Botulism, Shellfish Paralysis, Ciguatera, ndi Scombroid Poisoning¶

Unlike ordinary bacterial food poisoning that causes temporary stomach cramps and diarrhea, foodborne neurotoxins and marine biotoxins attack the human nervous system and cardiovascular system directly. Ingesting botulinum neurotoxin from improperly home-canned vegetables or fermented fish, saxitoxin from filter-feeding shellfish, tetrodotoxin from pufferfish, ciguatoxin from tropical reef fish, or massive histamine loads from spoiled dark-meat fish can trigger cranial nerve palsy, rapidly ascending paralysis of the breathing muscles, or sudden allergic-like shock within minutes to hours.

This guide provides step-by-step emergency procedures aligned with clinical directives from the World Health Organization (WHO), the United States Centers for Disease Control and Prevention (CDC), the US Food and Drug Administration (FDA), the European Centre for Disease Prevention and Control (ECDC), and the UK Health Security Agency (UKHSA). Recognizing early neurological warning signs, calling emergency services before diaphragmatic paralysis stops breathing, and preserving suspect food samples for public health antitoxin dispatch saves lives.

Chitani izi tsopano¶

If you or someone nearby develops neurological symptoms (blurred or double vision, drooping eyelids, slurred speech, trouble swallowing, tingling lips or tongue, muscle weakness) or sudden facial flushing and wheezing after eating canned, preserved, or marine foods:

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 manambala angozi 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. Tetezani njira ya mpweya ndipo musapereke kalikonse pakamwa (NPO): Chifukwa chakuti botulism ndi ma neurotoxins a m'madzi amapundula gag reflex ndi kumeza minofu mofulumira, **musamapatse munthuyo madzi, mkaka, chakudya, kapena mankhwala akumwa kuti ameze **, zomwe zingayambitse kupha kapena kulakalaka kwambiri m'mapapu. Musayambe kusanza ndi zala, madzi amchere, kapena madzi a ipecac.
4. Ikani wodwalayo bwinobwino ndikuyang’anitsitsa kupuma mosalekeza: Ngati munthuyo akudziwa koma akuvutika kumeza malovu kapena kufooka, mukhazikitseni mowongoka pang’ono pamakona a digirii 30 mpaka 45 kapena muwaike kumbali yawo kuti pamene akuchira kotero kuti malovu ophatikizidwa kapena masanzi akutuluka m’kamwa m’malo motsikira ndi mpope. Penyani kukwera ndi kugwa kwa chifuwa chawo masekondi 60 aliwonse. Ngati kupuma kumakhala kocheperako, kuyima, kapena kumachepera nthawi zina, yambani kupuma ndikupulumutsa CPR nthawi yomweyo.
5. Yang'anirani epinephrine auto-injector ngati scombroid kapena anaphylaxis ndi kotheka: Ngati munthuyo adadya nsomba, mahi-mahi, mackerel, kapena bluefish mkati mwa mphindi 10 mpaka 60 zapitazi ndipo nkhope ndi khosi, ming'oma, kupuma, kupuma movutikira, kapena chizungulire. thupi lawo siligwirizana ndi anaphylaxis ndi kubaya jekeseni wawo wa epinephrine auto-injector mu ntchafu yakunja nthawi yomweyo podikirira opereka chithandizo.
6. Tetezani ndi kulemba chizindikiro chomwe mukuchiganizira kuti ndi chakudya osachigwira manja: Kuvala magolovu otaya (kapena kugwiritsa ntchito thumba lapulasitiki m'manja), sindikizani chakudya chotsalacho, mbiya yoyambirira, chitini, kapena choyikapo nsomba m'chidebe chapulasitiki chosadukiza kapena thumba. Ilembeni "ZOYAMBIRA: POMUGANIZIRA POIZO / OSADYA" ndikuipereka kwa othandizira kuti ma laboratories azaumoyo athe kutsimikizira poizoniyo ndikutulutsa mwadzidzidzi Equine Heptavalent Botulinum Antitoxin (BAT).

