2023 Author: Philip Bishop | [email protected]. Last modified: 2023-08-25 07:54
The first signs, symptoms, prevention and treatment of botulism
Botulism is a disease that humanity officially became acquainted with in the 18th century. It was in 1793 in Württemberg that the first poisonings with blood sausage and fish were documented, 6 out of 13 victims died. The author of the modern name of the disease was a bacteriologist from Hungary, who at the end of the 19th century removed the infectious agent from the intestines of deceased patients. The invention of the first immune serum against botulism belongs to the same time period.
What is botulism?
Botulism is a dangerous infectious disease that develops as a result of ingestion of the waste product of the bacteria Clostridium botulinum - botulinum toxin - into the human body. The disease is rare these days, about 1000 cases per year are recorded all over the world. The disease continues to be deadly. Its main source is food, although others are also allocated.
On average, the incubation period of the disease can last from several hours to one day. Its duration is determined by the amount of infection in the body. The period from poisoning to the appearance of the first signs of botulism can be up to 2-3 days and even up to 10 days, but such cases are quite rare. Cases were recorded when the duration of the incubation period increased in connection with the use of alcohol by the patient.
The manifestations of the disease are most often sudden in nature, strongly resembling the symptoms of food poisoning. The toxin with contaminated products is rapidly absorbed into the intestines, enters the bloodstream and instantly spreads throughout the body. In this case, vital organs become objects of defeat.
The sooner botulism makes itself felt, the more severe the course of the disease is.
Does boiling kill botulism?
It is customary to distinguish two forms of the existence of botulism bacteria - spore and vegetative. To destroy the vegetative form, it is enough to boil the product for five minutes. The spore variety shows great resistance to boiling; it is able to endure this procedure for about five hours. Only after that, botulism spores die if the temperature reaches the desired level.
Vegetative forms of botulism, even with slight warming, have the ability to produce spores, called "dormant", which germinate after about six months. Such spores show resistance to drying, freezing, the influence of ultraviolet rays. Airless conditions are optimal for their development.
It is boiling that is the most reliable way to protect canned foods for the human body. Bacteria are not subject to acidic environments, it is useless to fight them with an increased content of table salt, they cannot be eliminated by enzymes of the digestive tract. Boiling alone is an effective preventive measure.
At what temperature does botulism die?
Temperature readings sufficient to kill botulism bacteria depend on the form in question.
- Vegetative bacteria are unable to cope with temperatures of 80 ° C for more than half an hour. Also, for their complete elimination, a five-minute boil is enough.
- Disputes are more persistent. To get rid of them, it is necessary to place the bacteria in a 120-degree temperature, keep this indicator for at least half an hour. This is not enough for certain strains.
The first signs of botulism poisoning
The first symptoms of botulism are nonspecific, short-term, reflecting manifestations of infectious intoxication and acute gastroenteritis.
The patient may be concerned about the following problems:
- severe abdominal pain, concentrated mainly in the central part;
- headache attacks;
- manifestations of diarrhea (approximately 3-5 times a day, up to 10);
- repeated vomiting;
- weakness, fatigue, malaise;
- an increase in body temperature up to 40 ° C.
Toward the end of the day, the temperature returns to normal, persistent constipation replaces the excessive activity of the gastrointestinal tract. These "improvements" should not be deceiving, you should definitely see a doctor.
Botulism symptoms and manifestations
The general symptoms of botulism are characterized by variability, determined by the variant of the course of the disease, its stage. It is customary to distinguish three options: gastrointestinal (the most common), "eye", acute respiratory failure.
At the initial stage of botulism development, the manifestations of the gastrointestinal version of the disease can be easily confused with the symptoms of food poisoning:
- vomiting (single, double);
- cramping pain attacks felt in the upper abdomen;
- diarrhea (diarrhea);
- excessive dryness of the oral mucosa, which has no normal explanation.
Also, this variant is characterized by a normal or slightly increased body temperature, a feeling of a "lump" in the throat associated with poor passage of food through the esophagus.
The "ocular" variant of the onset of botulism is less common, the characteristic manifestations are as follows:
- visual disorder;
- lack of clarity of the contours of objects;
- nets, fog, "flies" floating before the eyes;
- the effect of farsightedness, in which the patient sees poorly near objects, while distant ones are perfectly visible.
In acute respiratory failure, there is a rapid spread of obvious violations of the respiratory process. The patient can find:
- respiratory "failures" (change in number, rhythm, pace);
- blue skin;
- increased heart rate;
- shortness of breath.
In the midst of an illness, combinations of symptoms from all groups, which are listed below, may appear.
