Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan
Outbreak of bronchiolitis obliterans associated with consumption of Sauropus androgynus in Taiwan
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DOI：
10.1016/s0140-6736(96)00450-3
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发表时间：
1996-07-13
期刊：
影响因子：
168.9
通讯作者：
Roggli, V
中科院分区：
文献类型：
--
作者：
Lai, RS;Chiang, AA;Roggli, V
背景1995年8月，台湾爆发了一场与食用未煮熟的守宫木（Sauropus androgynus）有关的快速进行性呼吸窘迫，守宫木是一种声称具有控制体重效果但未经证实的蔬菜。我们报告了23例临床表现惊人相似的患者。影像学检查结果，肺生理变化，免疫学和微生物学研究，病理检查进行了evaluated.Findings所有患者均为年轻和中年女性（平均年龄39岁[范围21-52]）。他们服用生的S androgynus果汁，通常与番石榴或菠萝汁混合，平均持续时间为10周。进行性呼吸困难和持续咳嗽是主要症状。肺功能检查均显示中度至重度气流阻塞，平均1秒用力呼气量（FEV（1））为0。66 L（预测值的26%）。未观察到支气管扩张剂反应。室内空气动脉血气分析显示低氧血症（平均PaO 2 9。6 [SD 1 . 6]kPa）。胸片基本正常。高分辨率计算机断层扫描显示双侧支气管扩张和肺实质斑片状低密度伴马赛克灌注。通气-灌注造影结果与阻塞性肺疾病一致。4例患者的开放肺活检标本的组织学证实了闭塞性细支气管炎的存在。开放肺活检标本的免疫组化染色显示T细胞多于B细胞。IgG、IgM、伊加、C1 q、C3和C4免疫荧光染色均为阴性。血清肿瘤坏死因子a浓度高于正常对照组。泼尼松龙的临床反应是有限的。解释我们描述了闭塞性细支气管炎和蔬菜S androgynus摄入之间的不寻常的关联。T细胞介导的免疫可能参与发病机制。
Background In August, 1995, there was an outbreak in Taiwan of rapidly progressive respiratory distress associated with consumption of uncooked Sauropus androgynus, a vegetable with a claimed yet unconfirmed effect on weight control. We report on 23 patients with strikingly similar clinical presentations.Methods A structured questionnaire for clinical manifestations was completed. Radiographic findings, pulmonary physiological changes, immunological and microbiological studies, and pathological examination were evaluated.Findings All patients were young and middle-aged women (mean age 39 years [range 21-52]). They took uncooked S androgynus juice, generally mixed with guava or pineapple juice, for a mean duration of 10 weeks. Progressive dyspnoea and persistent cough were the main symptoms on presentation. Pulmonary function testing uniformly revealed moderate to severe airflow obstruction with mean forced expiratory volume in 1 s (FEV(1)) of 0 . 66 L (26% of predicted). No bronchodilator response was observed. Room-air arterial blood gas analysis showed hypoxaemia (mean PaO2 9 . 6 [SD 1 . 6] kPa). Chest radiographs were essentially normal. High-resolution computed tomography showed bilateral bronchiectasis and patchy low attenuation of lung parenchyma with mosaic perfusion. Ventilation-perfusion scintigraphic findings were compatible with obstructive lung disease. Histopathology of open lung biopsy specimens in four patients confirmed the presence of bronchiolitis obliterans. Immunohistochemical stains of the open lung biopsy specimens showed predominance of T cells over B cells. Immunofluorescent stains for IgG, IgM, IgA, C1q, C3, and C4 were negative. Serum concentrations of tumour necrosis factor a were higher than those of normal controls. Clinical response to prednisolone was limited.Interpretation We describe an unusual association between bronchiolitis obliterans and ingestion of the vegetable S androgynus. T-cell mediated immunity may be involved in the pathogenesis.