Emergency syndromic triage flowchart ya neurotoxic ndi poyizoni wam'madzi¶

flowchart TD
    Start["Matenda Aakulu Atatha Kudya Zakudya Zazitini / Zosungidwa, Nsomba, Kapena Nkhono"] --> RespCheck{"Kodi wodwala akuvutika kupuma, kumeza, kapena kulankhula?"}

    RespCheck -->|Yes: Bulbar Palsy or Shortness of Breath| Call911["IMBANI 911 / 112 / 999 NTHAWI YOMWEYO<br/>OSAPATSA KANTHU PAkamwa; malo ogona m'mbali mwa kuchira<br/>Konzekerani kupuma kopulumutsira / CPR ngati kuyenda kwa chifuwa kukuchedwa"]

    RespCheck -->|No: Alert with stable airway| Pattern{"Kodi ndi zizindikiro ziti zachipatala ndi zakudya zomwe zimagwirizana?"}

    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["Kukayikiridwa Botulism (Kutsika Flaccid Paralysis)<br/>Mayendedwe a Emergency ICU popumira mpweya wamakina<br/>Kutulutsidwa mwachangu kwa Botulinum Antitoxin (BAT) kapena 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["Paralytic Shellfish Poisoning (Saxitoxin) kapena Tetrodotoxin<br/>Kumangidwa kofulumira kwa kupuma kotheka mkati mwa 1 mpaka maola 6<br/>Kuyendera ambulansi mwamsanga kwa endotracheal intubation & mpweya wabwino"]

    Pattern -->|1-6h after tropical reef fish (barracuda, grouper, snapper, amberjack):<br/>Vomiting/diarrhea + tingling lips/teeth + cold objects feel burning hot| Ciguatera["Ciguatera Nsomba Poizoni (Ciguatoxin)<br/>Kuyeza mwadzidzidzi kwa bradycardia ndi kutsika kwa magazi<br/>madzi a IV, atropine ngati pakufunika, ndi IV mannitol therapy"]

    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["Poizoni wa Nsomba za Scombroid (Histamine Toxicity)<br/>Gwiritsirani ntchito epinephrine auto-injector ngati mukupumira kapena hypotensive<br/>Chipatala cha H1 + H2 antihistamines (diphenhydramine + famotidine)"]

Kuyerekezera kwakukulu kwa matenda: Botulism vs. Marine Biotoxins¶

Kusiyanitsa mofulumira pakati pa ma syndromes asanuwa kumathandiza madokotala adzidzidzi kuyembekezera ngati wodwalayo adzafunika njira yodzidzimutsa ya airway, antitoxin yeniyeni, intravenous atropine, kapena antihistamines.

1. Botulism: kutsika kwakufa ziwalo ndi kupulumutsa mpweya¶

Botulism ndi matenda owopsa a neuroparalytic omwe amayamba chifukwa cha botulinum neurotoxin (BoNT), opangidwa ndi bakiteriya wopanga spore Clostridium botulinum. Gramu pa gramu, poizoni wa botulinum ndiye chinthu chakupha kwambiri chamoyo chomwe chimadziwika: mlingo wocheperako wochepera 1 microgram ukhoza kupha munthu wamkulu.

Momwe poizoni wa botulinum amaumitsa minofu¶

Kamodzi kamene kamatengedwa kuchokera m'mimba (mu chakudya kapena botulism ya ana) kapena kupangidwa mkati mwa bala loipitsidwa (bala botulism), poizoni wa botulinum amadutsa m'magazi kupita ku zotumphukira za mitsempha ya cholinergic: makamaka neuromuscular junction kumene minyewa yamagalimoto imalamula kuti chigoba chigwirizane.

