一起有毒牛肝菌引起食物中毒的调查

摘要

Objective To identify the source of infection and risk factors and to provide control measures regarding an outbreak of gastroenteritis involving 30 villagers.Who attended the same wedding party held on March 5th,2012,a survey was carried out.Methods Case was defined as having onset of vomiting,nausea,stomachache or diarrhea among the attendees of a wedding party.We randomly selected and interviewed 140 from 470 attendees on their symptoms and food exposures at the wedding.We compared food-specific attack rates (AR) for gastroenteritis in a retrospective cohort study.The leftover foods were tested for Salmonella,Shigella,and Staphylococcus aureus.The leftover Boletus mushrooms were examined and species determined by the Kunming Institute of Botany,Chinese Academy of Sciences.Results Of the 140 attendees 61％ (85) developed gastroenteritis.Case-attendees had vomiting (94％),nausea (89％),stomachache (53 ％),and diarrhea (51％).The AR among attendees who ate Boletus mushroom was 69％ (81/118),compared to 18％ (4/22) of those who did not (RR＝3.8,95％ CI:1.5-9.2).When comparing the ARs between the attendees on consumption of other foods,data did not show statistically significant differences.Among the 7 species of Boletus identified from the leftover mushrooms,3 (B.venenatus,B.sinicus and B.magnificus) were toxic.Store keepers bought dried or fresh mushrooms from local villagers who had picked up them from the mountains.Salmonella,Shigella,and Staphylococcus aureus tests on those leftover food showed negative results.Conclusion Poisonous Boletus mushroom contributed to this outbreak.We recommended that education should be targeted on mushroom-pickers regarding how to recognize the poisonous mushrooms.Regulations and laws should also be developed to facilitate the necessary process.%目的 调查一起婚宴聚餐后胃肠炎暴发的原因及危险因素,提出预防或干预措施.方法 该次胃肠炎暴发病例的定义为2012年3月5日婚宴参加者中,出现恶心、呕吐、腹痛或腹泻症状者.从470名参加宴席者中随机选取140名,通过电话访谈,询问发病情况及食物暴露情况.对参加晚宴的140人开展回顾性队列研究,计算各种食物的危险性.采集剩余食物检测沙门菌、志贺菌和金黄色葡萄球菌；采集剩余未烹调的牛肝菌送中国科学院昆明植物研究所做形态学鉴定.结果140人中有85人患病(罹患率61％).主要临床表现为恶心(89％)、呕吐(94％)、腹痛(53％)和腹泻(51％).参加3月5日晚宴者中,食用牛肝菌的罹患率(69％)高于不食用者的罹患率(18％)(RR＝3.8,95％CI:1.5～9.2).其余各种食物的差异无统计学意义.剩余菜品沙门菌、志贺菌和金黄色葡萄球菌检测均阴性.菌类形态学鉴定显示共有7种牛肝菌,其中3种有毒.牛肝菌购自某商店门市部,而后者收购于周边县村民手中.结论 该次中毒系由于混入有毒牛肝菌所致.建议在蘑菇采摘地区加强针对相关人员的科普宣传及提高收购部门识别毒蘑菇的能力,避免中毒事件发生.