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Zur Phänomenologie beim positiven Clostridien-Nachweis

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Zusammenfassung

Bei plötzlichen Todesfällen fallen immer wieder positive Botulismus-Nachweise auf. Klinisch wird eine korrekte Diagnose oft verspätet oder gar nicht gestellt. Ausgehend von einem Literaturüberblick und eigenen rezenten Daten bei Sudden-infant-death- (SID-)Fällen werden Problemkonstellationen von 5 Todesfällen Erwachsener erläutert und diskutiert. Neben positivem Keim- und Toxinnachweis sind Hauptkriterien typische Anamnese, Symptombild und Obduktionsmorphologie. Häufig bestehen Diskrepanzen hinsichtlich des positiven Keimbefundes bei fehlendem Toxinnachweis. Auch ist die Lokalisation des Toxins (Blut, Leber, Darm) von Bedeutung. Entscheidend ist jedoch bei unklaren plötzlichen Todesfällen die Einbeziehung mikrobiologischer Untersuchungen in die postmortale Diagnostik.

Abstract

In cases of sudden death Clostridium can often be detected butin a clinical setting the correct diagnosis is often made too late or even is not made at all. Based on a literature review some recent data of our own cases with sudden infant death (SID) are given. The discussion is focussed on five adults who died suddenly and in each case clostridium and/or botulinum toxin were detected. Other main criteria for the diagnosis were anamnesis, symptomatology, and pathomorphology. There were often discrepancies between the positive clostridium detection and failure to detect botulinum toxin. Furthermore, the compartment in which the toxin was found was of special importance (e.g. blood, liver tissue, intestines). The most effective measure to verify botulism is the combination of postmortem diagnostic procedures with microbiological investigations.

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Authors and Affiliations

  1. Institut für Rechtsmedizin, Georg-August-Universität, Göttingen

    G. Kernbach-Wighton & K.-S. Saternus

  2. Institut für Tropentierhygiene, Georg-August-Universität, Göttingen

    H. Böhnel

  3. Institut für Rechtsmedizin, Georg-August-Universität, Windausweg 2, 37073, Göttingen

    G. Kernbach-Wighton

Authors
  1. G. Kernbach-Wighton
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  2. H. Böhnel
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  3. K.-S. Saternus
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Correspondence to G. Kernbach-Wighton.

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Kernbach-Wighton, G., Böhnel, H. & Saternus, KS. Zur Phänomenologie beim positiven Clostridien-Nachweis. Rechtsmedizin 13, 86–90 (2003). https://doi.org/10.1007/s00194-003-0201-y

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