The first signs of botulism: diagnosis, treatment and prevention

Sign of poisoning

Botulism – an acute infection, a characteristic manifestation of which is a paralytic syndrome. Striking as the older population and children of any age.

The first outbreak of infection is described in 1793, it happened in the town of württemberg, Germany. Poisoning linked with the consumption of blood sausage. In more detail the clinical picture was described in 1818 in Russia the researcher Sagenbuch. He noted the link between infection and consumption of smoked fish.

Pathogen isolated in 1894 by van Ermengem from the intestines of the dead from botulism and ham that they used. He proved that the symptoms associated with toxin action.

In Germany the disease called "botulism" as he linked it with sausage (botulus, sausage). In Russia it is marked as "atheism" because the "culprit," thought the fish (ichtios).

The work of Ermengem supplemented by, information about Clostridium expanded, isolated new types of the pathogen. Only eight known strains, designated by Latin letters A-G.

Etiology

Causes this disease is the toxin of a bacterium called Clostridium botulinum. It is a fusiform movable wand with many flagella. Best of all, it multiplies in an oxygen-free environment (anaerobic) at a temperature of 300C and in a neutral environment.

In adverse conditions to form a protective form – dispute. On one end there is a thickening, so looks like a tennis racket. In this state, the bacteria persist for decades, can withstand temperature range from +1200C to — 190oS not be subject to the action of disinfectants.

Epidemiology

Clostridia are widespread everywhere. They live in soil, water, often colonize the intestines of fish and animals without causing disease. Free-living bacteria are not dangerous to humans, as it does not produce a toxin. Its accumulation occurs in the finished products: fish, meat or vegetable preserves, pickled mushrooms, jams and other things.

If the product was not processed before preserving it remains the microorganisms, in an oxygen-free environment, they begin to proliferate, releasing a toxic substance into the product. Its presence in canned food does not change its appearance and taste, therefore, the use of untested products dangerous.

In the body the bacterium enters either through the digestive tract with food or through a wound surface with the pollution of its soil. In infants is possible the multiplication of clostridia with the release of the toxin in the intestine, in adults, this path is not found.

Have younger children it is impossible to detect contact with an infected products that cause poisoning. Since botulism most often affects infants on artificial feeding, think spores into the mixture along with the honey. Exciter bring him bees collecting pollen in the meadows, where grazed the cattle, the distribution of microorganism.

The peak incidence occurs in autumn and winter.

Pathogenesis

Factor that ensures the development of infection is the botulinum toxin.

Botulinum toxin is more poisonous than potassium cyanide.

It acts on motor neurons located in the anterior horns of the spinal cord, and interrupting the movement of impulses along them. It explains the main symptoms of poisoning: flaccid (peripheral) paralysis. Because of the weakness of the respiratory muscles, the respiratory movements become insufficient, is formed by progressive hypoxia.

Due to lack of oxygen disturbed function of the nervous system. Develops pathology of blood coagulation that leads to thrombosis, ischemia and disruption of those bodies, where they formed a clot. The progression of the disease leads to a buildup of respiratory failure and death.

The immune system is not formed, since even a lethal dose of toxin is so small that it does not stimulate the immune system.

A typical picture of the disease

The incubation period of botulism lasts from eight hours to ten days, depending on the amount trapped in the body of the toxin.

Initial signs of botulism – muscle weakness, spongy feet, fatigue. Gradually these disorders progress, which the victim could not stand up, keep my head in the air, raise your hand.

One of the early symptoms – a violation of salivation, manifested by severe dryness of the mouth. Because of this voicebecomes husky, on unprotected mucous membranes of the oral cavity appear cracks and scratches.

A clear manifestation of the symptoms of botulism are blurred vision. Particularly characteristic is the violation of the first near vision, that is located in front of the text to discern more complicated than something in the distance. Arise complaints about "the grid before eyes". Reduced vision is getting worse, sometimes it becomes impossible to see even her own fingers. The selection of glasses does not change the situation, as symptoms occur due to paralysis of the muscles, constricts the pupil. So they are constantly expanded, the light react poorly. Noteworthy drooping of the upper eyelid (ptosis), abnormal movement of the eyeball medially (towards the nose).

Sometimes in the first days of illness may be signs of defeat of digestive system: nausea, vomiting, diarrhea.

A symptom is severe bulbar syndrome: choking when swallowing, slurring of speech, weakness of the muscles of the tongue and soft palate. These symptoms reflect lesions of the medulla oblongata, where the centers that regulate breathing and heartbeat. Formed flaccid paralysis of the extremities, when the muscles are relaxed, motionless.

The toxin reduces the activity of the respiratory muscles, so any complaints about the difficulties of breath, suffocation. Due to the increasing hypoxia of the patient's face becomes cyanotic, the heartbeat accelerates, your blood pressure falls. Can cause respiratory failure. Impairment of consciousness for botulism are not typical.

