O botulismo de origem alimentar é a forma mais comum de botulismo, uma doença rara da junção neuromuscular adquirida com paralisia flácida descendente devido a neurotoxinas botulínicas (BoNTs). É causada pelo consumo de alimentos contaminados contendo BoNTs.
Introdução
O que você precisa saber de cara
O botulismo de origem alimentar é a forma mais comum de botulismo, uma doença rara da junção neuromuscular adquirida com paralisia flácida descendente devido a neurotoxinas botulínicas (BoNTs). É causada pelo consumo de alimentos contaminados contendo BoNTs.
Escala de raridade
<1/50kMuito rara
1/20kRara
1/10kPouco freq.
1/5kIncomum
1/2k
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Publicações mais relevantes
The unsung hero: ntnh gene as complementary botulism marker.
Botulism is a rare but severe neurological disease caused by botulinum neurotoxins (BoNTs). Standard diagnostic methods including the mouse bioassay (SMB) and bont gene type-specific PCR, are often limited by the high genetic diversity among bont subtypes, which can lead to false-negative results. The nontoxin-nonhemagglutinin (ntnh) gene is highly conserved and exclusively co-located with the bont gene complex. Thus, this study evaluates the use of ntnh gene as a complementary diagnostic tool for botulism and assesses its association with BoNT types. The ntnh gene was detected in a prospective BoNT-diagnostic group (n=88) and a BoNT-historical group (n=54). Toxin cluster proteins were identified in GenBank and RefSeq Clostridium proteomes using MMSeqs2. ntnh gene detection reinforced positive results from SMB or bont gene tests in 26 cases (35.62% of the total confirmed cases) of foodborne and infant botulism. In two foodborne cases from the BoNT-diagnostic group, the ntnh gene was detected despite negative results from both SMB and bont gene tests, highlighting its potential to identify missed cases. An in silico analysis of 3,250 RefSeq and 2,494 GenBank annotated Clostridium proteomes was conducted. respectively. So, NTNH showed a high co-presence pattern with BoNT. Moreover, NTNH sequences were far more conserved than BoNT sequences in inter-type comparisons (67.2 vs.39.7), which highlights its applicability as a disease biomarker. The ntnh gene analysis is a valuable complementary tool enhancing the diagnosis of botulism. The study highlights the need for clear guidelines to interpret positive ntnh results when direct toxin or bont gene confirmation are negative.
Accidental Botulism Caused by Consumption of Vacuum-Packaged Rabbit-Head Meat.
With the increase of sporadic cases of foodborne botulism and the occurrence of several large incidents of botulinum contamination in food, botulism has received greater attention in clinical practice. Foodborne botulinum toxin poisoning is an acute foodborne toxic disease caused by ingestion of food contaminated with Clostridium botulinum exotoxin. We present two cases of foodborne botulism affecting a mother and daughter who were admitted to our department after consumption of vacuum-packed rabbit-head meat. The time to symptom onset was less than 24 h in the daughter (aged 8 years) and 1 week for the mother (aged 45 years). The main clinical manifestations included fatigue, dizziness, diplopia, blurred vision, ptosis, dysphagia, and slurred speech. Blood samples tested positive for botulinum toxin type A. The daughter developed pneumonia and respiratory failure and required mechanical ventilation. Treatment measures included the use of botulinum antitoxin, fluid replacement, anti-infection, and nutritional nerve therapy. Two patients eventually recovered. When botulinum toxin poisoning is diagnosed, early administration of the appropriate antitoxin is paramount. When necessary, life support for severe cases can improve the success rate. Considering that these cases of botulism were caused by the consumption of vacuum-packed rabbit-head meat, we recommend enhancing public awareness of food safety.
Clinical and electrophysiological features of foodborne botulism: a retrospective case series.
