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目的分析云南省腾冲县一起毒蕈中毒事件的流行病学调查结果,为预防与控制类似毒蕈中毒事件提供借鉴。方法接到中毒事件报告后,当地疾病预防控制中心(CDC)专业人员迅速赶往现场开展流行病学调查和毒物鉴定工作,并对调查结果进行分析。结果 2012年6月30日15时左右,同一家庭的6人,包括祖父(例1,56岁)、祖母(例2,47岁)和4个孙女(例3～6,分别为8、8、7、1.5岁)一起食用了含“麻栗菌”(祖父当日自采)的午餐。次日凌晨4～6时,2个孙女(例3、5)和祖父母先后出现恶心、呕吐、腹泻,就诊于当地卫生院,给予对症治疗后返家;例4仅出现腹泻,未就医;例6仅进食少量菜汁,未出现明显症状。7月2日例3、5出现嗜睡、昏迷,6人均被送往腾冲县人民医院,诊断为群体性毒蕈中毒并上报当地CDC。例3在急诊科经抢救无效死亡;例1入院,例2急诊留观治疗,分别在中毒后第26、19天痊愈;其他3例患儿当日转诊省级医疗机构,中毒后第10～13天痊愈。CDC专业人员在事发当地采集的新鲜“麻栗菌”标本经鉴定确认为毒蕈条盖盔孢伞(Galerina sulciceps),而非当地俗称“麻栗菌”的可食性酒色蜡蘑(Laccaria vinaceoevellanea),明确该起事件为误采误食条盖盔孢伞导致的急性中毒事件。结论条盖盔孢伞与酒色蜡蘑外观形态易混淆,故因误采误食导致中毒。专业机构应加强中毒信息管理,掌握不同地区毒蕈谱。应对医务人员进行毒蕈中毒诊断和救治知识的培训,并对普通群众开展预防常见毒蕈中毒的科普教育。
Objective To analyze the epidemiological findings of poisonous mushroom poisoning in Tengchong County, Yunnan Province, and provide references for the prevention and control of poisonous mushroom poisoning. Methods After receiving the report of the poisoning incident, local CDC professionals rushed to the scene to carry out epidemiological investigations and toxins identification and analyzed the findings. Results At about 15:00 on June 30, 2012, six people in the same family, including the grandfather (1,5 years old), grandmother (2,47 years old) and four grandchildren (cases 3 to 6, respectively, 8,8 , 7,1.5 years old) eaten together with “” chestnut bacteria “(grandfather since the day of mining) lunch. The next day at 4 am to 6 pm, two granddaughters (3, 5) and grandparents have nausea, vomiting, diarrhea, visited the local hospitals, symptomatic treatment to give home; Example 4 only diarrhea, not medical treatment; 6 Eat only a small amount of juice, no obvious symptoms. July 2 cases 3,5 drowsiness, coma, 6 per capita were sent to Tengchong County People’s Hospital, diagnosed as a group of mushroom poisoning and reported to the local CDC. Case 3 died in the emergency department after the rescue died; case 1 admission, case 2 emergency observation treatment, were poisoned after the first 26,19 days cured; the other three cases were referred to the provincial medical institutions the same day, after poisoning 10 ~ 13 days cured. The fresh ”Clarianthracema“ specimens collected by CDC professionals at the scene were identified as Galerina sulciceps, rather than the locally ferocious ”echinacea" Mushrooms (Laccaria vinaceoevellanea), clearly the incident as a misuse of false eating accident caused by Helicoverpa arm umbrella poisoning. Conclusions The Helicoverpa armigera is easily confused with the appearance of the waxy wax mushroom, which leads to poisoning due to mishandling and eating. Professional agencies should strengthen the management of poisoning information, to master the different areas of mushroom spectrum. The medical staff should be trained in the diagnosis and treatment of poisonous mushroom poisoning, and carry out popular science education to prevent the common mushroom poisoning.