The patient has the following difficulty swallowing:
- first solid food does not give in to him, then liquid foods;
- the tongue in the pharynx remains absolutely immobile;
- the tongue also becomes inactive.
The patient can observe the eye symptoms of botulism in its midst:
- doubles in the eyes;
- eyelids droop;
- converging squint appears;
- gaze is difficult or impossible to keep in one direction.
Violations of sound pronunciation are also considered characteristic for this stage. Among them, the following manifestations are possible:
- loss of speech associated with immobility of the vocal cords;
- a feeling of porridge in the mouth;
Botulism, which is in full swing, may indicate itself and indirect manifestations:
- unsure gait;
- pronounced muscle weakness;
- problems with urination, constipation;
- feeling of dry mouth;
- blanching of the skin;
- rapid pulse.
Rare, but still occurring symptoms: inability to demonstrate teeth, make a grin, facial muscle tension, distorted face. At the same time, the patient's body temperature does not rise, his hearing remains in order, clarity of thought remains, and there are no problems with skin sensitivity.
When the disease enters its final phase, respiratory dysfunctions predominate. Patients feel a lack of air, they are forced to interrupt the conversation with pauses, a feeling of compression or tightness arises in the chest. Respiratory failure increases due to the frequent development of pneumonia.
The final period is characterized by complete relaxation of the skeletal muscles, its pastiness. Patients are unable to hold their head, their movements become very limited. Despite clear consciousness, complete immobility occurs, respiratory paralysis is fatal.
If the sick person does not receive proper treatment, the following complications and consequences threaten him.
- Secondary bacterial complications. These are atelectasis, pneumonia, pyelonephritis, purulent tracheobronchitis, sepsis.
- Specific complications. Damage to the nerve nodes of the heart, the development of arrhythmias, myositis of the occipital, femoral, and calf muscles.
- Iatrogenic complications (post-treatment). Among them are hyperglycemia, intestinal atrophy, serum sickness, hyperphosphatemia.
On average, the illness can last 3 weeks if the patient receives proper treatment. Restoration of neurological symptoms occurs in the reverse order, first breathing is normalized, then swallowing is restored. Other manifestations of the disease - nasalness, headache, and so on, can remain up to 1.5 months. In people who have had botulism, the symptoms disappear without a trace, there is no need to be afraid of disabling complications.
Causes of Botulism
The causes of botulism in humans depend on the form in question. The disease can be:
- "For children";
- to others.
Clostridium botulinum is known as an anaerobic bacterium and only develops when oxygen is absent. The food form is threatened if bacteria grow and produce harmful toxins in food prior to consumption. The bacteria produce spores that are common in the environment, including sea and river water, and soil.
The formation of bacteria, the production of toxin are observed in products under conditions of low oxygen concentration, require a certain combination of preservation conditions and storage temperatures. In most cases, this affects lightly preserved food products that have not been subjected to the necessary processing, prepared at home.
An acidic environment is not conducive to toxin production, however, previously produced toxin cannot be destroyed there. Storage at a low temperature, reaching a certain concentration of acidity and salt, can prevent the growth of bacteria.
Botulinum toxin has been found in many foods. Among them are low-acid canned vegetables - beets, mushrooms, spinach, green beans. The danger is represented by sausages and ham, fish, smoked and salted, canned tuna. The list of "prohibited" dishes depends on the state, local nuances of conservation and nutrition. There are known cases of detection of bacteria in industrial production results.
This form of the disease is much less common than foodborne botulism. It is caused by spores that penetrate the open wound of the patient, capable of reproduction in such conditions. The symptoms of the disease are largely reminiscent of the manifestations of the food form, they can occur after two weeks. The risk group is represented by people suffering from drug addiction, heroin injections are especially dangerous.
This form threatens mainly infants under six months of age. Childhood botulism is the result of a child swallowing spores that release bacteria that invade the intestines and produce toxins. After 6 months, children practically do not encounter a similar form, it is not dangerous for adults either. This is due to the fact that pore germination is prevented by natural defense mechanisms that the body acquires later.
There are several sources of infection, the most famous and dangerous of them is honey. That is why doctors do not recommend feeding children under one year old with this product.
The symptoms of illness in nursing infants are also different:
- inability to hold the head;
- hoarse crying;
- lack of appetite;
- stool problems;
- deterioration of the sucking, swallowing reflex.
Household dust and soil are also a threat to children. The children's form is characterized by a long incubation period, babies are more susceptible to complications such as pneumonia, and the risk of death increases.