BACKGROUND: Foodborne botulism is a rare but potentially serious and lethal disease that is considered a threat to public health systems across the globe. Botulism is a paralytic disorder caused by the neurotoxin, produced by Clostridium botulinum, which acts upon peripheral cholinergic nerve terminals by inhibiting acetylcholine release, subsequently causing denervation to muscle fibers. CASE SERIES: In April 2024, an outbreak of foodborne botulism was reported in Riyadh, Saudi Arabia, following consumption of contaminated fast food. Four patients were affected: two females and two males, aged 14 to 21 years. All patients developed neurological symptoms, including cranial nerve involvement, dysphagia, and generalized weakness. Three patients progressed to severe hypercapnic respiratory failure requiring prolonged mechanical ventilation. Electrophysiological studies demonstrated characteristic findings of presynaptic neuromuscular junction dysfunction. CONCLUSIONS: This case series adds to existing knowledge by providing detailed descriptions of the clinical course, neurological examination findings, and electrodiagnostic features of foodborne botulism cases in Saudi Arabia. Our findings highlight that, despite early antitoxin administration, patients can develop prolonged neuromuscular weakness requiring extended mechanical ventilation. This underscores the importance of considering botulism in the differential diagnosis of acute flaccid paralysis and the need for timely electrophysiological evaluation to guide management and prognosis. https://www.europeanreview.org/wp/wp-content/uploads/Graphical-ABSTRACT-19.jpg.
Molecular Typing of Clostridium botulinum Isolated from Chili Pepper Preserves During a Botulism Outbreak.
Foodborne botulism is a potentially fatal disease caused by Clostridium botulinum neurotoxins (BoNTs). These spore-forming bacteria are ubiquitous in the environment and can contaminate various food products, especially raw vegetables. During the preparation of home-made preserves, favorable conditions of anaerobiosis, temperature, salinity, and pH can lead to spore germination and toxin production. BoNTs can reach neuromuscular junctions where they block the release of acetylcholine. In this study, we present a case of foodborne botulism associated with the consumption of chili peppers preserve containing BoNT/B. The isolated strains were characterized through Whole Genome Sequencing, confirming the strains involved in the outbreak. This work increases the understanding of the epidemiology and the ecology of C. botulinum, highlighting the importance of raising medical awareness and making timely clinical diagnoses for the effective management of botulism outbreaks.
Foodborne Botulism Presenting With Isolated Cranial Nerve Involvement in a Young Adult.
A young man presented with progressive cranial nerve dysfunction following participation in a communal meal. Initial investigations and imaging were inconclusive; Guillain-Barré syndrome and viral encephalitis were considered in the differential diagnosis. He was admitted to the intensive care unit (ICU) due to the potential need for respiratory support. The progression of neurological dysfunction, combined with relevant dietary exposure, raised clinical suspicion for botulism. The patient was treated with heptavalent botulinum antitoxin, and serum testing later confirmed the presence of botulinum toxin type A. With multidisciplinary supportive care, he fully recovered without requiring mechanical ventilation. This case highlights the importance of early recognition of bulbar symptoms, the timely administration of empirical antitoxin therapy, and the role of ICU monitoring. It also underscores how non-specific early symptoms can delay diagnosis and emphasizes the need for high clinical suspicion in otherwise healthy young patients.
Publicações recentes
Genomic Characterization of Clostridium botulinum Isolates from Soil and Soybean Samples in High-Incidence Regions - Xinjiang, Inner Mongolia, and Qinghai PLADs, China, 2024.
The unsung hero: ntnh gene as complementary botulism marker.
Accidental Botulism Caused by Consumption of Vacuum-Packaged Rabbit-Head Meat.
Molecular Typing of Clostridium botulinum Isolated from Chili Pepper Preserves During a Botulism Outbreak.
Foodborne Botulism Presenting With Isolated Cranial Nerve Involvement in a Young Adult.
📚 EuropePMC138 artigos no totalmostrando 129
The unsung hero: ntnh gene as complementary botulism marker.
Frontiers in cellular and infection microbiologyAccidental Botulism Caused by Consumption of Vacuum-Packaged Rabbit-Head Meat.
Foodborne pathogens and diseaseMolecular Typing of Clostridium botulinum Isolated from Chili Pepper Preserves During a Botulism Outbreak.
Foods (Basel, Switzerland)Foodborne Botulism Presenting With Isolated Cranial Nerve Involvement in a Young Adult.
CureusFoodborne botulism from consumption of homemade spoiled eggs: a case series and literature review.
Frontiers in medicineFamilial Cluster of Foodborne Botulism Associated with Homemade Dairy Products: A Case Series.