1. Kuphwanya kosasinthika kwa mapuloteni a SNARE: Poizoniyo amalowa mu presynaptic motor nerve terminal ndikuchita ngati lumo la maselo, ndikudula mapuloteni amkati a SNARE (synaptobrevin, SNAP-25, kapena syntaxin) ofunikira kuti ma acetylcholine vesicles agwirizane ndi nembanemba ya minyewa.
2. **Kutsekeka kwathunthu kwa kutulutsidwa kwa acetylcholine **: Popanda acetylcholine kuwoloka synapse, ulusi wa minofu umalandira chizindikiro cha zero kuti chigwirizane, zomwe zimapangitsa ** kufooka (kupuwala) ziwalo **.
3. Chifukwa chiyani kuchira kumatenga milungu kapena miyezi: Poizoni ya botulinum ikalowa m'malo opha minyewa ndikudula mapuloteni a SNARE, antitoxin sangathenso kubweza kuwonongeka kwa mkati mwa minyewayo. **Botulinum Antitoxin (BAT) imangochepetsa poizoni yomwe imazungulirabe momasuka m'magazi **, kuteteza ziwalozo kuti zisafalikire ku mitsempha yowonjezera. Kuti mukhalenso ndi mphamvu m'minofu yomwe inazimiririka kale, minyewa ya wodwalayo iyenera kumera pang'onopang'ono ma axon terminals pa 2 mpaka masabata a 12, panthawi yomwe makina opangira mpweya wa ICU amathandizira kuti wodwalayo akhale ndi moyo.

Mitundu inayi yazachipatala ya botulism yaumunthu¶

• Foodborne Botulism: Imayamba chifukwa chodya chakudya chomwe Clostridium botulinum tinjere tambiri timamera m'malo opanda okosijeni, asidi otsika (pH > 4.6) potentha komanso kutulutsa poizoni wopangidwa kale. Olakwa akale akuphatikizapo zakudya zam'chitini zokhala ndi asidi otsika zam'nyumba ** (nyemba zobiriwira, chimanga, katsitsumzukwa, beets, tsabola), ** adyo wodzipangira tokha kapena zitsamba zothira mafuta zosiyidwa popanda firiji, nsomba zofufumitsa kapena zamchere komanso zoyamwitsa zam'madzi (monga mchira wa beaver, mchira wa beaver, mchira wophimbidwa) mbatata** amasiyidwa kutentha kwa firiji asanatumikire, ndi kusungidwa molakwika soups wamalonda kapena sosi wa tchizi.
• Botulism ya Ana (Yofala kwambiri ku United States): Imakhudza makanda osakwana miyezi 12 (90 peresenti ali osakwana miyezi 6). Chifukwa chakuti tizilombo ta m'matumbo a khanda sinakhwime mokwanira kulepheretsa timbewu ta Clostridium, tinjere tomeza timamera m'matumbo akulu a mwanayo ndi kutulutsa poizoni mosalekeza. Uchi wauwisi kapena wosakanizidwa ndiye nkhokwe imodzi yayikulu yomwe ingapewedwe ya Clostridium botulinum spores; fumbi losawoneka bwino ndi tinthu tating'ono ta dothi ndizomwe zimayambira. Musamadyetse uchi kapena zakudya zokhala ndi uchi kwa mwana wosakwana chaka chimodzi.
• Botulism Wachilonda: Amachitika pamene Clostridium botulinum tinjere tawononga bala lakuya, lophwanyika, kuthyoka kotseguka, kuvulala kwapang'onopang'ono, kapena malo ojambulira pakhungu (makamaka ogwirizana ndi jakisoni wa black-tar heroin), kumera movutikira ngati kafumbata. Mosiyana ndi botulism ya chakudya, botulism ya chilonda ilibe kusanza kwa m'mimba kapena kutsekula m'mimba ndipo imakhala ndi nthawi yotalikirapo ya 4 mpaka 14 masiku.
• Iatrogenic kapena Adult Intestinal Colonization Botulism: Nthawi zambiri potsatira jekeseni wodzikongoletsera kapena wochizira wa poizoni wa botulinum kapena akuluakulu omwe ali ndi opaleshoni yoopsa ya m'mimba kapena matenda opweteka a m'mimba.