This form of the disease is extremely rare. Its appearance in natural conditions is not possible, it is influenced by premeditated (biological terrorism) and accidental events associated with the release of toxins in aerosols. The same clinical manifestations are characteristic that can be observed with foodborne botulism. The rate of onset of the first symptoms depends on the level of poisoning, on average it takes 1-3 days.
In theory, the spread of the disease through water is not excluded if a previously produced toxin is ingested. However, the danger is minimal, as wet processing kills bacteria. Doctors diagnose "undetermined botulism" if it is not possible to establish the source that provoked the patient's wound or food form of the disease.
Prevention of botulism
In recent years, cases of botulism in Russia are mainly associated with poisoning with homemade canned food. Therefore, preventive measures are primarily related to this area. The safety of the jars cannot be ascertained by eye, botulinum toxin does not change the color, smell or taste of food.
- Products that serve as the basis for making homemade canned meals must be thoroughly cleaned of dust and dirt. It is advisable to remove soil particles with a brush.
- The same applies to canning utensils - cans, lids. Products are necessarily washed, scalded and dried. Tin lids need boiling.
- There are products that doctors advise to completely refuse canning at home. These are meat, fish, mushrooms and herbs. Fungi are especially dangerous, which, according to statistics, account for about 70% of all cases of botulism. Meat and fish should be preserved only if an autoclave is used, the products should be fresh.
- Overripe, stale, spoiled fruits and vegetables should not be used.
- Immediately before eating, it is advisable to boil such food for half an hour, this will eliminate toxins that could have formed. This rule is especially important for children who are sensitive to botulinum toxin.
- The storage temperature of products that cannot be heat treated should not exceed 10 ° C. We are talking about fish, salted and smoked, sausages, lard.
- Bloated cans are certainly taken away and destroyed.
- Vegetables or mushrooms rolled up in homemade jars are strictly forbidden to buy in markets from strangers.
- If one of the family members falls ill, all household members who ate the same food as him need to be administered a prophylactic serum and medical supervision for 10 days. It is imperative to disinfect the dishes from which the patient ate, his clothes.
When it comes to wound botulism, the only preventive measure is proper wound care in the hospital.
Every person suspected of having botulism of any severity is immediately hospitalized, since the possibility of complications and the nature of the course of the disease cannot be predicted. For those around them, such patients are not dangerous, the disease is not transmitted by airborne droplets.
The likelihood of a sudden drop in blood pressure, pronounced muscle weakness are the reasons why patients are shown strict bed rest. If the case is severe, the patient is fed intravenous nutritional formula or a nasogastric tube is used. The medical menu in mild cases implies the rejection of products saturated with extractive elements, fatty and spicy dishes. The patient is prescribed diet No. 10.
The question of whether a patient admitted with botulism needs urgent ventilation of the lungs is decided by the doctor in the admission department. It is respiratory "failures" that pose the greatest danger to the life of such patients, therefore adequate ventilation plays an important role.
If there is a threat of developing acute respiratory failure, patients need to establish the vital capacity of the lungs, constant pulse oximetry. Cases of development of acute respiratory failure at an incredible rate are frequent. The question of the need for ventilation and intubation arises if the vital capacity of the lungs is reduced by less than 30%, paralysis progresses rapidly, hypercapnia and hypoxemia are present. The patient may feel the need for ventilation and intubation from several days to several months.
If the patient has urinary retention, catheterization by means of Foley catheters is prescribed. This avoids the development of an ascending urinary infection.
If the patient has no obvious respiratory distress, the doctor resorts to emergency detoxification technologies. Washing of the intestines and stomach is a procedure of paramount importance, they help destroy the toxin, get rid of the substance that has not yet been absorbed. The first rinsing is done on the basis of pure boiled water, its samples are then subjected to specific analysis.
The patient is not prescribed laxatives in order to avoid the activation of intestinal paresis, the development of neuromuscular disorders. A probe is used to flush the stomach, the portions of fluid should be small, especially if the patient has respiratory failure. Otherwise, there is a risk of reflex respiratory arrest.
If the patient has bulbar disorders, the introduction of the probe should be carried out as accurately as possible, while a laryngoscope is used. This makes it possible to avoid the penetration of the probe into the trachea, which is important due to the absent gag reflex, paresis of the palate muscles.
Gastric lavage is prescribed at any time during the patient's hospitalization. However, a serious condition in which serious respiratory distress is observed may force the doctor to limit himself only to washing the intestines and ventilating the lungs. In this case, flushing begins with the setting of a siphon enema, which leads to a reduction in abdominal distention, provides the necessary conditions for a lung excursion. As a result, gastric lavage is easier for patients with botulism. Siphon enemas are given daily, the procedure is repeated twice a day if there is severe bloating.