International medical case reports journalClinical and electrophysiological features of foodborne botulism: a retrospective case series.
European review for medical and pharmacological sciencesFeatures of the First Case of Foodborne Botulism Caused by Dual-Toxin Clostridium parabotulinum Subtype A1(B5) in Spain.
ToxinsReview of Foodborne Botulism in the UK: 2006-2024.
Foods (Basel, Switzerland)Molecular Characterization of Clostridium botulinum Isolates from Sichuan Province, China (1990-2024).
Foodborne pathogens and diseaseFoodborne Botulism Caused by Clostridium botulinum Subtype A5(b3) by Self-Packaged Vacuum Spicy Rabbit Heads.
MicroorganismsFoodborne Botulism Outbreak After Consumption of Home-Canned Cactus (Nopales) - Fresno County, California, June 2024.
MMWR. Morbidity and mortality weekly report[Food-induced Botulism - Diagnosis, treatment and course].
Fortschritte der Neurologie-PsychiatrieDual-Toxin-Producing Clostridium botulinum Strain Isolated from a Foodborne Botulism Case in Korea: Genomic and Functional Insights.
ToxinsEffect of sodium nitrite, sodium chloride, sodium erythorbate, and sodium tripolyphosphate on nontoxigenic Clostridium botulinum LNT01 and C. sporogenes in growth medium and cooked cured beef - Development and validation of critical control surface.
Food research international (Ottawa, Ont.)Public knowledge of food poisoning, risk perception and food safety practices in Saudi Arabia: A cross-sectional survey following foodborne botulism outbreak.
MedicineTracing and characterization of foodborne botulism caused by the new MLST type Clostridium botulinum A2 in Hebei province, China.
Frontiers in microbiologyBotulinum Neurotoxins as Two-Faced Janus Proteins.
BiomedicinesAn Outbreak of Foodborne Botulism Caused by Clostridium botulinum BoNT/A3 in Pickled Eggs - Weihai City, Shandong Province, China, July 2024.
China CDC weekly[Infant botulism: an underestimated problem. A review].
Terapevticheskii arkhivTowards safer practices: A spotlight on foodborne botulism following the recent outbreak in Saudi Arabia in 2024.
New microbes and new infectionsHealthcare workers' knowledge and preparedness for unprecedented foodborne botulism outbreak in Saudi Arabia.
Journal of infection and public healthFoodborne Botulism Type F: A Rare Presentation of Neurologic Manifestation and Successful Management.
CureusThe First Reported Foodborne Botulism Outbreak in Riyadh, Saudi Arabia: Lessons Learned.
Journal of epidemiology and global healthFoodborne botulism outbreak with potential new management options.
Saudi medical journalBotulism Cases in Romania-An Overview of 14-Year National Surveillance Data.
BiomedicinesIatrogenic botulism cases after gastric and axillary application of botulinum toxin and review of literature.
Journal of infection in developing countriesInfective Endocarditis by Clostridioides and Clostridium Species-A Narrative Review.
Antibiotics (Basel, Switzerland)Non-invasive diagnosis of diaphragmatic paralysis in botulism using ultrasound.
Toxicon : official journal of the International Society on ToxinologyComplete genomes of Clostridium botulinum type B(F) isolates associated with a 1995 foodborne botulism outbreak from commercial pâté reveals a recombination event disrupting the ntnh gene.
Microbial genomicsA Challenging Case: Botulism in a Toddler.
CureusClinicopathological insights into an outbreak of foodborne botulism in Hamadan, Iran, in 2023: A microbiological and laboratory findings.
SAGE open medicineRare Case of Botulism and Dysphagia: The Role of Physical and Rehabilitation Medicine.
CureusFoodborne botulism outbreak involving different nationalities during the Rugby World Cup: critical role of credit card data and rapid international cooperation, France, September 2023.
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletinFoodborne botulism in Poland in 2018-2021.
Przeglad epidemiologicznyFood-borne botulism outbreak during the Rugby World Cup linked to marinated sardines in Bordeaux, France, September 2023.
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletinPostprandial hypotension as a predictor of respiratory failure in patients with foodborne botulinum intoxication - a case-control study in outbreak investigation.
