CIGUATERA ON KAUAI - INVESTIGATION OF FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS
CIGUATERA ON KAUAI - INVESTIGATION OF FACTORS ASSOCIATED WITH SEVERITY OF ILLNESS
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DOI：
10.4269/ajtmh.1993.49.448
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发表时间：
1993-10-01
影响因子：
3.3
通讯作者：
SASAKI, DM
中科院分区：
文献类型：
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作者：
KATZ, AR;TERRELLPERICA, S;SASAKI, DM
由于缺乏实验室证实、缺乏前瞻性随访以及年龄相关因素分析不完整，雪卡鱼中毒的流行病学特征受到限制。 1985 年，夏威夷州考爱岛爆发了一场涉及 15 名不同年龄段人员的疫情，我们对此次疫情进行了调查，以确定与疾病严重程度相关的因素。通过酶免疫分析，在涉案鱼的剩余部分中检测到了雪卡毒素的存在。所有病例均经过医学和流行病学调查并进行前瞻性随访。 15例中有10例表现为心动过缓；七人住院，其中两人需要接受重症监护。心动过缓与年龄和体重的增加（分别为 P < 0.01 和 < 0.05）以及有毒鱼的食用量（P < 0.0 1）有关。病程从 2 天到 132 天不等。病程的增加与年龄和体重的增加相关（分别为 r(s) = 0.64 和 r(s) = 0.72，均 P < 0.01），并且与食用有毒鱼的数量和成分无关。年龄和体重的增加与症状的持续时间和严重程度之间的相关性可以通过先前的亚临床毒素暴露来解释，并且与反复暴露于雪卡毒素与更严重的疾病相关的观察结果是一致的。食用有毒鱼的数量与心动过缓之间的关联与雪卡毒素剂量的增加是一致的。这次疫情调查的结果支持了之前未经证实的观察结果。
Epidemiologic characterization of ciguatera fish poisoning has been limited by lack of laboratory confirmation, absence of prospective follow-up, and incomplete analysis of age-related factors. A 1985 outbreak on the island of Kauai in the state of Hawaii that involved 15 persons of various ages was investigated to determine factors associated with disease severity. The presence of ciguatoxin was detected in leftover portions of the implicated fish by enzyme immunoassay. All cases were medically and epidemiologically investigated and followed prospectively. Ten of the 15 cases demonstrated bradycardia; seven were hospitalized, including two requiring placement in intensive care. Bradycardia was associated with increasing age and body weight (P < 0.01 and < 0.05, respectively) as well as the amount of toxic fish consumed (P < 0.0 1). Duration of illness ranged from two to 132 days. Increasing duration of illness was correlated with both increasing age and weight (r(s) = 0.64 and r(s) = 0.72, respectively, both P < 0.01) and was independent of amount and components of toxic fish consumed. The correlation between increasing age and weight with duration and severity of symptoms may be explained by prior subclinical toxin exposure and is consistent with the observation that repeated ciguatoxin exposures are associated with more severe illness. The association between amount of toxic fish consumed and bradycardia is consistent with an increased dose of ciguatoxin. The findings of this outbreak investigation support previously unconfirmed observations.