Botulisme, Paralysie ya ba moules, Ciguatera, mpe Empoisonnement ya Scombroide¶

Na bokeseni na ngɛngɛ ya bilei oyo euti na mikrobe oyo esalaka ete libumu ekóma kolɛmba mpo na mwa ntango mpe kozoka, ba neurotoxines oyo eutaka na bilei mpe ba biotoxines ya mbu ebundisaka mbala moko système nerveux mpe système cardiovasculaire ya moto. Komela neurotoxine botulinum oyo euti na ndunda oyo batyá na bibombelo na ndako na ndenge oyo ebongi te to mbisi oyo esili kopɔla, saxitoxine oyo euti na mbisi oyo elyaka na filtre, tétrodotoxine oyo euti na poisson pufferfish, ciguatoxine oyo euti na mbisi ya récif tropical, to mikumba minene ya histamine oyo euti na mbisi ya misuni ya moindo oyo ebebi ekoki kobimisa paralysie ya misisa ya motó, oyo ezali komata nokinoki paralysie ya misisa ya kopema, to kobanga na mbalakaka lokola allergie na boumeli ya miniti to bangonga.

Buku oyo epesi ba procédures ya urgence étape par étape oyo eyokani na ba directives cliniques ya Organisation mondiale de la santé (OMS), ba Centres ya Etats-Unis ya Contrôle et prévention ya maladie (CDC), Administration alimentaire et drogue ya Etats-Unis (FDA), Centre européen ya prévention et contrôle ya bokono (ECDC), mpe Agence ya sécurité santé ya Royaume-Uni (UKHSA). Koyeba bilembo ya likebisi ya neurologie ya liboso, kobenga ba services ya urgence avant paralysie diaphragmatique etika kopema, mpe kobatela ba échantillons ya biloko ya kolia oyo ba suspecter mpo na kotinda antitoxine ya santé publique ebikisaka bomoi ya bato.

Sala boye sikoyo¶

Soki yo to moto moko oyo ozali penepene azwi bilembo ya misisa (komona malamu te to mbala mibale, paupières ya miso oyo ezali kokita, koloba malamu te, mokakatano ya komela, kolɛmba mbɛbu to monoko, kolɛmba ya misisa) to elongi na mbalakaka ezali kopumbwapumbwa mpe kopema nsima ya kolya bilei ya bibombelo, oyo ebombami, to ya mbu:

1. Call your local emergency number immediately: Call 911 in the United States and Canada, 112 across the European Union, or 999 in the United Kingdom (or check our banimero ya mbalakaka directory). Tell the dispatcher clearly: "Suspected neurotoxic food poisoning or botulism with neurological symptoms and risk of respiratory paralysis." Never attempt to drive a patient with drooping eyelids, slurred speech, or tingling lips to the hospital yourself, as complete paralysis of the breathing muscles can occur suddenly in transit.
2. Stop everyone else from eating the suspect food: Immediately warn anyone who shared the meal, picnic, or restaurant dish to stop eating. Do not taste the food yourself to see if it "tastes spoiled": botulinum toxin, saxitoxin, ciguatoxin, and tetrodotoxin are completely odorless, colorless, and tasteless.
3. Batela nzela ya mopepe mpe pesa eloko te na monoko (NPO): Lokola botulisme mpe ba neurotoxines ya mayi e paralyser réflexe ya gag mpe misisa ya komela na ebandeli, kopesa ata moke te moto mayi, miliki, bilei, to nkisi ya monoko mpo na komela, oyo ekoki kosala ete a étouffer to aspiration na poumons oyo ebomaka. Kosala jamais kosanza na misapi, mayi ya mungwa, to sirop ya ipecac.
4. Position ya malade sans danger mpe suivre pema continuellement: Soki mutu azali conscient mais azali na problème ya ko mela saliva to azo sentir faible, fandisa ye propped mua semba na angle ya 30 à 45 degrés to tia bango na côté na bango na position ya récupération po pooled saliva to vom e drainer libanda ya munoko au lieu ya kokita na pipe ya mopepe. Talá ndenge ntolo na bango ezali komata mpe kokwea nsima ya segɔnde 60 nyonso. Soki kopema ekomi mozindo te, etelemi, to ekiti na kopema ntango mosusu, banda kopema ya kobikisa mpe CPR ya CPR mbala moko.
5. Tala soki ezali na auto-injecteur ya épinephrine soki scombroïde to anaphylaxie ekoki: Soki moto yango aliaki thon, mahi-mahi, maquereau, to mbisi ya bleu na boumeli ya miniti 10 kino 60 oyo euti koleka mpe azwi kopumbwa ya motane makasi ya elongi mpe nkingo, ba ruches, kopema, kokangama ya zolo, to kizunguzungu, salela yango lokola likama ya bomoi ba réactions allergie mpe anaphylaxie mpe batyaka auto-injecteur na bango ya épinephrine oyo bakomeli bango na loketo ya libándá mbala moko ntango bazali kozela bato oyo basalisaka maladi.
6. Kanga mpe tyá bilembo na eloko oyo bakanisaka ete ozali na bilei kozanga kosimba yango na mabɔkɔ mpamba: Lata ba gants oyo ekoki kobwakama mbala moko (to kosalela saki ya plastiki likoló ya mabɔkɔ na yo), kangá bilei oyo etikali, molangi ya ebandeli, biloko ya kolya, to biloko oyo batyaka na mbisi na kati ya eloko to saki ya plastiki oyo ekoki kofukama te. Botia yango étiquette "DANGER: SUSPECTE POISON / KOLIA TE" pe pesa yango na ba paramédicaux po ba laboratoires ya santé publique ekoka ko confirmer toxine pe kobimisa na urgence Antitoxine Botulinum Heptavalent Equine (BAT).

