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Botulism: the first signs, symptoms, treatment and prevention

The term "botulism" comes from the Latin word, translated as "sausage". Such an interesting comparison of an infectious disease with an alimentary product arose because in 1822 sausages were considered the cause of infection.

This was explained by the fact that they allegedly contain dangerous fatty acid. But it was only in 1897 that a true causal relationship was established, revealing why the disease develops when using sausages. This sensational discovery was made by Ermengen, who isolated a bacterial toxin.

Content

Botulism, what is it?

Botulism

Botulism is an acute infection in which pathological processes in the body are associated with exotoxin of botulinum clostridia. Typical clinical manifestations are considered to be paralysis of the skeletal and smooth muscles.

The latter is localized in the internal organs. Her paralysis can lead to the development of acute pulmonary insufficiency, with the involvement of the respiratory muscles in the pathological process.

The cause of botulism is considered neurotoxin produced by clostridia. It causes damage to the nervous system, which leads to paralysis. Currently, there are 8 known serological types of this toxin, and in the antigenic ratio they are completely different.

This means that the formation of antibodies to one type of toxins does not protect against others at all. Currently botulinum toxin is recognized as the strongest biological poison. Its toxicity is compared with sarin, which it exceeds 20-100 thousand times.

Causative agent of botulism

Causative agent of botulism

Under adverse conditions, botulism pathogens form spores, which allow to maintain viability for a long time. These "protective" forms are widespread in soil, water, rotting plants and animal carcasses. However, they do not become the cause of the disease.

The most common way when botulism poisoning occurs is the consumption of unfit preservation, especially when cooked at home. This is due to the incredible stability of the dispute to environmental factors:

  • boiling they stand for 5 hours;
  • salt concentration up to 18% does not kill them;
  • in an acidic environment (pH> 4.7), they remain viable;
  • do not die and with a strong freezing (up to -190 ° C);
  • direct ultraviolet rays they are indifferent.

However, the clinical symptoms of botulism can only cause toxin, which is secreted by vegetative forms (spores do not form it). Danger arises when spores germinate and the pathogen multiplies in suitable conditions.

The latter include:

  • lack of oxygen;
  • sufficient temperature;
  • a certain level of acidity of the environment;
  • presence of other microbes, etc.

In order for a disease to develop, all these factors must necessarily be present - only their combined effect leads to the formation of botulinum toxin. For this reason, botulism is not a common pathology.

In most cases, botulinum toxin is present in conservation, which is the source of infection. When eating fresh food poisoning is impossible, even if it contains controversy. They are not toxin-producing.

Sources and methods of bacterial toxin in the body may be different. On this basis, there are four main forms of the disease:

  1. Food, developing when ingested toxin with food, in which it is already contained.
  2. Wound - toxin is formed in anoxic conditions of wounds infected with clostridia.
  3. Infant, which can develop only in children up to 12 months of age as a result of absorption of toxin into the bloodstream, which is formed in the intestine as a result of spore germination.
  4. Botulism in children older than 12 months and adults (there are isolated reports on this variant in the literature), which is also associated with the formation of toxins in the intestine.

Food botulism is the most common form. Infection most often occurs when using such products as:

  • canned food, especially cooked at home;
  • smoked meat;
  • dried foods;
  • fish products;
  • canned mushrooms.

The main condition when a disease can occur is the use of only those products that were stored without oxygen (or with a small amount of oxygen) and that have not been thermally pretreated (at the proper temperature for a certain time).

So, at home it is not possible to achieve the death of a dispute, because unable to create a high pressure and temperature of 120 ° C. At the same time, there are no signs of botulism in the preservation - the dishes do not have an unpleasant odor, they look normal, therefore, it is impossible to organoleptically calculate the infected products.

The first signs of botulism, the incubation period

The first signs of botulism

The first clinical signs of botulism appear after an incubation period that lasts from 6 hours to 10 days. Its average duration is from 18 to 36 hours.

The onset of the disease can be both acute and gradual. The severity of the symptoms is also different. In some cases, they can be light, and in others - significantly pronounced. In most cases, patients are engaged in self-diagnosis, referring to various specialists - depending on what hurts. However, this approach only leads to a delay in time.

Common signs of botulism that distinguish it from other diseases are:

  • no increase in body temperature (fever is almost always characteristic of acute infections);
  • symmetrical development of neurological symptoms;
  • lack of depression and loss of consciousness, except in cases of acute insufficiency of the respiratory system;
  • no sensitivity disturbances.

The first signs of suspicion for botulism are:

  • dry mouth;
  • difficulty in viewing closely spaced objects;
  • difficulties in reading the usual font, which was previously easily perceived;
  • a net appears before my eyes;
  • duplication of the objects in question (see photo).

In some patients with this, the progression of clinical symptoms stops and the person recovers. As a rule, he does not seek medical help, and these cases of the disease remain unrecorded. With a more severe course, the initial symptoms are aggravated and new signs of the disease appear. These include:

  • changes in voice - he becomes rough and hoarse;
  • the speech becomes obscure and blurred with characteristic French spoken language;
  • there is a lump in the throat;
  • gagging;
  • insufficient saliva formation, which further aggravates the manifestations of dysphagia;
  • severe muscle weakness (a person does not want to do anything because of muscle weakness);
  • constipation associated with paralysis of the intestinal muscles;
  • difficulty urinating, etc.

