介绍。蓖麻毒素是一种从蓖麻子植物中提取的有毒糖蛋白,是世界上已知的最强毒物之一。蓖麻毒素中毒是一种致命且罕见的疾病,最近也有报道称其被用作潜在的生物恐怖主义制剂。本研究旨在确定全球确诊的蓖麻毒素中毒病例的主要特征,以提高民众和临床医生对这种毒素的认识。方法。制作了世界范围内蓖麻毒素中毒的人体案例研究集。使用数据库 Pubmed、Sciencedirect 和 Google Scholar 提取 1980 年 1 月至 2020 年 6 月的文章结果。文献中描述的全球 50 名蓖麻毒素中毒患者已被确定。大多数病例出现在亚洲(19 例)、欧洲(12 例)和美洲(15 例)。中毒大多是意外(37 例)。蓖麻子中毒以急性胃肠炎样疾病为主要表现,导致严重的液体和电解质失衡。死亡机制是中毒后10-72小时发生外周血管塌陷和进展性多器官衰竭。通过对患者和家属的询问,可以检索蓖麻籽或蓖麻油摄入史。患者接受了对症治疗,主要包括在摄入后一天内用静脉输液补液和用活性炭进行消化道净化和/或洗胃,以减少胃肠道对蓖麻毒素的吸收。这种早期实施的去污治疗非常有效。仅观察到六人死亡。讨论。 目前,尚无针对蓖麻毒素中毒或预防的解毒剂、疫苗或其他特异性有效治疗方法。及时采取支持性护理治疗对于限制发病率和死亡率是必要的。迄今为止,患者教育对于防止这种意外中毒至关重要。结论。当面临严重的呼吸道或胃肠道疾病爆发时,临床医生和卫生保健专业人员应保持高度怀疑。
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Ricin poisoning: A review on contamination source, diagnosis, treatment, prevention and reporting of ricin poisoning
Introduction. Ricin, a toxic glycoprotein derived from the castor bean plant, is one of the most potent poisons known in the world. Ricin intoxication is a fatal and uncommon medical condition and recently its use as a potential bioterrorism agent has also been reported. This study aims to identify the main characteristics of diagnosed ricin poisoning cases worldwide in order to raise awareness of this toxin among the population and clinicians. Methods. A collection of human case studies of ricin intoxication in the world was produced. The databases Pubmed, Sciencedirect and Google Scholar were used to extract articles from January 1980 to June 2020. Results. Fifty ricin-intoxicated patients worldwide described in the literature have been identified. Most cases were found in Asia (19 cases), Europe (12 cases) and America (15 cases). Intoxication was mostly accidental (37 cases). Intoxication by castor bean is characterized by acute gastroenteritis-like disease as primary manifestations leading to severe fluid and electrolyte imbalance. The mechanism of death was peripheral vascular collapse and progressing multiple organ failure occurring 10h–72h after intoxication. The questioning of patients and family made it possible to retrieve an history of castor seeds or castor oil ingestion Patients received symptomatic treatment consisting mostly to rehydration with intravenous fluids and digestive decontamination performed with activated charcoal and/or gastric lavage within one day after the ingestion, to reduce gastrointestinal absorption of ricin. This decontamination treatment administered early has been very effective. Only six deaths were observed. Discussion. Currently, no antidote, vaccine, or other specific effective treatment is available for ricin poisoning or prevention. Prompt treatment with supportive care was necessary to limit morbidity and mortality. To date, patient education is essential to prevent this accidental poisoning. Conclusion. Clinicians and health care professionals should have a high level of suspicion when faced with an outbreak of serious respiratory or gastrointestinal illness.