Diagramme ya triage syndromique ya urgence mpo na empoisonnement neurotoxique mpe ya mayi¶

flowchart TD
    Start["Maladi ya makasi Nsima ya kolya Bilei ya bibombelo/oyo ebombami, Mbisi, to Poisson-eau"] --> RespCheck{"Mobɛli azali na mokakatano ya kopema, komela to koloba?"}

    RespCheck -->|Yes: Bulbar Palsy or Shortness of Breath| Call911["BENGA 911 / 112 / 999 MBALAMU<br/>Kopesa ELOKO TE na monoko; kotia na position ya récupération ya côté<br/>Bomibongisa pona pema ya kobikisa / CPR soki mouvement ya ntolo ekiti"]

    RespCheck -->|No: Alert with stable airway| Pattern{"Motindo nini ya bilembo ya kliniki mpe liziba nini ya bilei ekokani?"}

    Call911 --> Pattern

    Pattern -->|12-72h after home-canned vegetables, garlic oil, fermented fish, or honey in infant:<br/>Double vision, drooping eyelids, dry mouth, descending weakness| Botulism["Botulisme oyo ba suspecter (Paralyse flaccide descendante)<br/>Transport d’urgence ya ICU pona ventilation mécanique<br/>Libération urgent santé publique ya Antitoxine Botulinum (BAT) to BabyBIG"]

    Pattern -->|5-60 min after mussels, clams, oysters, scallops, or pufferfish:<br/>Burning/tingling lips and tongue spreading to fingers, floating sensation, ascending paralysis| PSP["Empoisonnement paralytique ya ba molinga (Saxitoxine) to Tétrodotoxine<br/>Arrêt respiratoire rapide possible na kati ya 1 à 6 heures<br/>Transport immédiat ya ambulance pona intubation endotrachéale & ventilation"]

    Pattern -->|1-6h after tropical reef fish (barracuda, grouper, snapper, amberjack):<br/>Vomiting/diarrhea + tingling lips/teeth + cold objects feel burning hot| Ciguatera["Empoisonnement ya mbisi ya Ciguatera (Ciguatoxin)<br/>Evaluation ya urgence mpo na bradycardie mpe tansion ya nse<br/>Mai IV, atropine soki esengeli, mpe traitement ya mannitol IV"]

    Pattern -->|10-60 min after dark-meat fish (tuna, mahi-mahi, mackerel, sardines):<br/>Fiery red face/neck flush, peppery taste, throbbing headache, palpitations, wheezing| Scombroid["Empoisonnement ya Mbisi ya Scombroide (Toxicité ya Histamine)<br/>Salelá auto-injecteur ya épinéphrine soki ozali kopumbwa to ozali na hypothénormose<br/>Ba antihistamines H1 + H2 ya lopitalo (diphenhydramine + famotidine)"]

Bokokanisi ya diagnostique ya maître: Botulisme vs. Biotoxines ya mayi¶

Kokesenisa nokinoki kati na ba syndromes mitano wana esalisaka minganga ya nokinoki bákanisa liboso soki moto ya maladi akozala na mposa ya kokɔtisa ye na nzela ya mopɛpɛ nokinoki, antitoxine spécifique, atropine intraveineuse, to antihistamines.