Botulism symptoms

Botulism symptoms

Neurological symptoms of botulism are dominant. In some cases, there may be an increase in body temperature. This is due to the presence in the food of other bacteria that can additionally provoke gastrointestinal syndrome. It manifests itself:

  • nausea and vomiting;
  • diarrhea;
  • pain in the abdomen.

However, these signs are not specific to botulism. They can either be present or absent, so they are not taken into account in the diagnosis. These symptoms may appear in front of or in neurological disorders.

Affections of the nervous system are characterized by a number of signs:

  • symmetry of disorders;
  • downward weakness, which in severe cases turns into paralysis;
  • involvement of the muscles of the trunk and neck, arms and legs.

Severe intoxication leads to severe ophthalmic manifestations and bulbar paralysis. During this period, the risk of aspiration of food, saliva and water increases, which leads to the development of aspiration syndrome, manifested by purulent tracheobronchitis and pneumonia.

A botulism patient has a distinctive appearance:

  • adynamicity;
  • mask-like face, which is deprived of facial expressions;
  • bilateral omission of the eyelids (sometimes can be one-sided);
  • dilated pupils that hardly respond to light;
  • floating look;
  • strabismus;
  • dry mouth mucosa;
  • inactivity and unsteady gait;
  • shortness of breath and weakness;
  • pallor of the skin associated with a drop in pressure;
  • bloating due to intestinal paresis.

In the clinical analysis of blood abnormalities are minimal. However, monocytosis is a characteristic hematological feature. An increase in the number of leukocytes and neutrophils, as well as the acceleration of ESR, are suspicious of suppurative inflammation.

Diagnosis of botulism

The final diagnosis is based on clinical data and the results of an epidemiological investigation. The presence of neurological disorders can lead to diagnostic errors when botulism is taken for a disease of the nervous system. At the same time, the doctor takes into account the signs that exclude botulinum toxin poisoning. These include:

  • the presence of tension in the occipital muscles;
  • sharp pains in the head;
  • pathological signs in the cerebrospinal fluid;
  • paralysis of central origin;
  • sensitive disorders;
  • convulsions;
  • loss of consciousness;
  • mental disorders.

In difficult cases, laboratory diagnosis may be required. It involves the detection of botulinum toxin in the blood, vomit, as well as in food that may have caused the poisoning. PCR diagnostics for this disease is currently under development.

Botulism treatment

Botulism treatment

Treatment of botulism is carried out without delay, because respiratory resuscitation may be necessary. The main therapeutic areas for this bacterial poisoning are:

1) Gastric lavage , if no more than 72 hours have passed since the moment the contaminated food arrived in the body. At the first stage, it is carried out with boiled water, and at the second stage, with the addition of soda, which neutralizes the toxin.

Gastric lavage should not be performed if there is paresis of the pharyngeal and laryngeal muscles, since stomach contents may be inhaled.

2) Administration of antitoxic antibotulinic serum. Do not hesitate because the serum can only neutralize the toxin that circulates in the blood until it has contacted the nerve endings.

Before the introduction of toxoid requires a skin test, because There may be cases of allergic intolerance. If the sample is positive, the serum can only be entered for health reasons.

3) The use of equine immunoglobulin is a promising therapeutic direction. It can also be used for prophylactic purposes, development in this direction is continuing.

4) Symptomatic therapy - desensitization, vitamins, detoxification, artificial pulmonary ventilation, antibiotics, etc. The choice of one or another method (means) depends on the specific clinical symptoms.

Disease complications

The direct complications of botulism are:

  • aspiration pneumonia;
  • areas of lung collapse (atelectasis);
  • purulent tracheobronchitis;
  • sialodenitis, purulent form (inflammation of the salivary glands).

The accession of a secondary bacterial infection, significantly weighting the course of the disease, is observed with the use of invasive treatment methods. Thus, the risk of purulent processes increases with intubation of the trachea, tracheostomy, artificial pulmonary ventilation and catheterization of the bladder.

Drug therapy may be complicated by the development of serum sickness. It develops in children at about the 8-10th day after the administration of anti-totulinic serum. Its main mechanism is immune. Symptoms of serum sickness usually appear when clinical neurological symptoms regress.

Prevention of botulism

Prevention of botulism is based on strict observance of the rules for the manufacture and storage of canned food, as well as meat and fish semi-finished products.

It should be remembered that the use of home-made canned food is particularly dangerous, in which trapped spores cannot die. Therefore, to avoid infection, it is recommended to boil homemade canned food for 15 minutes before eating.

This will completely neutralize botulinum toxins. Persons who have consumed unknown products must be under medical supervision for 12 days to identify the very first signs of the disease.

When making canned foods at home, it is recommended to adhere to the following rules:

  • canned food of greens, meat, mushrooms and fish should not be made;
  • vegetables that do not contain natural acid (green peas, cucumbers) require its artificial introduction (therefore, vinegar or citric acid is added);
  • do not preserve spoiled vegetables and fruits that have long been lying;
  • harvest only clean processed raw materials;
  • carefully handle jars and lids, observing the temperature;
  • optimal storage temperature from 3 to 6 ° C;
  • timely discard bombed canned food.

Vaccine administration (specific prophylaxis) is indicated only to those individuals who may be in contact with botulinum toxin. To create a lasting immunity, triple vaccination is necessary.

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