Botulism is an acute infectious disease caused by poisoning with botulotoxin entering the human body due to the use of various foods containing botulinum toxins and characterized by severe damage to the autonomic and central nervous systems
The causes of botulism
Bacteria botulism anaerobes, i.e. can exist only in places with no air. The place in which botulism is constantly inhabited is the soil. It is from this that they then enter the water, food, vegetables, fruits, and ultimately into the intestines of animals (fish, birds, invertebrates, mammals) or humans. Bacteria of botulism are widely distributed in nature in two forms - in spore and in vegetative. The vegetative form of these bacteria dies after 30 minutes at a temperature of 80 degrees and in five minutes - at boiling. Spores (spore form) are extremely resistant to chemical and physical factors, since they can withstand five-hour boiling and die only after 30 minutes at a temperature of 120 degrees.
One of the features of botulism is that if they are not warmed up properly, dormant spores can often form from vegetative forms, "which germinate only after six months. These spores are very resistant to direct ultraviolet radiation, drying and freezing. In anaerobic (airless) or close to them conditions (animal meat, canned food), spores are activated and begin to release toxins, which are 375,000 times stronger than the poison of the rattlesnake.
In the usual external environment, botulinum toxins can last up to one year, but in canned foods - for many years. They are not destroyed by enzymes of the digestive tract, they are stable in acidic medium, easily maintain a very high concentration of table salt (about 18%). But when boiling for fifteen to twenty minutes, or under the influence of alkalis, the toxins quickly decompose and lose toxic properties. You should also know that the presence of botulinum toxin in foods does not affect their taste qualities.
The source of causative agent of botulism is the contents of the intestine of domestic and wild animals, mollusks, fish, birds, sea or lakes, and soil.
Most botulism develops after eating various canned foods (fish, mushroom, meat, vegetable), salted and smoked fish (and other smoked products), sausages and hams. The most dangerous are products cooked at home, as well as those that for some reason were contaminated by soil.
With wound botulism, toxin formation occurs in necrotic tissues, and with botulism of infants - in the intestine. Botulinum toxin can selectively affect the cholinergic parts of the nervous system, resulting in the elimination of acetylcholine in the nervous synapses and the development of muscle paralysis
Symptoms and course of botulism
The incubation period of botulism can range from several hours to two to five days (in severe cases, usually not more than 24 hours). It was noted that the shorter the incubation period, the more severe the course of the disease will be.
As a rule, botulism begins suddenly. There is a pronounced general weakness, dizziness, headache, the overall well-being worsens, the body temperature is within normal limits or slightly elevated. In the abdomen begin cramping sharp pains, loose stools, nausea, vomiting. After a day, these manifestations are replaced by considerable dryness in the mouth, bloating and constipation . Further, after a short enough period of time, there are visual disturbances: the patients can not read, they see very indistinctly, there can be a double vision of objects. Due to incomplete paralysis (muscle paresis) of the face, wrinkles and nasolabial folds are smoothed, eyelid drooping is observed. With further progression of the disease, hoarseness appears (further, the voice can generally vanish) and swallowing is impaired. A very terrible sign, which indicates an unfavorable course of the disease, is a violation of breathing. Patients feel heaviness in the chest, lack of air, breathing becomes superficial, pains in the chest can be present, paresis of respiratory muscles develops (the cough reflex disappears). In particularly severe cases, due to a breathing disorder, a fatal outcome may occur
Diagnosis of botulism
The diagnosis of botulism is established based on the history, laboratory and clinical studies. Of great importance is the early diagnosis of this disease, based on the presence of typical clinical signs: As a rule, the absence of a febrile reaction, acute onset with symptoms of general intoxication, complete absence or very mild diarrheal syndrome, further nausea (rarely vomiting), constipation, ophthalmoplegic syndrome, weakness of skeletal muscles, respiratory disorders, pallor of the skin, hemodynamic disorders.
Epidemiological history plays an important role in the diagnosis of botulism: massive diseases of people who at one time used the same food (canned mushrooms, vegetables, meat, home-made juices, dried fish, smoked products, canned food).
Laboratory diagnostics of botulism consists in the study of leftovers of food products, feces, gastric lavage, vomit and blood. The presence of botulinum toxin in the test material is determined by the biological method.
It is necessary to conduct a differentiated diagnosis with stem encephalitis, rabies, poliomyelitis, with other food toxic infections, as well as intoxications of another etiology; Poisoning by poisonous fungi, methyl alcohol, belladonna, atropine
Treatment of botulism
All patients without exception, with the slightest suspicion of botulism, must immediately be hospitalized in an infectious hospital for urgent emergency treatment aimed at preventing possible serious complications. The primary objectives of emergency therapy are to ensure the functions of the cardiovascular and respiratory systems of the body, as well as neutralization, binding and subsequent removal of toxins from the body. In the case of the attachment of paralysis or paresis of the muscles of the larynx and pharynx, respiratory failure in botulism is significantly increased. This contributes to a serious deterioration of airway patency, as well as the development of atelectasis and aspiration pneumonia. Therefore, even at the pre-hospital stage, urgent measures should be taken such as: gastric lavage, initially boiled water, followed by 2% sodium hydrogencarbonate; give the patient a salt laxative (for 500 ml of water 30 g of sulfuric magnesia), and further enterosorbents (enterodes, polyphepan, etc.); make a cleansing enema with a polyphepan or 2-4% of sodium hydrogencarbonate; to appoint frequent copious drink with the introduction of diuretics (hypothiazide, lasix, etc.).
In particularly severe cases, it is necessary to perform an infusion detoxification therapy with forcing diuresis, administering guanidine hydrochloride at 20-35 mg / kg / day. When acute respiratory failure is carried out artificial respiration. When the respiratory paralysis, the patient is transferred to the artificial ventilation of the lungs. To neutralize botulinum toxin, therapeutic monovalent anti-botulinum serums are used. Since in the digestive tract, spores can be transformed into vegetative forms, antibiotic therapy is shown: tetracycline drugs or levomycetin.
Even in the case of timely provision of qualified medical care, recovery of patients with botulism is slow enough. Residual phenomena after paralysis can be observed for another one to two months
Prevention of botulism
Before use, a careful check of canned products is necessary, mandatory removal of "bomb" (inflated) cans. Before consuming it is necessary to warm (100 * C - 30 min.) Cooked at home, mushroom, meat and vegetable canned food.
After sampling for laboratory tests, the products that caused the infection must be removed and destroyed. Tableware, which is in contact with contaminated products, as well as underwear contaminated with the discharge of the patient, are thoroughly disinfected. People who used the products that caused the disease showed mandatory introduction of anti-botulinum serum with subsequent medical supervision for at least ten days.