1. Botulisme : paralysie flaccide descendante mpe kobikisa ba voies respiratoires¶

Botulisme ezali bokono ya neuroparalytique oyo ekoki koboma moto oyo eyaka na neurotoxine botulinum (BoNT), oyo ebimisamaka na bactérie anaérobie, oyo esalaka ba spores Clostridium botulinum. Gram na gramme, toxine ya botulinum ezali eloko ya bioloji oyo ebomaka mingi oyo eyebani: dose microscopique ya moke koleka 1 microgramme ekoki koboma moto oyo akómi mokóló.

Ndenge nini toxine ya botulinum e paralyser ba muscles¶

Soki ezwami na nzela ya misɔpɔ (na botulisme oyo euti na bilei to ya bebe) to ebimisami na kati ya mpota oyo ezali na mikrobe (botulisme ya mpota), ngɛngɛ ya botulin etambolaka na makila tii na ba terminaux ya misisa ya cholinergique périphérique: mingimingi na jonction neuromusculaire esika ba nerfs moteurs etindaka ete misisa ya mikuwa ekangama, mpe cholinergique autonomique ba synapses oyo esalemaka.

1. Clavage irreversible ya ba protéines ya SNARE: Toxine ekoti na terminal ya nerf moteur présynaptique mpe esalaka lokola ciseaux moléculaires, ekata ba protéines ya SNARE ya kati (synaptobrevine, SNAP-25, to syntaxine) oyo esengeli mpo ba vésicule ya acétylcholine e fusionner na membrane nerveuse.
2. Blocage complète ya liberation ya acétylcholine: Soki acétylcholine ekatisa synapse te, fibre musculaire ezuaka signal zéro ya ko contracter, esali que paralyse flaccide (limp).
3. Mpo na nini kozonga nzoto esɛngaka baposo kino basanza: Soki toxine ya botulinum ekɔti na terminal ya misisa mpe ekati ba proteine ​​ya SNARE, antitoxine ekoki lisusu te kozongisa nsima mbeba oyo ezali na kati ya nsuka wana ya misisa ya sikisiki. Antitoxine botulinum (BAT) e neutraliser kaka toxine oyo ezali kaka ko circuler librement na makila, kopekisa paralysie epalangana na ba nerfs ya kobakisa. Mpo na kozwa lisusu makasi na misisa oyo esi esili ko paralysé, misisa ya mobɛ́li esengeli kobimisa mokemoke ba terminaux axons ya sika mpenza na boumeli ya pɔ́sɔ 2 kino 12, na boumeli ya ntango yango, ventilateur mécanique ya ICU ebatelaka mobɛli na bomoi.

Mitindo minei ya kliniki ya botulisme ya moto¶

• Botulisme oyo euti na bilei: Ewutaka na kolia bilei oyo na kati na yango ba spores ya Clostridium botulinum ebimaki na esika oyo ezali na oxygène te, oyo ezali na acide mingi te (pH > 4.6) na température ya ndako mpe ebimisaki toxine oyo esalemaki liboso. Ba culpables classiques ezali bilei oyo ezali na acide mingi te oyo batye na bibombelo na ndenge ya mabe (ba haricots verts, maïs, asparagus, beets, pilipili), ail to matiti oyo basali na ndako oyo batye na mafuta oyo batiki na frigo te, mbisi mpe ba mammifères ya mayi oyo esalemi na fermentation to oyo esalemi na mungwa (lokola mokila ya castor, flipper ya poulet, to feseekh), pomme de terre ya kotumba oyo ezingami na papier ya papier oyo batiki na température ya ndako liboso ya kopesa yango, mpe ba soupes ya mombongo to ba sauces ya fromage oyo ebombami malamu te.
• Botulisme ya bana mike (Lolenge oyo emonanaka mingi na Etats-Unis): Ezwamaka na bana mike na nse ya sanza 12 (90% bazali na nse ya sanza 6). Lokola microbiome ya misɔpɔ ya bebe ekoli naino te mpo na kopekisa ba spores ya Clostridium, ba spores oyo emeli ebimaka kaka na kati ya misɔpɔ monene ya mwana mpe ebimisaka ngɛngɛ ntango nyonso. Mafuta ya nzoi ya mbindo to pasteurisé ezali réservoir moko ya bilei ya monene oyo ekoki koboya ya ba spores ya Clostridium botulinum; mputulu ya mikroskope mpe biloko mikemike ya mabele ezali liziba mosusu. Koleisa ata moke te mafuta ya nzoi to bilei oyo ezali na mafuta ya nzoi na mwana nyonso oyo azali na nse ya mbula 1.
• Botulisme ya mpota: Esalemaka tango ba spores ya Clostridium botulinum e contaminer mpota ya perforation ya mozindo, dévitalisée, fracture ouverte, blessure ya crush, to esika ya injection sous-cutanée ya loposo-popping (surtout associé na injection ya héroïne noir-goudure), ebimi na ndenge ya anaérobie lokola tétanos. Na bokeseni na botulisme oyo eyaka na bilei, botulisme ya mpota ezali na kosanza to diarrhee na misɔpɔ te mpe ezali na eleko ya kokangama molai ya mikolo 4 kino 14.
• Botulisme ya colonisation intestinal iatrogène to ya mikóló: Ba cas oyo esalemaka mingi te sima ya ba injections ya toxine botuline cosmétique to thérapeutique to na ba grands oyo bazali na lipaso makasi ya gastro-intestinal to maladie inflammatoire ya intestin.