Kuzindikira zizindikiro zapamwamba za Botulism Akuluakulu ndi Akhanda¶

Mwa Akuluakulu ndi Ana Okulirapo (The Classic Pentad): 1. Palibe kutentha thupi: Pokhapokha ngati chibayo chachiwiri chikukula, kutentha kumakhala bwino. 2. Momveka bwino, tcheru m'maganizo: Wodwala amakhala wogalamuka, wolunjika, ndipo amakhalabe ndi chidwi (palibe dzanzi), ngakhale kuti kulankhula mopanda phokoso ndi zikope zoledzera zingawapangitse kuwoneka oledzera kapena kugona. 3. Kugunda kwa mtima wamba kapena pang'onopang'ono komanso kuthamanga kwa magazi: Kupanda tachycardia pokhapokha ngati hypoxic. 4. ** Mitsempha Yoyamba Ya Mitsempha Yambiri (Bulbar Palsy: The "4 Ds")**: Chifukwa mitsempha ya cranial imakhala ndi kusintha kwakukulu kwa synaptic, ziwalo zimayamba nthawi zonse m'mutu ndi kumaso: ** Diplopia ** (kusokonezeka kapena kuwirikiza kawiri kuchokera ku ziwalo za extraocular minofu), ** Ptosis ** (kugwetsa zikope zakumtunda), * zopindika * zopindika * zopindika, * Slugg * Publish* (mawu okhuthala, osamveka), Dysphonia (mawu ofooka, a m'mphuno), ndi Dysphagia (kulephera kumeza malovu, ndi mafupa owuma, zilonda zapakhosi zomwe nthawi zambiri sizidziwika bwino monga strep throat kapena pharyngitis). 5. Symmetric KUTSUKA Flaccid Paralysis: Kwa maola ambiri mpaka masiku, kufooka kumafalikira mosiyanasiyana kuchokera pamwamba mpaka pansi: kuchokera m'maso ndi mmero mpaka minofu ya khosi (kulephera kukweza mutu), mapewa, mikono yakumtunda, **minofu yapakati ndi diaphragm (kuyambitsa kugwidwa bata, kupuma movutikira komanso kupuma movutikira, kupuma movutikira, kupuma movutikira, kupuma movutikira, kupuma movutikira komanso kupuma movutikira) kudzimbidwa ndi kusunga mkodzo.

Makanda Osapitirira Miyezi 12 ("Floppy Baby Syndrome"): - ** Kudzimbidwa nthawi zonse kumakhala chizindikiro choyamba ** (palibe kutuluka kwa matumbo kwa masiku atatu kapena kuposerapo), nthawi zambiri kumanyalanyazidwa kusanachitike kufooka kwa minofu. - **Kulira kofooka, kofooka, kapena kosinthika ** ndi kutayika kwa nkhope (kukhudzidwa kwamtundu). - Kudyetsedwa kosakwanira ndi kuyamwitsa kofooka: Mwana amathamangira bere kapena botolo mwachangu, amamenyetsa malovu, ndipo amataya mphamvu yake. - Ptosis (zikope zolerera) ndi kupumira m'mutu: Hypotonia yokhazikika ("floppy baby") pomwe miyendo ndi mutu wa khanda zimalendewera akatukulidwa.

2. Nkhono za Neurotoxins ndi Pufferfish Tetrodotoxin¶

Sefa-feeding bivalve nkhono (mussels, clams, oyster, scallops, cockles) amapopa malita a madzi a m'nyanja kudzera m'matumbo awo ola lililonse, ndikuyika ma dinoflagellate a m'madzi ang'onoang'ono komanso ma diatoms panthawi yamaluwa owopsa a algal (nthawi zina amatchedwa "mafunde ofiira," ngakhale kuti maluwa owopsa amapezeka pafupipafupi**madzi owoneka bwino kwambiri. Ma biotoxins onse a nkhono ndi **100 peresenti yosasunthika kutentha **: kutenthetsa, kuwira, kukazinga, kapena kuphika sikuchepetsa kawopsedwe nkomwe.

