Botulism is an infectious-toxic disease caused by toxins of bacteria Clostridium botulinum. The disease is widespread. The source of the pathogen is warm-blooded animals, fish and humans, with whose faeces, clostridia enter the environment, where they turn into spores. In this form, they can be stored in water and soil for a long time. In this article we will talk about the symptoms and treatment of botulism.
Once in the food, bacteria multiply rapidly in the absence of oxygen, releasing toxin. Most often botulism develops when eating canned vegetable, meat, mushroom or fish products, especially those prepared at home. Botulism may be infected by eating sausage, ham, smoked fish, and canned food. There are cases of wound botulism, which develops when bacteria enters the wound.
It should be noted that a person who is sick with botulism is not harmful to others.
The incubation period for the disease lasts several hours, sometimes several days. The main signs of botulism are neurological symptoms. Symptoms of gastroenteritis and general intoxication are detected only in half of the patients. Patients complain of severe abdominal pain, accompanied by repeated vomiting. A little later, diarrhea joins, the stool is liquid up to 10 times a day without any impurities. Intoxication syndrome is characterized by fever up to 40 ° C, malaise, and headaches. By the end of the first day, intestinal atony occurs, and diarrhea is replaced by persistent constipation, and body temperature is normalized.
After gastrointestinal symptoms begin to show neurological. The most typical early signs of botulism are visual impairment. Patients complain about the veil before the eyes, doubling of objects, it is difficult for them to distinguish between nearby objects. Then ptosis develops (the descent of the upper eyelids) and progressive muscle weakness.
Muscle weakness increases with the progression of the disease. At the beginning it is expressed in the occipital muscles, it is difficult for patients to hold their heads. Due to the increasing weakness of the intercostal muscles, shallow breathing becomes, it seems to the patients that the chest is compressed. Patients are adynamic, lethargic, mask-shaped face, the development of strabismus is possible. It is difficult for patients to stick their tongues out of their mouths.
Due to the atrophy of the muscles of the larynx, the pitch and timbre of the voice change, sometimes the nasal tone develops, the voice becomes hoarse. One of the typical signs of botulism is a violation of swallowing. First, patients have difficulty swallowing solid foods, and then fluids. In the most severe cases, complete aphagy occurs, when trying to swallow water, it pours out through the nose. In this period, aspiration pneumonia may develop due to the aspiration of food pieces, water or saliva. Due to paralysis of the diaphragmatic muscles, sputum discharge is disturbed, its accumulation can lead to asphyxiation.
Another mandatory symptom of botulism is a violation of salivation, patients complain of dry mouth. The mucous membrane of the mouth and pharynx is bright red.
Botulism requires emergency treatment in a hospital where emergency care can be provided for the progression of the disease and the development of complications.
At the first signs of the disease it is necessary to perform a gastric lavage. First, use boiled water, and vomit to collect for the study. In the ambulance and in the hospital for washing using probes. After washing the stomach, enterosorbents are prescribed to neutralize toxins from the intestinal lumen.
Simultaneously with the mechanical removal of botulinum toxin from the gastrointestinal tract, the patient is injected with anti-tumuli serum. The introduction of serum is made in the case of diagnosis according to clinical data, without waiting for laboratory confirmation of botulism. Serum is reintroduced and in the following days of treatment, the frequency of administration depends on the severity of the disease. The criterion for evaluating the effectiveness of antitoxic serum is the reverse development of symptoms of botulism. Usually, dry mouth disappears first, then neurological symptoms gradually disappear.
The treatment regimen also includes detoxification therapy, the administration of solutions is carried out intravenously (5% glucose solution, lactasol). In order to correct diuresis, diuretics can be prescribed.
All patients are prescribed chloramphenicol to suppress the vital activity of the pathogen. Instead, the drug may be prescribed ampicillin or tetracyclines. If purulent complications develop, antibacterial therapy is prescribed.
In case of progression of paralysis of the respiratory muscles, the doctor may decide to connect the patient to the ventilator.
Prevention of botulism
The main preventive measures are to comply with the rules for the preparation and storage of canned products, meat and fish semi-finished products.
In the event of a disease, suspicious products must be seized and subjected to laboratory monitoring. People who, along with the sick, consumed these products, should be under medical supervision for 10-12 days. Intramuscular administration of antitoxic antibotulinic sera and administration of enterosorbents is shown.
Immunization with polyanatoxin is carried out only to those who may have contact with botulinum toxins.
Which doctor to contact
If botulism is suspected (nausea, vomiting, fever, diarrhea that has arisen after eating home-made canned food), it is necessary to call an ambulance, which will take the patient to an infectious hospital. In addition to the infectious diseases doctor, a neurologist may be involved in treating a patient, in severe cases an anesthesiologist-resuscitator.