Koyeba bilembo ya kala ya Botulisme ya Mikóló mpe ya Bébé¶

Na Mikóló mpe Bana Mikóló (The Classic Pentad): 1. Fièvre te: Soki pneumonie ya aspiration secondaire ebandi te, température ezali totalement normal. 2. Etat mental ya polele, ya alerte: Mobɛli azali kolamuka, azali orienté, mpe abatelaka sensation mobimba (ezali kolɛmba te), atako koloba mabe mpe ba paupières ya miso oyo ezali kokita ekoki kosala ete amonana lokola alangwa masanga to azali kolala mpɔngi. 3. Futte cardiaque normale to malembe mpe tansion normal: Kozanga tachycardie soki hypoxique te. 4. Paalsies ya ba nerfs crâniens ya liboso (Palsie bulbar: Ba "4 Ds"): Lokola ba nerfs crâniaux ezalaka na rotation synaptique ya likolo, paralysie ebandaka tango nionso na mutu na elongi: Diplopie (vision flou to double à partir ya paralysie ya muscle extraoculaire), Ptose (ba paupières ya likolo oyo ekiti), Dilaté ya malembe to ya fixe ba pupilles, Dysarthrie (maloba ya monene, ya kozanga mayele), Dysphonie (mongongo ya bolembu, ya zolo), mpe Dysphagie (kozanga makoki ya komela saliva, na zolo oyo ekauki lokola mikuwa, ya mpasi oyo mbala mingi ezwamaka mabe lokola strep gorge to pharyngite). 5. Paralyse Flaccide DESCENDANT Symétrique: Na ba heures ti mikolo, bolembu epalanganaka symétrique kobanda likolo ti na se: kobanda na miso na zolo na se tii na ba muscles ya kingo (incapacité ya kosimba mutu likolo), mapeka, maboko ya likolo, muscles intercostals na diaphragme (esalaka pema ya kimia, ya mozindo te pe respiratoire hypercapnique ya mbalakaka arrest), tronc, mpe cuisse, elongo na constipation makasi mpe retention urinaire.

Na Ba bébé oyo bazali na se ya sanza 12 ("Syndrome ya bébé floppy"): - Constipation ezali presque toujours signe ya liboso mpenza (kolongola misɔpɔ te na boumeli ya mikolo 3 to koleka), mbala mingi babosanaka yango liboso ete bolembu ya misisa emonana polele. - Kolela ya bolembu, ya bolembu, to oyo ebongwani mpe kobungisa expression ya elongi (affect plat). - Koleisa malamu te mpe kosukola na bolembu: Bébé alemba noki na mabele to na molangi, azali kobwaka saliva, mpe abungisaka réflexe na ye ya gag. - Ptose (ba paupières oyo ezali kokita) mpe rag ya mutu: Hypotonie généralisée ("bébé disquette") esika maboko mpe motó ya bebe ekangamaka na bolɛmbu ntango etombolami.

2. Ba neurotoxines ya ba moules na ba tétrodotoxines ya poisson soufflet¶

Ba molinga bivalve oyo eleisaka filtre (ba moules, ba palourdes, ba huîtres, ba écailles, ba cockles) ba pomper ba litres ya mayi ya mbu na ba branquilles na bango ngonga nionso, ko concentrer ba dinoflagellates ya mayi na ba diatome microscopiques na tango ya ba fleurs ya ba algues ya mabe (ntango mosusu babengaka yango "marées rouges," atako ba fleurs ya likama esalemaka mingi na mai ya cristal-clair na décoloration ya langi zéro). Ba biotoxines nionso ya ba moules ezalaka 100 pour cent na chaleur: kosala vapeur, ko lamba, ko frire, to ko tumba ekitisaka toxicité ata muke te.