The anayi nkhono poizoni syndromes ndi Tetrodotoxin¶

1. Paralytic Shellfish Poisoning (PSP: Saxitoxin):
2. Njira: Saxitoxin imatchinga mwapadera njira za sodium kunja kwa zotumphukira za mota ndi minyewa yomva ndi nembanemba ya chigoba, kuyimitsa minyewa yogwira ntchito bwino (mofanana ndi tetrodotoxin).
3. Kuyamba msanga: Mkati mwa 5 mpaka mphindi 30 atadya nkhono kapena nkhokwe zoipitsidwa, wovulalayo amamva kuthwanima, kuluma, kapena kutentha kwa milomo, lilime, ndi mkamwa zomwe zimasanduka dzanzi mwachangu ndikufalikira kumaso, khosi, nsonga za zala, ndi zala.
4. Kukula: Kutsatiridwa pasanathe maola 1 mpaka 6 chifukwa cha chizungulire, kumva modabwitsa kwa kuyandama mumlengalenga, kuyenda mosagwirizana (ataxia), kulankhula movutikira, kumangika kwa mmero, ndi kupuwala kokwera kapena kowopsa kwa diaphragm. Imfa yochokera ku asphyxiation imapezeka mkati mwa ** 2 kwa maola 12 ** ngati wodwalayo sakulowetsedwa ndi mpweya wabwino.
5. Zodziwikiratu: Chifukwa saxitoxin imamangika mobwerera ndipo imatulutsidwa ndi impso mkati mwa maola 24 mpaka 72, wodwala aliyense yemwe amafika kuchipatala munthawi yake kuti alandire chithandizo cha endotracheal intubation ndikuthandizira mpweya wabwino asanayambe kumangidwa kwa mtima wa hypoxic amakhala ndi pafupifupi 100 peresenti ya kupulumuka ndikuchira kwathunthu.
6. Neurotoxic Shellfish Poisoning (NSP: Brevetoxin):
7. Njira: Yopangidwa ndi Karenia brevis dinoflagellates (makamaka zofala m'mphepete mwa Gulf of Mexico ndi Caribbean). Ma Brevetoxins amakakamiza mayendedwe a sodium-gated voltage kutsegula, kumayambitsa kuwombera kwa mitsempha mobwerezabwereza.
8. Zizindikiro: Zimayamba pakadutsa mphindi 30 mpaka maola 3 ndi gastroenteritis, kumva kulankhulira mkamwa ndi manambala, kulankhula mosamveka bwino, kufutukuka kwa ana, ndi kubwerera kuzizira kozizira (kufanana ndi ciguatera wofatsa), koma pafupifupi sikumayambitsa kufa ziwalo za kupuma. Mafunde a m'mphepete mwa nyanja amathanso kutulutsa mpweya wa brevetoxins, kuchititsa chifuwa chachikulu, kuyetsemula, ndi bronchospasm mwa anthu oyenda m'mphepete mwa nyanja. mphumu.
9. Amnesic Shellfish Poisoning (ASP: Domoic Acid):
10. Mechanism: Wopangidwa ndi Pseudo-nitzschia diatom mu mussels, malezala, ndi Dungeness crab viscera. Domoic acid ndi analogi yamphamvu yosangalatsa ya glutamate yomwe imawonjezera ndikuwononga ma neuron mu hippocampus muubongo.
11. Zizindikiro: Kusanza ndi kukokana mkati mwa maola 24, kutsatiridwa mkati mwa maola 48 ndi chisokonezo chachikulu, kusokonezeka maganizo, matenda a khunyu. kukomoka, chikomokere, ndi ** kutayika kosatha kwa anterograde kukumbukira kwakanthawi kochepa ** (makamaka achikulire ndi odwala matenda a impso).
12. Poyizoni wa Diarrhetic Shellfish (DSP: Okadaic Acid):
13. Zimayambitsa kutsekula m'mimba mwachangu, nseru, kusanza, ndi kukokana m'mimba mkati mwa mphindi 30 mpaka maola 4, kuthetseratu ndi kulowetsedwa m'kamwa kapena IV mkati mwa masiku awiri kapena atatu popanda matenda amisempha.
14. Tetrodotoxin (TTX: Pufferfish / Fugu ndi Blue-Ringed Octopus):
15. Kudya nsomba za puffer (fugu) zosakonzedwa bwino kapena kulumidwa mopanda ululu chifukwa cha octopus ya blue-ringed octopus kumapereka tetrodotoxin, yomwe imatchinga njira za neuronal sodium mofanana ndi saxitoxin.
16. Chenjezo Lofunika Kwambiri la ICU (Chidziwitso cha "Locked-In": Odwala omwe ali ndi poizoni woopsa wa tetrodotoxin kapena saxitoxin akhoza kukhala **100 peresenti olumala: osatha kupuma, kulankhula, kusuntha chala, kapena ngakhale kuphethira, ndi ana osasunthika omwe amadziwona okha: pamene akukhalabe maso, ozindikira, komanso okhoza kumva ndi kumva chilichonse **. Opulumutsa ayenera kulankhula modekha ndi molimbikitsa kwa wodwalayo panthawi ya CPR ndi zoyendera, ndipo madokotala odzidzimutsa ayenera kupereka mpweya wokwanira m'mitsempha ndi analgesia pamodzi ndi mpweya wabwino wa makina.