Briefly, the symptoms of botulism are:

  • muscular weakness,
  • visual impairment,
  • paralysis of the limbs,
  • respiratory failure,
  • bulbar syndrome.

For older children the same typical picture of the disease.

Symptoms of botulism in children

To recognize the signs of poisoning in infants is quite difficult, as normally they did not reveal contact with infected products, no specific complaints of vision, disturbance of speech, gait.

The causative agent enters the body from outside, colonize the gut of the child and starts to produce the toxin. Develops muscle weakness, which manifested sluggish sucking, choking, constant constipation not responding to treatment, sluggish movements. It is possible to determine by touch that the muscles become flaccid, their tonus decreases.

The disease is extremely dangerous for children as the signs are erased, it is still unclear what assistance might be delayed.

The outcome of the disease

The symptoms of botulism regress very slowly, complete recovery may occur in a few months. The longest preserved dry mouth, fatigue when reading, hoarseness, tendency to constipation and flatulence.

Botox is a highly diluted botulinum toxin. It causes paralysis of the facial muscles than wrinkles.

Complications

For botulism weight:

  • Stop breathing and heartbeat leads to death.
  • Malfunction of the muscles of the soft palate and the throat causes difficulty in swallowing and can cause aspiration of food and death.
  • The lack of oxygen leads to brain edema and disruption of its functions.
  • The effect of the toxin on the brain can cause psychosis.
  • Inadequate ventilation of lungs leading to pneumonia.

Diagnostics

Changes detected in the study of blood and urine tests are nonspecific.

Confirm the diagnosis by seeding samples taken from feces and vomit, followed by smear preparation and microscopy it.

Use a biological method, infecting laboratory mice. In the serum of patients with botulism reveal the increase of specific antibodies, which confirms the diagnosis.

Treatment

If you suspect botulism hospitalization is required to prevent sudden complications and the need for resuscitation.

Patients should observe strict bed rest to avoid falling as a result of pressure reduction or muscle weakness. Children and patients with severe hospitalitynet immediately to the intensive care unit.

At the first sign of toxin poisoning need to call an ambulance.

What to do before the arrival of SMP?

Emergency treatment of botulism – gastric lavage, begins before the arrival of the brigade. You must remove as much poison as possible before absorption into the bloodstream. To do this, the victim drank a liter of water or 5% solution of baking soda, and then pressure is applied on the root of tongue, causes vomiting. The procedure is repeated until then, until the waste fluid is clean. At the same time washed the intestines laxative and enemas with warm water.

When you stop a heartbeat (no pulse) conduct cardiopulmonary resuscitation (recommendations 2015):

  • the palms of the hands, located crosswise and place on lower third of sternum,
  • straighten the forearm at the elbow,
  • place the body over reanimiruyet so that the elbow and shoulder joints were on the same line. With this arrangement, the push is not only due to the muscle strength and due to the weight of the body,
  • pressing to carry out so that the excursion of the chest in older individuals was 5 cm, and in children of 2-3 cm, They should be uniform, rhythmic, with a frequency of 100-120 per minute,
  • every five minutes to check for a heartbeat when the pulse stop compressions,
  • if the pulse is notrecovering, hold clicking until the arrival of SMP,
  • according to the latest recommendations, professional animators don't have to carry out artificial respiration a type of "mouth to mouth".

Therapies

First aid for botulism in hospital probe washing the stomach and intestines by siphon enema.

Then enter protivobotulinicheskoy serum, which neutralizes the toxin circulating in the blood. The first dose is administered intravenously, the second intramuscularly. It is advisable to administer it in the stomach.

Antibiotic therapy plays a lesser role, since the bacteria themselves are not pathogenic. However, it is performed to eliminate the possibility of toxin production in the intestine. In addition, a medical prevention of suppurative complications, e.g. pneumonia. Assign chloramphenicol, ampicillin course of 5-7 days.

Spend detoxication therapy, inserting intravenous 3-3,5 liters of fluid in combination with diuretics (veroshpiron).

Introduction intramuscular solution of neostigmine reduces muscle weakness. In violation of swallowing food is carried out by nasogastric tube. With the development of respiratory complications was transferred on artificial lung ventilation. With timely early treatment the prognosis is favorable. Despite the long recovery, residual symptoms are not saved.

Prevention

Primary prevention of botulism involves thorough cooking of canned foods and smoked. If you doubt the quality of the product, you can boil it for ten minutes, this destroys the botulinum toxin.

Younger children not be left alone in places of intended distribution of clostridia: on the banks of rivers, near grazing. Avoid contact with sand, soil from contaminated hands to the mouth.

The detection of outbreaks of botulism in all subjects using a suspicious product, set the surveillance. If symptoms of diseases, hospitalitynet.

Specific prevention by Polianytsia exists, but it is performed only to persons who due to their professional activities are faced with the botulinum toxin.

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