Ba syndromes minei ya empoisonnement ya ba moules na Tetrodotoxine¶

1. Empoisonnement paralytique ya ba molinga (PSP: Saxitoxine):
2. Mecanisme: Saxitoxine e bloquer sélectivement ba canaux de sodium oyo ezali na tension-gated na libanda ya ba nerfs moteurs mpe sensoriels périphériques mpe ba membranes musculaires skeletales, etelemisaka ba potentiels d’action nerveuse na bopeto (identique na mécanisme na tétrodotoxine).
3. Ebandeli nokinoki: Na boumeli ya miniti 5 kino 30 nsima ya kolia ba mousses to ba palourdes oyo ezali na mikrobe, moto oyo azwi mpasi ayokaka kozoka, koswa, to kozika ba paresthésie ya mbɛbu, ya monoko, mpe ya mino oyo ebongwanaka nokinoki na kolɛmba mpe epalanganaka na elongi, nkingo, nsɔngɛ ya misapi, mpe misapi ya makolo.
4. Progression: Elandami na kati ya ngonga 1 to 6 na kizunguzungu, liyoki ya bizarre ya kopumbwa na mopepe, marche incoordonnée (ataxie), elobeli ya mabe, kokangama ya zolo, mpe paralyse flaccide ya diaphragme oyo ezali komata noki to généralisée. Liwa na asphyxiation esalemaka na kati ya heures 2 à 12 soki ba intubés na mobeli te mpe ba ventilé mécanique te.
5. Pronostic: Lokola saxitoxine ekangamaka na ndenge ya reversible mpe ebimisamaka na ba reins na kati ya ngonga 24 kino 72, mobeli nyonso oyo akomi na lopitalo na tango mpo na intubation endotrachée mpe soutien ya ventilateur avant arrêt cardiaque hypoxique azali na taux ya survie ya presque 100 pour cent na récupération mobimba.
6. Empoisonnement neurotoxique ya ba molinga (NSP: Brevetoxin):
7. Mecanisme: Ebimisami na ba dinoflagellates Karenia brevis (mingimingi mingi pembeni ya Golf du Mexique mpe Caraïbes). Ba brevetoxines e forcer ba canaux de sodium oyo ezali na porte à tension efungwama, esalaka que ba nerfs ebɛta mbala na mbala. (Gulf of Mexico)
8. Bilembo: Ebandi na miniti 30 kino ngonga 3 na gastro-entérite, kolɛnga ya monoko mpe ya ba chiffres, koloba mabe, kopanzana ya pupille, mpe kozonga nsima ya molunge ya malili kino molunge (ekokani na ciguatera ya pɛtɛɛ), kasi pene na ata moke te epesaka paralysie respiratoire oyo ebomaka. Action ya mbonge na ba plages ekoki mpe ko aérosoliser ba brevetoxines, kosala kosukosu ya makasi, koswa, mpe bronchospasme na ba beachgoers na maladi ya asthme.
9. Empoisonnement amnésique ya ba molinga (ASP: Acide domoïque):
10. Mecanisme: Esalemi na ba diatome Pseudo-nitzschia na ba moules, ba palourdes ya rasoir, na ba viscéres ya crabe Dungeness. Acide domoïque ezali analogue ya glutamate excitatoire ya makasi oyo ezo stimuler mingi pe ebebisaka ba neurones na hippocampe ya cerveau.
11. Bilembo: Kosanza mpe kozoka na kati ya ngonga 24, elandi na ngonga 48 na mobulungano makasi, désorientation, statut épileptique ba crises, coma, mpe bobungisi ya bokundoli ya ntango mokuse ya ntango mokuse ya ntango mokuse ya libela (mingimingi na mikóló oyo bakómi mibange mpe bato ya maladi oyo bazali na maladi ya rein).
12. Empoisonnement ya ba molinga diarrhétique (DSP: Acide okadaïque):
13. Esalaka diarrhee ya mayi oyo ebandi noki, nausea, kosanza, mpe ba crampe ya libumu na kati ya miniti 30 kino ngonga 4, esilaka na réhydratation orale to IV na mikolo 2 to 3 sans paralysie neurologique.
14. Tétrodotoxine (TTX: Poisson soufflet / Fugu na Pieuvre ya bague bleu):
15. Komela mbisi ya pufferfish (fugu) oyo ebongisami malamu te to konyokwama na mpasi te mpo na koswama na pieuvre bleu, epesaka tétrodotoxine, oyo ekangaka ba canaux neuronaux ya sodium ndenge moko na saxitoxine.
16. Avertissement critique ya ICU (Conscience "Locked-In"): Ba malades oyo baza na empoisonnement makasi ya tétrodotoxine to saxitoxine bakoki kokoma 100 pour cent paralysé: kokoka te kopema, koloba, koningisa mosapi, to kutu ko clignoter, na ba pupilles dilatées fixes: tango bazali kotikala totalement lamuka, conscient, pe bakoki koyoka pe koyoka nionso. Bato oyo babikisaka basengeli koloba na kimia mpe na kokitisa motema na mobɛli na ntango ya CPR mpe ya komema, mpe minganga ya nokinoki basengeli kopesa ye nkisi ya kokitisa motema mobimba mpe ya kosilisa mpasi na misisa pembeni ya ventilation mécanique.