3. Ciguatera Nsomba Poizoni: nsomba m'matanthwe otentha ndi ozizira allodynia¶

Ciguatera ndi nsomba yomwe imapezeka kwambiri padziko lonse popanda tizilombo toyambitsa matenda, yomwe imakhudza anthu okwana 50,000 pachaka m'madera otentha ndi otentha pakati pa 35 degrees North ndi 35 degrees South latitude (kuphatikizapo Caribbean, Florida, ** Gulf of Mexico**, Hawaii, South Pacific, Indian Ocean, ndi kumpoto kwa Australia komwe amadya nsomba zochokera kunja).

Kukula kwa biomagnification kukulitsa mndandanda wa chakudya cham'mphepete mwa coral¶

Maminoflagellate a Microscopic Gambierdiscus toxicus amamera pamalo owonongeka kapena owonongeka. Nsomba zazing'ono zam'mphepete mwa herbivorous zimadya ndere, nsomba zodya nyama zapakatikati zimadya herbivores, ndipo nsomba zazikulu zam'mphepete mwa nyanja zimadya nyama zazing'ono zomwe zimasungunuka m'madzi ciguatoxin m'thupi lawo, m'mutu, pachiwindi, m'matumbo, ndi m'mazira.

• **Nsomba zowopsa kwambiri zomwe muyenera kuzipewa (makamaka nsomba zazikulu zopitirira 2 mpaka 3 kilogalamu / 4.5 mpaka 6.5 mapaundi) **: ** Barracuda ** (osadya konse barracuda m'madzi otentha), ** moray eel *, ** gulu lalikulu , ** red snapper , ** amberhovalle, jackfish, * jacksh nsomba za parrot**, **nsombza ochita opaleshoni, ndi **nsomba zotentha mfumu.
• Nsomba za m'nyanja za m'nyanja zomwe zili pachiwopsezo chochepa: Tuna, mahi-mahi, salimoni, cod, ndi halibut sizimadya matanthwe a m'mphepete mwa nyanja ndipo sizimanyamula ciguatera (ngakhale tuna ndi mahi-mahi zimatha kuyambitsa scombroid ngati zitasiyidwa).

Magawo azachipatala ndi "Ice Cube Test"¶

1. Gawo la m'mimba kwambiri (maola 1 mpaka 6 mutadya): Kutsekula m'mimba mwadzidzidzi, nseru, kusanza, ndi kupweteka kwa m'mimba komwe kumatha maola 24 mpaka 48.
2. Chigawo chamtima (maola 1 mpaka 24): Ciguatoxin imatsegula njira za sodium pa mitsempha ya vagal ndi minofu ya mtima, kuchititsa ** bradycardia yoopsa (kugunda kwa mtima wapang'onopang'ono pansi pa 40 mpaka 50 kugunda pa mphindi) ndi orthostatic hypotension (kutsika kwa magazi ndi kukomoka pamene wayima)**. Odwala amafunika kuyang'anitsitsa mtima wachipatala mwamsanga, saline wamba, ndi intravenous atropine ngati kugunda kwa mtima kapena kuthamanga kwa magazi kutsika kwambiri.
3. Pathognomonic neurological phase (maola 3 mpaka Masabata/Miyezi):
4. Kupweteka kwapang'onopang'ono ndi kumathero: Kugwedezeka kosalekeza, kugwedeza, kapena dzanzi kuzungulira milomo, lilime, mmero, manja, ndi miyendo.
5. Dental dysesthesia: Kumverera kodabwitsa, kosamvetsetseka kuti **mano anu onse ndi omasuka kapena opweteka ** m'matumba awo.
6. Cold Allodynia (Kusintha kwa Kutentha): Mu 70 mpaka 90 peresenti ya odwala, kugwira malo ozizira, kusamba m'manja m'madzi ozizira ampopi, kuponda pansi pa matayala ozizira, kapena kumwa zakumwa zoziziritsa kukhosi kumayambitsa kupsa mtima, kuuma, madzi oundana, kapena kumva kupweteka kwamagetsi ** (kuyambitsidwa ndi ciguatoxin ya ciguatoxin pa TR. zotumphukira C-zingwe).
7. Kupsa mtima kwakukulu (kuyabwa), kulumala kutopa, kuwawa kwa minofu (myalgias), ndi kupweteka kwa mafupa (arthralgias).
8. Chithandizo chamankhwala komanso Chakudya cha Miyezi 6 cha Post-Ciguatera:
9. M'chipatala, kupereka ** mtsempha wa D-mannitol (1.0 g/kg pa 30 mpaka 45 mphindi) ** mkati mwa maola 48 mpaka 72 oyambirira (pokhapo * pambuyo * kutaya madzi m'thupi ndi hypotension zakonzedwa mokwanira ndi madzi a IV) amachepetsa edema ya neuronal axonal ndikufupikitsa zizindikiro za mitsempha.
10. Kupewa kuyambika kwa miyezi 6: Kwa miyezi 3 mpaka 6 pambuyo pa kupha poyizoni wa ciguatera, odwala ayenera kupewa *nsomba ndi nkhono zonse (ngakhale nsomba za m'madzi opanda mchere), moŵa wonse (ngakhale kumwa kamodzi kokha moŵa kapena vinyo kumayambitsa kuyambiranso chiwawa cha minyewa ndi kuyabwa), caffeine, ndi mtedza/mbewu.

