Symptoms and treatment of botulism

2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14

Botulism is an acute foodborne infection that occurs when botulinum toxin enters the human body. Infection occurs through the fecal-oral (alimentary) route, mainly through the use of canned food containing botulism spores.

The disease manifests itself as damage to the nervous system, manifests itself in the form of muscle paresis and paralysis. Botulism is dangerous because it can lead to irregular heart rhythms and respiratory failure. Diagnose it based on information from the anamnesis and the results of a neurological examination.

What is botulism: the pathogenesis of the disease

The harmful toxin is produced by the bacterium Clostridium botulinum, a gram-positive spore-forming bacillus, an obligate anaerobe.

In unfavorable conditions, it is in the form of a dispute.

The latter can be kept dry for decades and are activated when placed in optimal conditions: high temperature (+ 35 ° C), lack of oxygen.

When boiled, vegetative forms of bacteria die after 5 minutes, and at a temperature of 80 ° C - after half an hour. Fungi (spores) of botulism remain viable in boiling water for 30 minutes and only die in an autoclave.

The toxin produced by the bacterium is destroyed during boiling, but remains in food, canned food, pickles, which contain many spices, while their taste does not change in any way. It should be noted that botulinum toxin in medicine belongs to the strongest biological toxic substances.

Clostridium botulism spreads from the soil. Also, the source and reservoir for it are wild and a number of domestic animals (horses, pigs), birds (mainly waterfowl), rodents. Bacteria are generally not harmful to animal carriers, bacteria are excreted along with feces and enter the environment. Seeding is possible when the carcasses of animal carriers decompose.

The infection is transmitted, as mentioned, by the fecal-oral route through food. More often people become infected by eating spore-infected vegetables, mushrooms, salted fish and meat. The main condition for the multiplication of bacteria in food and the accumulation of toxins is the absence of oxygen (eg, tightly closed canned food).

Infection can occur through wounds and ulcers, leading to wound botulism. Botulinum toxin is absorbed into the blood from the gastrointestinal tract, mucous membranes of the respiratory tract, eyes. In case of poisoning, cases of family infection are often noted. The disease is quite common due to the popularity of home canning.

Symptoms of different forms of botulism

The incubation period, as a rule, lasts no more than a day, mostly 4-6 hours. There are times when it lasts up to 10 days. For this reason, it is necessary to observe people who ate the same food with the sick for 10 days.

The initial stage of the disease is accompanied by nonspecific prodromal symptoms.

There are several forms of the disease, which are classified depending on the predominant syndrome: eye, gastroenterological, in the form of acute respiratory failure.

1. Most often, there is a gastroenterological form of the disease, which proceeds as a food toxicoinfection. In this case, a person has symptoms such as pain in the epigastric region, nausea, vomiting, and upset stools (diarrhea). Enteral symptoms are mild, but dry skin is observed, inappropriate to overall fluid loss. Often patients complain of difficulty swallowing food, or rather, a lump in the throat;
2. The development of the disease in the ocular form is accompanied by visual impairment. The patient has a loss of clarity, fogging, "flies" in front of the eyes, decreased visual acuity. In some cases, acute hyperopia develops;
3. Acute respiratory failure, as one of the forms of infection, is the most dangerous. It is accompanied by such signs as spreading cyanosis, cardiac arrhythmias, sudden and progressive shortness of breath. Signs develop very quickly, death in this case can occur in 3-4 from the moment of their appearance.

Other signs and symptoms of botulism

When the infection progresses, the clinical picture becomes specific: there are paresis and paralysis of different muscle groups. Symmetrical ophthalmoplegia is also observed: the pupils are steadily dilated, there is strabismus (usually converging), drooping of the eyelids, vertical nystagmus.

With progressive paresis of the pharyngeal muscles, dysphagia is observed - a disorder of swallowing. At the initial stages of the development of the disease, difficulties arise only with swallowing solid food, but as it progresses, it is impossible to swallow liquid food either.

Also, speech impairment appears, which has 4 stages of progression. At first, hoarseness appears, the timbre of the voice changes. This is due to insufficient moisture in the mucous membrane of the vocal cords. With the development of muscle paresis, dysarthria occurs - the so-called porridge in the mouth. Then the voice becomes nasal, which is caused by paresis of the muscles of the palatine curtain. After paresis of the vocal cords, it completely disappears.

Since the innervation of the muscles of the larynx is disturbed, the cough push is lost. In this case, a sick person may suffocate if liquid or mucus enters the respiratory tract.

Botulinum toxin provokes paralysis and paresis of the facial muscles, provoking dysmimia and facial asymmetry.

Also, the patient has such signs of the disease as gait disturbance (instability) and deterioration in general well-being.

Due to paresis of the intestinal muscles, the diarrhea that occurs at the beginning is replaced by constipation.

Diagnosis of infection

This infection is not accompanied by fever, but sometimes the temperature can rise to subfebrile numbers. With regard to cardiac activity, there is a slight increase in peripheral blood pressure, increased heart rate. The disease is not characterized by sensitivity disorders or loss of consciousness.

First of all, an examination by a neurologist is required. The diagnosis is made on the basis of the clinical picture and anamnesis data. In the midst of an infection, the pathogen can be identified by ELISA, RIA and PCR methods.

Botulism treatment

Therapy should be carried out only in a hospital setting. It should be possible to connect mechanical ventilation in order to timely help the patient with the development of complications. First of all, the stomach is washed out to the patient. The toxin circulating in the blood is neutralized with polyvalent anti-botulinum sera according to the Bezredki method (after desensitization). If the introduction of monovalent serum of type A, B or C did not help, and the symptoms worsen, it is reapplied after 12-24 hours.

The administration of anti-botulinum human plasma is effective for botulism, but this is a rather rare drug. Anti-botulinum immunoglobulin is now widely used.

To destroy Clostridium fungi, antibiotic therapy, ATP and cocarboxylase are prescribed. Basically, doctors act on the basis of the existing symptoms and the severity of the disease. The artificial lung ventilation device is connected in case of acute respiratory failure. With paresis of the larynx, feeding is carried out through a tube or parenterally.

At the stage of recovery, physiotherapy procedures are prescribed to restore muscle function.

Forecast for the future

With severe poisoning (receiving a large dose of toxin) and the absence of medical assistance, the prognosis is very unfavorable.

In such a situation, the risk of death rises to 60%. If a serious patient was provided with medical care on time, then the risk decreases to 3-4%, but still exists.

Treatment started on time is the key to a speedy recovery. Muscle functions can be fully restored after a few months.

Disease prevention

As in all other cases related to infection with various infections through food, it is required to strictly observe sanitation and hygiene, especially in home-made preservation, sterilization of dishes for long-term storage products.

Fish and meat can only be preserved fresh; first, they must be thoroughly cleaned of various contaminants.

Overripe foods cannot be preserved. At home, you need to strictly adhere to the recipe, add a sufficient amount of salt and acid to the vessels open for oxygen.

Take care of your health and do not self-medicate!