3. Empoisonnement ya mbisi ya Ciguatera : mbisi ya récif tropicale mpe allodynia ya malili¶

Ciguatera ezali mbisi oyo ezwamaka ngɛngɛ mingi oyo ezali na mikrobe te na mokili mobimba, oyo ezwamaka na bato tii 50 000 mbula na mbula na bisika ya molunge mpe ya molunge oyo ezali kati na 35 degrés ya Nɔrdi mpe 35 degrés ya latitude ya Sudi (na kati na yango Caraïbes, Floride, Golf du Mexique, Hawaii, Pasifike ya Sudi, Océan Indien, mpe nɔrdi ya Australie) bakisa mpe moto nyonso oyo azali kolya ba récifs tropicals oyo euti na mikili mosusu mbisi na mokili mobimba. (Gulf of Mexico)

Biomagnification likolo ya chaîne alimentaire ya ba récifs ya corail¶

Ba dinoflagélates microscopiques Gambierdiscus toxicus ekolaka na ba surfaces ya ba récifs ya corail oyo ekufi to ebebi. Mbisi ya mike ya mabanga ya ntalo oyo elyaka matiti elyaka na algues, mbisi ya moyenne oyo elyaka misuni elyaka banyama oyo elyaka matiti, mpe mbisi ya minene ya mabanga ya ntalo oyo elyaka na nsɔngɛ elyaka banyama ya mike oyo elyaka misuni: ekɔtisaka ciguatoxine oyo ekoki kopɔla na lipide na misuni na yango, na motó, na foie, na misɔpɔ, mpe na ngulu (makei).

• Mbisi ya risque makasi oyo esengeli koboya (mingimingi mbisi ya minene oyo eleki kilo 2 to 3 / 4,5 à 6,5 livres): Barracuda (aliya jamais barracuda na mayi ya tropical), moray eel, groupe ya munene, snaper rouge, amberjack, jack crevalle, poisson ya hogfish, mbisi ya perroquet, mbisi ya lipaso, mpe mackerel mokonzi ya mikili ya molunge.
• Mbisi ya pélagique ya océan ouvert ya risque moke: Thon, mahi-mahi, loso, morue, mpe halibut elyaka ba récifs ya corail te mpe ememaka mingi te ciguatera (atako thon mpe mahi-mahi ekoki kosala scombroid soki etiki yango malili te).