4. Scombroid Fish Poisoning: histamine overload vs. fish ziwengo¶

Poyizoni wa Scombroid ndi matenda achiwiri omwe amapezeka ndi nsomba padziko lonse lapansi ndipo nthawi zambiri samazindikiridwa molakwika ngati ziwengo zadzidzidzi, zomwe zangoyamba kumene kunyanja zam'madzi. Mosiyana ndi vuto lenileni la IgE-mediated fish allergen (zomwe zikutanthauza kuti munthuyo sangadyenso nsomba), scombroid ndi **mankhwala a histamine kuledzera ** chifukwa cha kudya nsomba zomwe zinakhala pa kutentha kwa maola angapo zitagwidwa.

Momwe kusungirako kutentha kumasinthira nsomba zotetezeka kukhala bomba la histamine¶

Nsomba zam'madzi zamtundu wakuda: zonse Scombridae mitundu ya mabanja (tuna, makerele, bonito, skipjack) ndi mitundu ya nyama yakuda yopanda scombroid (mahi-mahi / dorado, bluefish, amberjack, sardines, anchovies, marlin, swordfish): mumnofu wake muli amino acid ambiri****

1. zenera losokoneza kutentha: Ngati nsomba yogwidwa kapena mahi-mahi yasiyidwa pamalo ofunda a ngalawa, doko, kapena khitchini pamwamba pa 4 digiri Celsius (40 degrees Fahrenheit)* kwa maola 2 mpaka 4, mabakiteriya opezeka pamwamba (Morganella morganii, Klebsiella pneumoniae, Hafnia alveisti gwiritsani ntchito ma enzymes achilengedwe kuti agwiritse ntchito) histidine mu kuchuluka kwakukulu kwa ** histamine ** ndi ** saurine **.
2. Kuphika kumapha mabakiteriya, OSATI histamine: Ngakhale malo odyera kapena ophikira kunyumba ataundana nsombazo molimba kenaka kuziwotcha, zitini, kapena kuziphika pa madigiri 200 Celsius (400 degrees Fahrenheit), **histamine siwonongeka konse ndi kutentha kapena kuzizira **.

