated for specific conditions for further management.
Patient poisoned with Minh Chay’s pate is being treated at Bach Mai Hospital. Image: Thanh Duong.
Dr. Nguyen said that food poisoning caused by botulinum toxin is Poisoning is classic in the literature but in fact it occurs infrequently, Epidemiological factors and specific manifestations of the disease are often difficult to exploit, making definitive diagnosis very difficult. Bach Mai Hospital and many medical facilities have not officially reported cases of this type of poisoning before.
This type of poisoning is derived from the production of food products in sealed packages (bottles, jars, cans, boxes, bags) that are not safe, causing bacteria to enter, grow and cause poisoning. factor.
The culprit bacteria is Clostridium botulinum, also known as poisonous bacteria (because it primarily occurs with canned meat initially). Bacteria exist widely in the environment and can mix with food ingredients, at this time shell-like bacteria that resist normal cooking well (called spores). Bacteria have anaerobic properties, they only grow in an air-deficient environment, not in an acidic and salty environment. Therefore, when processed food contains some bacterial spores (because the production process is not guaranteed to be clean), after production, the food is packaged without sufficient acidity, salinity will create the conditions. bacteria grow and secrete botulinum toxin.
Botulinum toxin is an extremely powerful neurotoxin, but it is destroyed quickly at 100 degrees C, therefore, poisoning does not occur from eating freshly cooked food. After ingestion, the botulinum toxin is absorbed into the body, attaches to the nerves and causes paralysis of all muscles. Symptoms of poisoning appear after eating, usually between 12 and 36 hours, possibly up to a week. The patient presented sequential paralysis in the head, face and neck area (difficulty swallowing, sore throat, difficulty speaking, hoarseness, eyes unable to open, spreading to the hands (weak arms), then to the legs (weak legs), paralysis of the respiratory muscles (wheezing, massive stasis of phlegm in the throat, difficulty in breathing).
The characteristic feature of paralysis is a mild paralysis, bilateral symmetrical paralysis, extending from the head to the feet. In particular, the patient does not have any sensory disturbances and remains awake because the toxin does not affect the brain. The digestive system may experience nausea, vomiting, abdominal pain, decreased bowel movements. Severe paralysis can cause respiratory failure, which is fatal. In the case of complete paralysis, many patients have dilated pupils, making it look like a deep coma, but they are actually awake and conscious. Mild cases can only weaken muscles such as weakness, inability to perform vigorous movements. The paralysis time is prolonged, the mean time of mechanical ventilation in patients is 2 months, which can be longer and it takes many months to recover.
This is a special type of poisoning, which occurs infrequently.. The symptoms of poisoning are similar to many other diseases like tetrodotoxin poisoning (such as puffer fish, blue ring octopus), polyneuropathy, myasthenia gravis, … so it is easy to be wrong. Some patients with this type of poisoning can also go unnoticed when paralysis appears quickly, there are no witnesses, when they are dead or severely paralyzed, they cannot communicate and therefore cannot count the suspicious food. typical and expected manifestations of the disease mentioned above.
Due to the low number of cases of poisoning, very few companies want to manufacture and supply this drug, which makes it difficult to buy and its price is very high. When the drug is stored until the expiration date, it needs to be canceled, but if disaster strikes suddenly due to a food safety incident, it will be easy to miss the drug. In the world, the drug is classified in the group of rare drugs, orphan drugs (orphan drugs), and countries must store this drug and other rare drugs.
Two patient vials were shipped in Bach Mai from Thailand antidote storage, on the label stating that the drug is for the exclusive use of strategic national reserves only. There is also a small amount of this drug reserve in your country, said the doctor.
Le Nga – Nguyen Chi