Ba phases cliniques na "Test ya Cube de glace".¶

1. Fase gastro-intestinal aiguë (heure 1 à 6 après kolia): Diarrhee ya mayi ya mbalakaka, nausea, kosanza, mpe crampe ya libumu oyo eumelaka ngonga 24 à 48.
2. Fase cardiovasculaire (1 à 24 heures): Ciguatoxine efungolaka ba canaux ya sodium oyo ezali na tension na ba nerfs vagales mpe na muscle cardiaque, epesaka bradycardie ya likama (rythme cardiaque malembe na se ya 40 à 50 bets par minute) mpe hypothénormose orthostatique (tansion makila ya nse mpe kosila mayele ntango ozali kotelema). Ba malades basengeli na suivi cardiaque ya lopitalo noki, saline normale intraveineuse, mpe atropine intraveineuse soki rythme cardiaque to tansion ekiti makasi.
3. Fase neurologique pathognomonique (3 heures ti na ba Poso/Sanza):
4. Paresthésie périorale mpe extremité: Kozoka, koswa, to kolɛmba nzoto oyo eumelaka zingazinga ya mbɛbu, monoko, zolo, mabɔkɔ, mpe makolo.
5. Dysthésie dentaire: Liyoki ya bizarre, incontestable que mino na yo nionso ekangami to ezo sala pasi na ba sockets na yango.
6. Allodynie ya malili (Reversal ya température): Na 70 à 90 pour cent ya ba malades, kosimba esika nionso ya malili, kosukola maboko na mayi ya malili ya robinet, konyata na mabele ya carreaux ya malili, to komela masanga ya malili e déclenchaka sensation ya mpasi makasi ya kozika, glace ya kokauka, to choc électrique (ewutaka na ciguatoxine hyper-sensitizing cold-sensing TRPM8 ba canaux ions na ba fibres C périphériques).
7. Prurite généralisée makasi (ko démangeaison), kolɛmba oyo elɛmbisaka nzoto, mpasi ya misisa (myalgie), mpe mpasi ya matonga (arthralgie).
8. Traitement médicale mpe Régime ya 6 Mois Post-Ciguatera:
9. Na lopitalo, kopesa D-mannitol intraveineux (1,0 g/kg na boumeli ya miniti 30 kino 45) na kati ya ngonga 48 kino 72 ya yambo (kaka nsima ya déshydratation mpe hypothénormose e corrigé mobimba na ba fluides IV) ekitisaka œdème axonale neuronale mpe ekitisaka ba symptômes neurologiques mokuse.
10. Koboya déclencheur obligatoire ya sanza 6: Na boumeli ya sanza 3 kino 6 sima ya poison ya ciguatera, ba maladi basengeli koboya mpenza mbisi nyonso mpe mbisi ya molungé (ata mbisi ya mai ya pɛto oyo ezali na likama te), masanga nyonso (ata komela bière to vinyo mbala moko esalaka ete mpasi ya misisa ya kozika mpe kolɛmba nzoto ezonga mbala moko, na mobulu), caféine, mpe ba noix/momboto.

4. Empoisonnement ya mbisi ya Scombroid: surcharge ya histamine vs allergie ya mbisi¶

Empoisonnement ya Scombroid ezali bokono ya mibale oyo ezwamaka na mbisi na mokili mobimba mpe mbala mingi ezwamaka na mabe lokola allergie ya mbalakaka, ya sika oyo ebandi na mbisi ya mbu. Na bokeseni na allergie ya solo ya mbisi oyo esalemi na IgE (elingi koloba ete moto akoki kolia lisusu mbisi te), scombroid ezali intoxication chimique ya histamine oyo eyaka na kolia mbisi oyo efandaki na température ya molunge mwa bangonga sima ya kokangama.

Ndenge nini kobombama na molunge ebongoli mbisi oyo ezali na likama te na bombe ya histamine¶

Mbisi ya mbu oyo ezali na misuni ya moindo : ezala lolenge ya libota ya Scombridae (tuna, maquerele, bonito, skipjack) mpe lolenge ya misuni ya moindo oyo ezali na scombroïde te (mahi-mahi / dorado, poisson bleu, amberjack, sardines, anchois, marlin, poisson épéage): na ndenge ya bomoto ezali na ba concentrations ya likolo ya acide aminé libre L-histidine na misisa na yango ba tissus.

1. Fenetre ya mabe ya température: Soki batiki thon to mahi-mahi oyo ekangami na pont ya masuwa ya molunge, na libongo, to na comptoir ya cuisine likolo ya 4 degrés Celsius (40 degrés Fahrenheit) ata ngonga 2 to 4, bactérie ya surface enterique (Morganella morganii, Klebsiella pneumoniae, Hafnia alvei) ebakisami noki mpe esalela enzyme histidine décarboxylase mpo na kobongola histidine naturelle na ba quantités massives ya histamine na saurine.
2. Kolamba ebomaka bactérie, histamine TE: Ata soki na sima kolamba ya restaurant to ya ndako a congeler mbisi solide mpe sima a griller, a bidon, to a lambi yango na 200 degrés Celsius (400 degrés Fahrenheit), histamine ebebaka totalement indestructible na chaleur to na congelation.

