Miscellaneous

Botulism: Symptoms in humans, the first signs of botulism

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The disease is caused by bacteria Clostridium botulinum, which is present in foods. Pathology suddenly develops after eating contaminated food botulism stick, sometimes quite benign in appearance, it appears paralysis and paresis.

In the initial stage of development, it is easy to be confused with gastroenteritis - an inflammation of the mucosa of the small intestine and stomach. In late therapy, a high concentration of poison taken into the body and in severe cases lead to death.

What it is?

Botulism - an infectious disease that develops as a result of contact with the human body the bacteria Clostridium botulinum waste product - botulinum toxin. The disease occurs in these days are rare, recorded about 1,000 cases per year worldwide. The disease continues to be deadly. Its main source of food, but stand out among others.

Classification

There are four kinds of botulism:

  1. Food (at infection by consumption of food products containing botulinum toxin);
  2. Wound (if contaminated open wounds contaminated soil);
  3. insta story viewer
  4. Childhood Botulism (children up to 6 months due to falling spores Clostridia in the gastrointestinal tract; source is most often an infected soil, household dust, less honey);
  5. Botulism unknown etiology.

According to the severity of botulism is divided into an easy, srednetyazholuyu and heavy forms. See also: epidemiology of botulism.

How do you get?

Pathogen - Clostridium botulinum - are widely distributed in nature with a permanent habitat in the soil. It produces spores are extremely resistant to physical and chemical factors.

  • Spores kept refluxing 5 hours and at a temperature of 120 deg. Celsius die within 30 minutes. In a medium with a small amount of oxygen multiply and form a toxin. The toxin is partially destroyed by heating to 70-80 deg. Celsius under reflux for 5-15 minutes completely destroyed. Botulinum Toxin - one of the strongest known naturally occurring poisons, its lethal dose for a human is about 0.3 mg.
  • Reservoir botulism agents in warm-blooded nature are, at least cold-blooded animals, in the intestine which are Clostridium, feces excreted into the external medium. Sam pathogen does not cause human disease, only dangerous toxin. For the occurrence of poisoning must be multiplication of the pathogen to the accumulation of botulinum toxin in the environment mlenkim the amount of oxygen (ham, sausages, canned foods, salted fish), as well as canned vegetables, fruits, mushrooms.

In recent years, the occurrence of botulism has increased the role of canned mushrooms. The accumulation of toxins occur particularly intense at 22-37S. A person becomes ill, consuming foods that contain botulinum toxin. The patient is dangerous to others.

incubation period

The average incubation period for the disease may last from several hours to one day. Its duration is determined by the number of infections, which happened in the body.

Term of poisoning before the first signs of botulism can be up to 2-3 days or even 10 days, but such cases are rare. cases have been recorded, when the duration of the incubation period, increased in relation to the use of alcohol patients.

Manifestations of the disease often have a sudden character, strongly resemble symptoms of food poisoning. The toxin from contaminated food is rapidly absorbed in the intestine into the blood stream and instantly spread throughout the body. At the same time defeat the object becomes vital organs.

The earlier botulism makes itself felt, the more severe is the disease.

The first signs

Among the first symptoms of botulism include:

  1. Sharp abdominal pain with cramping in nature.
  2. Nausea and uncontrollable vomiting.
  3. Diarrhea, stool is frequent and liquid, no impurities in it does not.

This early signs of botulism, many of them associated with the usual food poisoning and did not go to the doctor, relying on their own strength, thus only worsen his condition and prognosis.

symptoms of botulism

botulism above symptoms last for about a day, then there is bloating, a feeling of "fullness" in the stomach, diarrhea, constipation is replaced. Due to such displays of development of intestinal paresis. Affects the motor neurons responsible for peristalsis. Accordingly, this leads to the fact that peristalsis disappears, no passage through the intestines, it accumulate gases stool.

Neurological symptoms appear after gastrointestinal. Among them:

  1. A person becomes like a mask, facial expression is absent, the patient is unable to stick his tongue.
  2. Separately worth noting the muscle weakness, it is manifested in almost all muscle groups.
  3. Among the first affects the motor neurons that innervate the neck that causes their paralysis, head hanging down, and to keep it in the normal position, the patient has to hold her in his arms.
  4. Among the neurological symptoms are also the omission of one or two of the upper eyelids, dilated pupils, weak reaction of pupils to light, or lack thereof, strabismus, nystagmus, weak convergence.
  5. The patient is lethargic, he was concerned about the diffuse nature of the headaches, dizziness, weakness, usually no fever.
  6. The weakness of the intercostal muscles causes respiratory disorders, breathing becomes shallow. Gradually there is a weakness in the limbs.
  7. Double vision, feeling the mist before his eyes, the inability to see small details, difficult to read, it is due to the paralysis of accommodation.

Also there is a violation of the cardiovascular system, cardiac auscultation revealed muffled tones. Because of respiratory disorders hypoxia (lack of oxygen in the blood). The appearance of respiratory failure is a poor prognostic sign, since it is the main cause of death in people with botulism.

There are other symptoms of poisoning, botulism occurs dryness of the mouth, mucous membrane of the mouth is dry, bright red color. The supraglottic area is an accumulation of clear mucus, which eventually becomes a whitish color. Change voice becomes muffled, the patient worried feeling of "lump" in the throat.

complications

The most frequent consequences of botulism - is:

specific myositis (often affects the hip, occipital and calf muscles, it manifests itself in the form of swelling, pain and difficulty in movement) and the defeat of nervous knots of the heart with the subsequent formation arrhythmias
Secondary bacterial complications pneumonia, atelectasis, purulent traheobranhit, pyelonephritis, sepsis.
Iatrogenic (post-treatment) serum sickness, hyperglycemia, hyperphosphatemia, atrophy of the intestine.