International journal of infectious diseases : IJID : official publication of the International Society for Infectious DiseasesFoodborne Botulism, Canada, 2006-20211.
Emerging infectious diseasesPathogenicity and virulence of Clostridium botulinum.
VirulencePhysical Treatments to Control Clostridium botulinum Hazards in Food.
Foods (Basel, Switzerland)Foodborne botulism and the importance of recognizing the disease in the emergency department: a case report.
Journal of medical case reportsInactivation of Group I and Group II Clostridium botulinum spores by ultraviolet irradiation in water.
International journal of food microbiologyBotulism in the 21st Century: A Scoping Review.
The Brown journal of hospital medicinePotential Risk of Botulinum Neurotoxin -producing Clostridia Occurrence in Canned Fish.
Journal of veterinary researchFirst cross-border outbreak of foodborne botulism in the European Union associated with the consumption of commercial dried roach (Rutilus rutilus).
Frontiers in public healthBotulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997-2019.
ToxinsCrystal structures of OrfX1, OrfX2 and the OrfX1-OrfX3 complex from the orfX gene cluster of botulinum neurotoxin E1.
FEBS lettersDraft Genome Sequences of 20 Clostridium botulinum Type A Isolates from Foodborne Botulism Outbreaks.
Microbiology resource announcementsHuman and animal botulism surveillance in France from 2008 to 2019.
Frontiers in public healthTracing Foodborne Botulism Events Caused by Clostridium botulinum in Xinjiang Province, China, Using a Core Genome Sequence Typing Scheme.
Microbiology spectrumGenomic Diversity, Competition, and Toxin Production by Group I and II Clostridium botulinum Strains Used in Food Challenge Studies.
Microorganisms[The problem of diagnosis and differential diagnosis of botulism in pregnant women. Case report].
Terapevticheskii arkhivEpidemiological Analysis of Foodborne Botulism Outbreaks - China, 2004-2020.
China CDC weeklyOutbreak of Foodborne Botulism Associated with a Commercially Produced Multipack Potato Product, Colorado: September 2019.
Foodborne pathogens and diseaseIn response to: Why foodborne botulism cannot be caused by honey.
AnaerobeWhy foodborne botulism cannot be caused by honey.
AnaerobeFoodborne botulism, a forgotten yet life-threatening disease: a case report.
European review for medical and pharmacological sciencesInadequate Refrigeration of Some Commercial Foods Is a Continued Cause of Foodborne Botulism in the United States, 1994-2021.
Foodborne pathogens and diseaseSynergistic interaction between pH and NaCl in the limits of germination and outgrowth of Clostridium sporogenes and Group I Clostridium botulinum vegetative cells and spores after heat treatment.
Food microbiologyPauci-symptomatic foodborne botulism due to Clostridium botulinum type B with predominant ophthalmologic presentation possibly after consumption of honey.
AnaerobeGastrointestinal tract necrosis caused by severe foodborne botulism.
Polish archives of internal medicineSerotype Features of 17 Suspected Cases of Foodborne Botulism in China 2019-2022 Revealed by a Multiplex Immuno-Endopep-MS Method.
Frontiers in microbiologyFoodborne botulism: A brief review of cases transmitted by cheese products (Review).
Biomedical reportsInvestigation and Identification of Food Poisoning Caused by Clostridium botulinum Type B1 in Shenzhen, China.
Foodborne pathogens and diseaseOutbreak of foodborne botulism in Alexandria, Egypt: modulating indications for administration of heptavalent botulinum antitoxin.
Environmental science and pollution research internationalFirst report of foodborne botulism due to Clostridium botulinum type A(B) from vegetarian home-canned pate in Hanoi, Vietnam.
AnaerobeBotulism outbreak in a rural Ethiopia: a case series.
BMC infectious diseasesFoodborne Botulism in Western Romania: Ten Years' Experience at a Tertiary Infectious Disease Hospital.
Healthcare (Basel, Switzerland)Mild Botulism From Illicitly Brewed Alcohol in a Large Prison Outbreak in Mississippi.
Frontiers in public healthFoodborne Botulism Outbreaks in the United States, 2001-2017.
Frontiers in microbiologyEpidemiology of botulism in the north-western Romania-a 7-year survey.