The next task is to neutralize the toxin circulating in the blood. At any stage of botulism, the patient is administered anti-botulinum heterogeneous serum. A supraclavicular vein catheter is used to insert the PBS.
Anaphylactic shock is considered the most dangerous complication that a patient can experience during botulism therapy. The condition can arise immediately, regardless of the strict observance of all important rules. In addition, some patients who have undergone serotherapy develop serum sickness after 7-10 days.
If the course of the disease is severe, instantly progresses, PBS is injected intravenously. After 12 hours, intramuscular administration of a similar dose is carried out. You can enter the serum for the third time after a day. It is impossible to prescribe the drug more than 4 times.
Hyperbaric oxygenation is an effective treatment technology that allows tissues to be under high partial pressures, including severe histotoxic hypoxia. For the introduction of the drug, a central access is prepared, a supraclavicular vein catheter is used. Hypocoagulation drugs are necessarily used as a tool for the prevention of venous thrombosis.
There are also minor treatments that are considered complementary in the fight against botulism. In order to avoid the development of a secondary infection in the patient (pyelitis, pneumonia), he may be prescribed penicillin, clindamycin, chloramphenicol and other antibiotics. In terms of eradication of the causative agent of the disease, they are useless if we are not talking about a wound or infant form. If the patient has wound botulism, surgical treatment of the wound is mandatory.
Treating botulism at home
Botulism is a deadly disease that cannot be dealt with on your own. A number of actions can be taken before an ambulance arrives if it is delayed. The patient can take a laxative, say magnesium sulfate, half a glass of vegetable oil, which has a binding effect on harmful toxins. A cleansing enema with herbal decoction or highly diluted potassium permanganate helps.
It will also be advisable to wash the stomach, it is advisable to choose a 2% soda solution for this. This agent provides an alkaline environment that has a devastating effect on botulinum toxin. This procedure is especially effective in the first two days, the contaminated product can still be stored in the stomach.
However, the success of rehabilitation after inpatient treatment largely depends on the patient. A hospital stay on average lasts up to 10 days until the patient has all neurological disorders. The severity of the illness is determined by the duration of the sick leave, which can be issued for 1-2 weeks.
A person who has had botulism should be under the supervision of a local physician for 2 weeks after discharge. If he has residual effects, observation by a cardiologist (with myocarditis), a neuropathologist, an ophthalmologist (with consequences associated with the organs of vision) is also mandatory.
If there are indications during the recovery period, the attending physician can prescribe medication to the patient - drugs against optic nerve atrophy, vitamins, nootropics, cardiovascular agents.
For 3 or more (according to indications) months, the patient should avoid excessive physical activity. Specialized sports training, hard physical labor, work involving strong stress on the visual analyzer are prohibited.
A patient who has had botulism should pay special attention to his diet, its calorie content and composition. It is recommended to take food 4 times a day, doing it at the set time intervals. It is not allowed to include fatty and spicy dishes in the menu, it is necessary to limit the intake of salts. It is advisable to abandon animal fats in favor of vegetable fats, to provide a sufficient amount of protein. The lack of vitamins can be replenished by taking special complexes - compliit, vitrum, alphabet and so on.
Also, a person who has had botulism may be prescribed physiotherapy procedures. This includes water manipulations (therapeutic shower, baths), hardening, oxygen inhalation, electrosleep. This is necessary to get rid of the residual effects of hypoxia, if the disease is acute. General wellness procedures will also benefit, including therapeutic exercises, massage, swimming in the pool. All this together will speed up the process of restoring the normal functions of the muscular system.
The doctor may recommend the patient to spend a rehabilitation period in a sanatorium institution specializing in diseases of the nervous system.
As a rule, doctors do not object to the treatment of the patient during the rehabilitation period to folk remedies, but it is still worth consulting with a specialist before using them. If the acute manifestations of the disease are already behind, you can use decoctions of plantain, echinacea, nettle.
Cinnamon is also highly valued by folk healers in the fight against botulism. To prepare the broth, you will need to mix 200 grams of cold water with a teaspoon of chopped cinnamon. The mixture is brought to a boil, cooked for three minutes, stirred. If a gelatinous mass appears, remove the composition from the fire. The broth of cinnamon is drunk slightly chilled. If it is used to treat a child, the addition of sugar is permitted.
With timely medical attention and proper treatment, the prognosis for patients with botulism is favorable.
Author of the article: Danilova Tatyana Vyacheslavovna | Infectionist
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