Diagnostics

The diagnosis is usually made on the basis of medical history (a reference to the use of poorly processed food), clinical examination and bacteriological studies of feces, vomit, washing waters of the stomach and intestine, the contents of the wounds, the suspect food.

Also conduct detection of the toxin in the test materials of biological method (white mice).

How to Treat Botulism?

Algorithm intensive care patients botulism includes:

  • gastric lavage to remove residual toxin from the stomach;
  • intestinal dialysis (5% soda solution);
  • antitoxic serum (type A, C, E of 10,000 ME, type B 5000 ME);
  • Parenteral administration infusion media for the purpose of detoxification, correction fluid and electrolyte disturbances and protein;
  • antibiotic therapy;
  • hyperbaric oxygen therapy as a means of eliminating hypoxia;
  • complications of therapy.

Botulism Treatment consists of two directions. The first - to prevent the implementation of the hypothetical possibility of the formation in vivo toxin excretion of the poison from the body to neutralize the toxin circulating in the blood. The second - the elimination of botulinum toxin caused by pathological changes, including secondary.

  1. All patients and those with suspected botulism are subject to compulsory hospitalization. Regardless of the timing of its treatment is initiated with gastric and intestinal lavage with 2% solution of sodium hydrogen carbonate (soda) and siphon enema with 5% sodium bicarbonate solution volume up to 10 liters for removing not yet vsosavshegosya toxin. Gastric lavage is advantageously carried out in the first 1-2 days of illness, when the stomach can still remain an infected food. Washing is carried out with a probe in order to avoid possible aspiration of wash water, in small portions fluid, especially in the presence of respiratory failure, so as not to cause a reflex stop breathing.
  2. In the treatment of botulism used antibiotics. It is indicated for the prevention and treatment of inflammatory processes caused by botulism agent, who has fallen into the intestine, and also to prevent frequent complications (pneumonia, cystitis). If not broken swallowing, the prescribed chloramphenicol 0.5 g 4 times a day for 5 days or ampicillin at 0.75-1 grams per day.
  3. Glucocorticoids are used as pulse therapy, warning allergic reaction to a heterogeneous antitoxin sera. Also glucocorticoids used to treat serum sickness.

Also prescribed chelators (Polyphepanum, Enterodesum, microcrystalline cellulose, etc.). Daily injected intravenously with 400 ml laktasol, diuretics (furosemide, Lasix 20-40 mg). It is necessary to monitor compliance with the water-electrolyte balance, energy supply. Assign metabolic means of support, such as glucose-potassium-magnesium mixture Riboxinum, ATP, vitamins (mainly groups B).

Rehabilitation

The man who had endured botulism, shall, within 2 weeks, be supervised by district physician after discharge. If he has observed residual effects, be sure to also monitored by a cardiologist (myocarditis), neurologist, ophthalmologist (at the implications of the organs of sight). When indicated in the recovery period, the physician may prescribe medication to a patient treatment - drugs against atrophy of the optic nerves, vitamins, nootropics, cardiovascular agents.

  • For 3 or more (under indications) months, the patient should avoid excessive physical activity. Banned are specialized athletic training, heavy physical work, work, implying strong tension relating to the visual analyzer.
  • Special attention to patients undergoing botulism should be given to its diet, its calorific value and composition. It is recommended to eat 4 times a day, making it within the prescribed period. Not allowed to include in the menu fatty and spicy food, limit salt welcome. Animal fats, it is desirable to give up in favor of the plant, provide enough protein. vitamins shortage may be replenished reception special complexes - komplivit, vitrum, alphabet and so forth.

Also, a person ill with botulism, can be assigned to physiotherapy. These include water manipulation (therapeutic shower, bath), hardening, oxygen inhalation, electrosleep. This is necessary to get rid of the residual effects of hypoxia, if the disease is acute. Bring health benefits and general treatments, including physiotherapy, massage, swimming in the pool. All this together will accelerate the process of restoring the normal functions of the muscular system.

The physician may recommend to the patient to carry out the rehabilitation period in the health facility specializing in nervous system diseases.

Prevention of botulism

Major preventive measures against infection is to create conditions that prevent the growth and reproduction of bacteria and spores of the pathogen to prevent falling into the food. The latter includes measures to maintain cleanliness in places where prepared food products, which are a favorable place for the development of the causative agent.

home canning products in hermetically sealed containers are the most dangerous to humans, as in the home to achieve the complete destruction of Clostridium botulinum is impossible. Most of all it concerns the mushrooms, wash them because of the soil particles, which contains botulinum spores, very difficult.

Before use canned necessary to warm the opened cans at 100 ° C for 30 minutes (in boiling water) to destroy the toxin. Food products which are not subject to heat treatment, but which are suitable location for toxin (salted and smoked fish, bacon, sausage), must be kept at a temperature not higher than 10 ° C.

To which the doctor ask

For suspected botulism (nausea, vomiting, fever, diarrhea occurred after consumption of canned home-made), you must call "ambulance", which will take the patient to the infectious hospital. In addition to an infectious disease physician at the patient's treatment may participate neurologist, in severe cases - a physician anesthesiologist.

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