Kuzindikira ndi kuchiza Scombroid Poisoning¶

• Kuyamba msanga (mphindi 10 mpaka 60): Zizindikiro nthawi zambiri zimayamba wodyera asanamalize kudya.
• Zidziwitso Zokoma za "Peppery or Metallic": Ngakhale kuti nsomba zambiri za scombroid zimamva bwino, kuchuluka kwa histamine nthawi zina kumapangitsa kuti nsomba izi zizikhala zakuthwa, zokometsera, zokometsera, zitsulo, kapena kunjenjemera pa lilime. Ngati chidutswa cha nsomba kapena mahi-mahi chikalawa mosayembekezereka ngati tsabola kapena chitsulo, chilavule nthawi yomweyo.
• Zizindikiro zachipatala:
• Kunyezimira kofiira kofiira (kufanana ndi kutentha kwa dzuwa) kumaso, khosi, ndi pachifuwa.
• Kupweteka kwamutu kwa mitsempha, chizungulire, ndi kuthamanga, kugunda kwa mtima (tachycardia).
• Kutentha mozungulira mkamwa, kupweteka m'mimba, nseru, ndi kutsegula m'mimba.
• Pazovuta kwambiri (makamaka odwala omwe ali ndi mphumu kapena omwe amatenga isoniazid [INH] kapena MAO inhibitors, omwe amalepheretsa kuwonongeka kwa histamine m'matumbo), acute bronchospasm (kupuma) ndi hypotension.
• Chithandizo chadzidzidzi ndi momwe mungadziwire:
• Ngati wodwalayo akupumira, kutupa pakhosi, kapena kukomoka, perekani mwachangu ngati anaphylaxis ndi intramuscular epinephrine auto-injector (onani thupi lawo siligwirizana).
• Mu dipatimenti yodzidzimutsa, kutsekeka kwapawiri kwa histamine ndi H1 receptor antagonist (intravenous kapena oral diphenhydramine 25 mpaka 50 mg, kapena cetirizine) pamodzi ndi **H2 receptor antagonist ** (intravenous famotidine 20 mg) imathetsa kugwedezeka, kupweteka kwa mutu, ndi tachycardia 30.60 mphindi
• Chitsimikizo chofunikira: Ngati anthu angapo omwe adagawana mbale imodzi ya tuna kapena mahi-mahi ayamba kukomoka ndi kupweteka mutu, kapena ngati kuyezetsa magazi kutsimikizira scombroid, **wodwala SALI ndi matupi a nsomba ** ndipo safunikira kupewa nsomba zam'madzi zosungidwa bwino m'tsogolomu.

Mafunso omwe amafunsidwa pafupipafupi¶

Bukhuli ndi lofuna kudziwa zambiri ndipo sililowa m'malo mwa kuunika kwachipatala kapena maphunziro apamanja. Chifukwa chakuti poizoni wa zakudya za neurotoxic angayambitse kupuma mwadzidzidzi, timalimbikitsa kwambiri kutenga chithandizo choyamba chovomerezeka ndi maphunziro a CPR kupyolera mu International Federation of Red Cross ndi Red Crescent Societies (IFRC), gulu lanu la Red Cross, St John Ambulance, kapena wopereka maphunziro ovomerezeka kwanuko.

Magwero afufuzidwa¶

• Centers for Disease Control and Prevention (CDC, United States): * Malangizo Othandizira Kuzindikira ndi Kuchiza Botulism * ndi CDC Yellow Book: Food Poisoning from Marine Toxins (Ciguatera, Scombroid, and Shellfish Poisoning).
• Bungwe la World Health Organization (WHO): Botulism Fact Sheet and International Clinical Management Guidelines ndi Marine Biotoxins in Shellfish and Fish (FAO/WHO Expert Consultation).
• US Food and Drug Administration (FDA, United States): Bug Bug: Tizilombo toyambitsa matenda timene timayambitsa chakudya komanso poizoni wachilengedwe (Clostridium botulinum, Saxitoxin, Ciguatoxin, Tetrodotoxin, and Scombrotoxin).
• UK Health Security Agency (UKHSA, United Kingdom) & National Health Service (NHS): Botulism: Clinical and Public Health Management.
• Chithandizo cha Matenda a Botulism ndi Chitetezo cha Ana (California Department of Public Health, Global Distributor of BabyBIG): Kuzindikiritsa Zachipatala ndi Chithandizo cha Botulism Wakhanda.

Maupangiri ogwirizana¶

• Poizoni chakudya, pachimake gastroenteritis, ndi oral rehydration
• Thandizo loyamba la poyizoni ndi kuwongolera poyizoni
• Zotsatira zoyipa, anaphylaxis, ndi epinephrine auto-injection
• CPR ndikupulumutsa kupuma kwa akuluakulu
• CPR ya ana ndi makanda ndikutsamwitsidwa
• Nambala zadzidzidzi malinga ndi dziko