Environmental science and pollution research internationalNeurophysiological patterns of acute and post-acute foodborne botulism.
Muscle & nerveClinical Predictive Values in Botulism: A 10-year Survey.
Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care MedicineManagement of an outbreak of botulism with benign clinical presentation.
Journal of clinical neuroscience : official journal of the Neurosurgical Society of AustralasiaClinical Guidelines for Diagnosis and Treatment of Botulism, 2021.
MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reportsMortality of Western Gulls (Larus occidentalis) Associated with Botulism Type a in Coastal Southern California, USA.
Journal of wildlife diseasesFoodborne botulism: a case report.
Porto biomedical journalFoodborne botulism presenting as small bowel obstruction: a case report.
BMC infectious diseasesComplete Genome Sequence of Clostridium botulinum CJ0611A1, a Type A(B) Isolate Associated with an International Outbreak of Botulism from Commercial Carrot Juice.
Microbiology resource announcementsFoodborne Botulism in Ukraine from 1955 to 2018.
Foodborne pathogens and diseaseEarly recovery of botulism: one decade of experience.
Clinical toxicology (Philadelphia, Pa.)Foodborne Botulism: Clinical Diagnosis and Medical Treatment.
ToxinsAssessment of the risk of botulism from chilled, vacuum/modified atmosphere packed fresh beef, lamb and pork held at 3 °C-8 °C.
Food microbiologyA Quantum Dot Nanobiosensor for Rapid Detection of Botulinum Neurotoxin Serotype E.
ACS sensorsHuman Botulism in France, 1875-2016.
ToxinsPan-Genomic Analysis of Clostridium botulinum Group II (Non-Proteolytic C. botulinum) Associated with Foodborne Botulism and Isolated from the Environment.
ToxinsAdult Intestinal Toxemia Botulism.
ToxinsOutbreak of Foodborne Botulism Associated with Improperly Earthenware Cheese (Koupé): A Case Report.
Iranian journal of public healthLambert-Eaton Myasthenic Syndrome, Botulism, and Immune Checkpoint Inhibitor-Related Myasthenia Gravis.
Continuum (Minneapolis, Minn.)Foodborne Botulism Outbreak Associated With Commercial Nacho Cheese Sauce From a Gas Station Market.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaFoodborne Botulism: Neglected Diagnosis.
European journal of case reports in internal medicineOutbreak of Foodborne Botulism Associated With Prepackaged Pouches of Liquid Herbal Tea.
Open forum infectious diseasesFood-borne botulism in Apulia region, Italy: an expert witness testimony.
Annali di igiene : medicina preventiva e di comunitaDraft Genome Sequence of a Clostridium botulinum Isolate from Thailand Harboring the Subtype bont/B8 Gene.
Microbiology resource announcementsFoodborne botulism in Turkey, 1983 to 2017.
Infectious diseases (London, England)Foodborne botulism in Poland in 2017.
Przeglad epidemiologicznyFoodborne botulism: an evolving public health challenge.
Infectious diseases (London, England)Tetanus, Botulism, and Diphtheria.
Continuum (Minneapolis, Minn.)Foodborne botulism in Poland in 2016.
Przeglad epidemiologiczny[A case of sole supportive care of severe neuroparalytic foodborne botulism due to homemade pesto].
Medizinische Klinik, Intensivmedizin und NotfallmedizinFoodborne botulism due to ingestion of home-canned green beans: two case reports.
Journal of medical case reportsThe Epidemiology of Foodborne Botulism Outbreaks: A Systematic Review.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaOutbreak of Foodborne Botulism in an Immigrant Community: Overcoming Delayed Disease Recognition, Ambiguous Epidemiologic Links, and Cultural Barriers to Identify the Cause.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaEfficacy of Antitoxin Therapy in Treating Patients With Foodborne Botulism: A Systematic Review and Meta-analysis of Cases, 1923-2016.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaClinical Features of Foodborne and Wound Botulism: A Systematic Review of the Literature, 1932-2015.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaFoodborne botulism in Poland in 2015.
Przeglad epidemiologicznyFoodborne Botulism, I Only Had Nacho Cheese: A Case Report.
