Mar 05, 2018
Botulism is a severe disease from the group of toxic infections. It is caused by toxin Cl.botulinum( from Latin botulus - sausage).This is a life-threatening form of bacterial food poisoning "sausage poison", which, unlike the usual forms of food poisoning, affects the central nervous system. The poison is heat-resistant. It acts neuroparalytic;curare-like - mainly on the synapses of the motor nerves. Poisoning develops more often after consuming fish and meat products, especially sausages, hams, canned goods, house-preserving mushrooms( marinating), less often after consuming dairy and vegetable products.
Symptoms usually occur within the range of 18 to 36 hours after ingestion of contaminated food, and sometimes several days( up to 8 days).In 10 percent of cases, the disease is fatal, mainly due to breathing disorders.
The most severe form of the disease is seen in people who experience symptoms in less than 24 hours;they have the highest mortality rate. Those who survived during the first few days usually recover completely. Most often the disease affects children under the age of six months. Currently, the number of cases and deaths of botulism is declining.
• Botulism develops as a result of eating food contaminated with the bacterium Clostridium botulinum, which produces deadly botulinum, which interferes with the transmission of signals between nerve cells. Most often, botulism is transmitted through cooked not completely food or food with a low acid content.
• In rare cases, the disease occurs when an open wound is infected with spores of bacteria.
The clinical picture of botulism is characterized by a triad:
1) symmetrical bilateral neurological symptoms( visual disturbances, swallowing and muscle paresis);
2) lesions of the gastrointestinal tract with the change of the hypermotor function to suppression of intestinal peristalsis, stasis of its contents and persistent constipation;
3) development of acute respiratory failure.
• Dry mouth and sore throat.
• Fog and double vision, the appearance of a veil before your eyes, the vagueness of the contours of objects.
• Stopped dilated pupils, react poorly or do not react at all to light. Diplopia. Two-sided ptosis.
• Difficulty with swallowing and breathing. Paralysis of the soft palate, later - musculature of the pharynx and esophagus. Frustrated breathing. Attacks of suffocation, cyanosis. Sometimes there is asphyxiation.
• Violation of speech. The voice becomes hoarse.
• Abdominal cramps, diarrhea, nausea, vomiting. Diarrhea or severe constipation. Sometimes sharp flatulence with paresis of the intestine, bladder.
• Weakness in arms and legs, headache, unsteady gait, followed by paralysis.
Body temperature increased. At the beginning there is a bradycardia, then the pulse becomes more frequent. Cardiac activity falls. Dyspnea.
• A medical history and physical examination are needed.
• Blood, stool, stomach contents, and also suspected product can be tested for the presence of botulinum and bacteria, but the final diagnosis is based on symptoms.
• To detect other disorders, an electromyogram can be performed showing the transfer of electrical impulses along the nerves.
Differentiation is necessary from poisoning with fungi, methanol, atropine and hyoscyamine. Exclude also diphtheria, poliomyelitis, encephalitis.
Refinement of the diagnosis - by examining food, stool and vomit for the presence of toxin and clostridia. Biological test on guinea pig.
• Call an ambulance immediately;First aid and hospitalization are needed.
• If, after taking contaminated food, only a few hours have passed, induce vomiting of
• If possible, try to freeze some of the suspected food for analysis.
• The doctor prescribes an antitoxin that will help save lives, but can cause pronounced unpleasant side effects. When the doctor is almost sure of the diagnosis, the antitoxin is given before the laboratory confirmation of the diagnosis.
• Patients are often given penicillin, but its use is controversial, because the problem is not the presence of the bacterium itself.
• Patients may be given enemas or give medicines that cause bowel release to help the body get rid of the toxin.
• In case of severe breathing difficulties, mechanical ventilation of the lungs can be used.
• Get immediate help if you feel any symptoms of botulism .
1. At the pre-hospital stage, carry out resuscitation. Rinse the stomach.
Immediate hospitalization. In the ward to have ready-made equipment for intubation of the trachea or tracheostomy, an apparatus for mechanical ventilation.
2. Intramuscularly inject 100-150 ml of antibotulinic polyvalent serum. Simultaneously enter an anatoxin.
If improvement does not occur, then after 5-10 h, repeat serum administration( 500 ml).
In severe cases, the serum should be administered intravenously and intralumbally.
To prevent anaphylactic shock, 1 ml of serum is pre-injected under the skin. As a substitute, try to enter non-specific serum in the same doses. Have a set of medications ready to fight anaphylactic shock!
3. Rinsing the stomach through a probe with a large amount of water( up to 10-12 liters per session) with a suspension of activated carbon - 2 tablespoons per 1 liter of water, 0.2% tannin solution or 0.1% potassium permanganate solution.
4. Saline laxative - 30 g of magnesium sulfate or sodium sulfate in 200 ml of water enter through the probe after the end of gastric lavage.
5. Cleansing or siphon enema.
6. For severe pains, subcutaneously 1 ml of a 0.1% solution of atropine.
7. Subcutaneously 2-4 ml of sulfocamphocaine or cordiamine, 1 ml of 10% caffeine solution.
8. In severe cases of toxic infectious shock intramuscularly inject 125 mg of hydrocortisone and intravenously in the drip infusion of 30-60 mg of prednisolone, metipreda.
9. Bleeding. Exchange blood transfusion.
10. Intravenously 500-1000 ml of isotonic sodium chloride solution and 500-1000 ml of 5% glucose solution is drip followed by forcing diuresis by intravenous injection of 80-120 mg of lasix or 80-100 g of mannitol.
Polyglukin( 500-1000 ml), hemodez( 400 ml) is intravenously dripped.
11. Abundant drinking of alkaline water, for example Borjomi. Powered by a probe.
12. In the fight against paralysis of the respiratory center: subcutaneously 1 ml of a 1% solution of lobeline or cytitone, oxygen, carbogen;controlled breathing apparatus of artificial ventilation.
Vitamin B1( 1-2 ml of 5% solution) subcutaneously, intramuscularly or intravenously in cocktails from 5% glucose solution( 400-500 ml) with cardiac( 0.5 ml 0.05% solution of strophanthin) and vascular( 1,5-2 ml of cordiamine) by agents. In the absence of spontaneous breathing, urgent intubation of the trachea( or tracheostomy);mechanical ventilation of lungs with oxygen.
13. Constant monitoring of patient's condition, breathing( hardware artificial ventilation of lungs).
• Never eat a drop of food from a swollen can( this is a sign that bacteria are developing there), from a can that flows, or if the food has an unusual color and smell.
• Do not give honey to children under the age of one year. Infected honey is often the cause of pediatric botulism, but does not cause disease in older children and adults.
• Be wary of the following food, which is most often contaminated: to canned fruits and vegetables at home( especially green beans), fish, not completely cooked sausage and other products from pork, smoked meat, meat with bloodand dairy products.
• Store products for up to an hour before and after cooking. Thoroughly freeze all remnants of food( large pieces of food beforehand divide into smaller ones).