Botulism: ways of transmission, symptoms and treatment

Botulism – an infectious disease that cause toxins of Clostridium botulinum, the main manifestation of it is a violation of the pulse in the neuromuscular synapses, which leads to a paresis and paralysis.

Signs of botulism

Etiology

Factor in the development of the disease is the ingestion of toxins produced by the microorganism Clostridium botulinum. Bacteria is a movable wand with a large number of flagella. Microscopy of the smears it is evident that agents are arranged in chains or randomly.

Eight known serological variants of bacteria, which are denoted by Latin letters from a to G. To human pathogenic strains A, B, E, F.

Optimal growth conditions is a neutral environment, the temperature 30-350C, the absence of oxygen. Subject to the specified mode bacteria multiply and produce a toxin that is the cause of the infection.

If conditions become unfavorable, the pathogens form spores, which greatly increase their survival rate. If vegetative forms kept boiling for five minutes, then breaks down, then the spores are destroyed only under autoclaving (heating under high pressure). When hit in favorable conditions the spores of the newly developing vegetative form, which starts to proliferate and to synthesize botulinum toxin.

The toxin is destroyed by boiling for ten minutes, it does not apply salt, spices, gastric juice, acid.

Epidemiology

The source of infection in nature are warm – blooded animals, including man. In the body they are in the intestine where it stand out in the environment. They are found in soil, water, bottom sludge, shellfish.

When injected into the body pass it in transit, without causing pathology. A sick man and a carrier of the pathogen is not present epidemic the danger of Contracting them is impossible.

Botulism is transmitted by the faecal-oral mechanism. The main route of spread is the food. The disease occurs when you eat foods that are in anaerobic conditions (canned foods), as they are pathogen multiplies, releasing the toxin.

There is also a wound transmission path, when the soil with Clostridium pollute crush or a deep wound. Clostridia fall into oxygen-free environment, where conditions are favorable for infection. Bacteria multiply and produce toxin. This path is typical for addicts using "black death" – the method of preparation of heroin, which uses the soil.

In infants, the organism can multiply in the intestine, directly causing botulism. In 19% of cases observed that children received the honey, which is mistaken for the source of the infection. Most often, infants were on artificial feeding, which also added honey. Presumably, the spores enter the bee, pollinating the places of grazing. In the education of children in asocial families with low income, adverse sanitary conditions, and where child care is paid little attention to the possible entry of the pathogen from the environment: dust and dirt of the room. In this case, the implemented contact and by airborne dust pathway.

Sensitivity to the effects of botulinum toxin is very high, even the minimum dosage produce active reaction.

Botulism is most often revealed in the form of isolated cases or familial outbreaks, when all the relatives had the same dish. It usually occurs when you eat home-canned food, since this typically arise from the use of improper. Products do not change their appearance and taste, so that their suspect contamination is impossible, so they are the source of infection.

The immune system is not formed, as the dose of toxin is too low to cause him to react the body.

Pathogenesis

The toxin is rapidly absorbed into the blood and binds to motor neurons of the anterior horns of the spinal cord. In this area it causes a reversible violation of the exchange of carbon cells, which cease to produce the important neurotransmitter acetylcholine. This leads to the suspension of conducting of impulse at the neuro-muscular synapse, so the excitation of nerve cells on the muscle ceasestransfer.

Botulinum toxin inhibits the activity of the parasympathetic nervous system, which causes pupil dilation, dryness of mucous membranes, constipation.

The symptoms of botulism

The incubation period is short – up to six hours. In rare cases it lasts up to ten days.

The initial symptoms are varied, are nonspecific, making it difficult for early diagnosis.

Begins with symptoms of the digestive tract: abdominal pain, occasional vomiting, diarrhea. Concerned about severe dry mouth.

Characterized by a syndrome of visual impairment by type of hyperopia: difficult perception of near objects. Are developing complaints of "grid before eyes", "fly", the double vision. Dilated pupils, lowered eyelids, sometimes strabismus occurs.

Appears and increases muscle weakness. In the end, the victim can't walk, open my eyes. Also affects the respiratory muscles; oppression of breathing, hypoxia, which can lead to death.

Loss of muscle leads to difficulty swallowing, change of voice timbre. When choking food and fluid can enter the lungs, causing aspiration pneumonia.

The lack of oxygen leads to acidosis (lower blood pH), brain edema, which exacerbates the picture of poisoning.

Botulism does not cause a rise in body temperature.

Thus, the main syndrome of the disease is the paralytic.

Diagnostics

Botulism does not cause any specific changes in clinical tests. Sometimes noted an increase in the number of monocytes in the blood test.

To confirm the diagnosis is carried out the detection of toxin in biological material. For this purpose of infection by toxin cook four mice. Each of them enter your toxoid, after which the botulinum toxin. The surviving animal will indicate what remedy will be effective.

Also conduct serological tests with a special serum that reacts to the poison, but they are less accurate.

Treatment

Since botulism is often accompanied by respiratory failure and severe complications, the treatment is carried out under conditions of infectious hospital equipped with an intensive care unit.

The first stage is washed with the stomach and intestines to remove the source of toxin. Then enter up to three doses of antitoxic serum.

Simultaneously with these activities, conduct detoxication therapy by infusion up to three liters in combination with diuretics.

Important is the suppression of individual symptoms of the infection:

• Respiratory distress – transfer to ALV.
• The inability to take food due to paresis of the muscles of the pharynx – tube feeding.
• Massage and turning of the patient to prevent bedsores.
• The installation of a urinary catheter if you cannot urinate due to an infection.

Prevention

Is in compliance with the sanitary standards in the preparation of salting, Smoking, pickling.

To avoid illness, it is better not to buy a smoked, salted and pickled products "with hands".

At the outbreak of botulism suspected to toxin content of the products are removed and sent for diagnosis to identify the source of infection of the Person who consumed them together with the patient for twelve days under the supervision of a physician. At the first sign of intestinal infection hospitalitynet them. Possible prophylactic administration of antitoxic serum.