Cureus[Botulism: Diagnosis and Therapy].
Deutsche medizinische Wochenschrift (1946)Detection and Quantification of Biologically Active Botulinum Neurotoxin Serotypes A and B Using a Förster Resonance Energy Transfer-Based Quantum Dot Nanobiosensor.
ACS applied materials & interfacesGenome Sequence of Clostridium botulinum Strain Adk2012 Associated with a Foodborne Botulinum Case in Tottori, Japan, in 2012.
Genome announcementsFoodborne botulism in the Faroe Islands in a two-decade period.
Infectious diseases (London, England)[Foodborne botulism - a re-emerging public health challenge].
Epidemiologie, mikrobiologie, imunologie : casopis Spolecnosti pro epidemiologii a mikrobiologii Ceske lekarske spolecnosti J.E. PurkyneImpact of Clostridium botulinum genomic diversity on food safety.
Current opinion in food scienceComplete paralytic botulism mimicking a deep coma in a child.
The Turkish journal of pediatricsFoodborne botulism in Poland in 2014.
Przeglad epidemiologiczny[Clostridia: toxin masters. Botulism: from botox to sausages?].
Revue medicale suisseOutbreak of Foodborne Botulism Associated with Improperly Jarred Pesto--Ohio and California, 2014.
MMWR. Morbidity and mortality weekly reportEarly diagnosis and treatment in a child with foodborne botulism.
Anaerobe[Intoxication of botulinum toxin].
Polski merkuriusz lekarski : organ Polskiego Towarzystwa LekarskiegoEarly, Real-Time Medical Diagnosis of Botulism by Endopeptidase-Mass Spectrometry.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of AmericaNew Elements To Consider When Modeling the Hazards Associated with Botulinum Neurotoxin in Food.
Journal of bacteriologyFoodborne botulism in Poland in 2013.
Przeglad epidemiologicznyArchitecture of the botulinum neurotoxin complex: a molecular machine for protection and delivery.
Current opinion in structural biologyFoodborne botulism associated with home-preserved turnip tops in Italy.
Annali dell'Istituto superiore di sanitaRegional variations in home canning practices and the risk of foodborne botulism in the Republic of Georgia, 2003.
Journal of food protectionWhole-Genome Sequence of Clostridium botulinum A2B3 87, a Highly Virulent Strain Involved in a Fatal Case of Foodborne Botulism in Italy.
Genome announcementsTwo Complete and One Draft Genome Sequence of Nonproteolytic Clostridium botulinum Type E Strains NCTC 8266, NCTC 8550, and NCTC 11219.
Genome announcementsFatal outbreak of botulism in Greenland.
Infectious diseases (London, England)Botulism mortality in the USA, 1975-2009.
The botulinum journalAssociações
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Referências e fontes
Bases de dados externas citadas neste artigo
Publicações científicas
Artigos indexados no PubMed ligados a esta doença no grafo RarasNet — título, periódico e PMID direto da fonte, sem intermediação de IA.
- The unsung hero: ntnh gene as complementary botulism marker.
- Accidental Botulism Caused by Consumption of Vacuum-Packaged Rabbit-Head Meat.
- Clinical and electrophysiological features of foodborne botulism: a retrospective case series.
- Molecular Typing of Clostridium botulinum Isolated from Chili Pepper Preserves During a Botulism Outbreak.
- Foodborne Botulism Presenting With Isolated Cranial Nerve Involvement in a Young Adult.
- Genomic Characterization of Clostridium botulinum Isolates from Soil and Soybean Samples in High-Incidence Regions - Xinjiang, Inner Mongolia, and Qinghai PLADs, China, 2024.
Bases de dados e fontes oficiais
Identificadores e referências canônicas usadas para montar este verbete.
- ORPHA:228371(Orphanet)
- MONDO:0016453(MONDO)
- GARD:20591(GARD (NIH))
- Busca completa no PubMed(PubMed)
- Q18553250(Wikidata)
Dados compilados pelo RarasNet a partir de fontes abertas (Orphanet, OMIM, MONDO, PubMed/EuropePMC, ClinicalTrials.gov, DATASUS, PCDT/MS). Este conteúdo é informativo e não substitui avaliação médica.
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