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El brote de botulismo tipo A y el desarrollo de un sistema de vigilancia del botulismo y de liberación de antitoxinas

R G Villar¹, R L Shapiro, S Busto

¹Foodborne and Diarrheal Diseases Branch, National Center for Infectious Diseases, Epidemic Intelligence Service, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

|April 20, 1999

Resumen

Un brote de botulismo en Buenos Aires en 1998 relacionado con un matambre inadecuadamente preparado puso de relieve los problemas de seguridad alimentaria. Esto condujo al establecimiento de un sistema de vigilancia y antitoxina para mejorar la atención y respuesta del paciente.

Área de la Ciencia:

Epidemiología de las enfermedades transmitidas por los alimentos.
La vigilancia de la salud pública.
Investigación de brotes de enfermedades infecciosas.

Sus antecedentes:

El botulismo plantea un desafío significativo para la salud pública en Argentina, exacerbado por la limitada disponibilidad mundial de antitoxinas.
Un brote de botulismo en Buenos Aires en enero de 1998 requirió una investigación y respuesta inmediatas.

Objetivo del estudio:

Para identificar la fuente del brote de botulismo de 1998 en Buenos Aires.
Mejorar los sistemas de vigilancia del botulismo en Argentina.
Implementar un mecanismo robusto de suministro y liberación de antitoxinas.

Principales métodos:

Un estudio de cohorte con 21 conductores de autobuses de una ruta específica en Buenos Aires se llevó a cabo en enero de 1998.
Investigó la aparición de botulismo e identificó un alimento específico como el probable vehículo de transmisión.
Analizó los patrones de preparación, almacenamiento y consumo de alimentos para identificar el origen del brote.

Principales resultados:

Nueve de los 21 conductores de autobuses (43%) desarrollaron botulismo, exhibiendo síntomas desde gastroenteritis hasta insuficiencia respiratoria.
El consumo de matambre (rollo de carne argentino) se asoció fuertemente con la enfermedad (9/11 casos frente a 0/10 controles, P<.001).
Se identificó toxina de tipo A en muestras de suero de pacientes; todos los pacientes recibieron antitoxina y no se produjeron muertes.

Conclusiones:

Temperaturas y tiempos de cocción inadecuados, envases de plástico que se contraen con el calor y una refrigeración insuficiente probablemente facilitaron la supervivencia de las esporas de Clostridium botulinum y la producción de toxinas.
El establecimiento de un sistema de vigilancia de botulismo de respuesta rápida y de liberación de antitoxinas en Argentina tiene como objetivo el tratamiento oportuno de los pacientes.
Este sistema puede servir potencialmente como modelo para otros países que enfrentan desafíos similares de salud pública.

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