Koyeba mpe kosalisa Empoisonnement ya Scombroid¶

• Ebandeli noki (miniti 10 kino 60): Mbala mingi bilembo ebandaka liboso kutu moto oyo azali kolya asila kolya bilei.
• The "Peppery or Metallic" Taste Clue: Atako mbisi mingi ya scombroid ezalaka na goût normal, niveau ya histamine ya likolo epesaka tango mosusu mbisi sensation distincte sharp, pilipili, épicé, métallique, to bubbly na monoko. Soki eteni ya thon to mahi-mahi ezali na elɛngi ya pilipili to ya bibende oyo okanisaki te, bwaka yango mbala moko.
• Bilembo ya clinique:
• Kopumbwa ya motane makasi (ekokani na kozika makasi na moi) na elongi, na nkingo, mpe na ntolo ya likolo.
• Motó mpasi ya misisa ya nzoto oyo ezali kobɛtabɛta, kizunguzungu, mpe motema oyo ezali kobɛtabɛta mbangu, oyo ezali kobɛta (tachycardie).
• Kozika zingazinga ya monɔkɔ, kolɛmba ya libumu, kozoka, mpe kozoka oyo ezali na mai.
• Na ba cas ya makasi (mingimingi na ba maladi oyo bazali na asthme to baye bamelaka isoniazide [INH] to ba inhibiteurs ya MAO, oyo e bloquer bopanzani ya histamine na intestin), bronchospasme aigu (kopema) mpe hypothénormose.
• Traitement ya urgence na pronostic:
• Soki mobɛli azali na kopema, kovimba ya zolo, to kolɛmba nzoto, salisa mbala moko lokola anaphylaxie na auto-injecteur intramusculaire ya épinephrine (tala ba réactions allergie oyo esalemaka).
• Na departement ya urgence, blocage double ya histamine na antagoniste ya récepteur H1 (diphenhydramine intraveineuse to orale 25 à 50 mg, to cetirizine) esangani na antagoniste ya récepteur H2 (famotidine intraveineuse 20 mg) esilisaka rougeur, mutu pasi, mpe tachycardie na kati ya 30 à 60 minutes.
• Rassurance ya ntina: Soki bato ebele oyo bakabolaki bilei ya thon to mahi-mahi moko bazui rougeur mpe mutu pasi, to soki test ya allergiste endimisi scombroid, mobeli azali allergie TE na mbisi mpe asengeli te koboya mbisi ya mbu oyo ezali na frigo malamu na mikolo ekoya.

Mituna oyo batunaka mingi¶

Buku oyo ezali mpo na kopesa sango mpe ezwi esika ya botalisi ya monganga ya mosala to mateya ya maboko te. Lokola ba poisons alimentaires neurotoxiques ekoki kosala que respiration ekangama na mbalakaka, tosengi makasi osala cours ya secours ya liboso mpe ya CPR oyo endimami na nzela ya Fédération internationale ya ba sociétés ya Croix-Rouge mpe ya Croissant-Rouge (IFRC), société ya Croix-Rouge na yo ya ekolo, Ambulance Saint-Jean, to mopesi mateya ya mboka oyo azali na mokanda ya kondimama.

Ba sources e vérifié¶

• Centres ya contrôle mpe prévention ya bokono (CDC, Etats-Unis): Mabongisi ya clinique mpo na diagnostic mpe traitement ya botulisme mpe CDC Jaune Book: Empoisonnement alimentaire na ba toxines ya mayi (Empoisonnement ya Ciguatera, Scombroid, mpe ya ba molinga).
• Organisation mondiale de la santé (OMS): Fiche ya makambo ya botulisme mpe malako ya gestion clinique internationale mpe Ba biotoxines ya mayi na ba molinga mpe mbisi (Consultation ya ba experts ya FAO/OMS).
• Administration ya biloko ya kolia mpe ya nkisi ya Etats-Unis (FDA, Etats-Unis): Buku ya ba insectes mabe: Ba micro-organismes pathogènes oyo ewutaka na bilei mpe ba toxines naturelles (Clostridium botulinum, Saxitoxine, Ciguatoxine, Tétrodotoxine, mpe Scombrotoxine).
• Agence ya Sécurité ya Santé ya Royaume-Uni (UKHSA, Royaume-Uni) & Service National de Santé (NHS): Botulisme: Gestion clinique mpe ya santé publique.
• Programme ya traitement mpe prévention ya botulisme ya bébé (Departema ya santé publique ya California, Distributeur mondial ya BabyBIG): Reconnaissance clinique mpe traitement ya botulisme ya bébé.

Ba guides oyo etali yango¶

• Empoisonnement alimentaire, gastro-entérite aiguë, mpe réhydratation ya monoko
• Triage ya secours ya liboso ya empoisonnement mpe ya contrôle ya poison
• Ba réactions allergie, anaphylaxie, mpe ba auto-injecteurs ya épinephrine
• CPR mpe kopema ya kobikisa mpo na mikóló
• CPR ya bana mpe ya bebe mpe kokangama
• Mituya ya mbalakaka na kotalela mboka