The causative agent of botulism is Specific drug therapy. Video: what foods cause botulism

Diagnostics botulism should be comprehensive and include both objective data and laboratory methods.

Methods for diagnosing botulism are:

• collection of anamnesis and objective data;
• microbiological diagnostics.

Collection of anamnesis and objective data

The collection of anamnestic data (medical history) plays an important role in the diagnosis of botulism. Importance knows what and when the patient ate. If the patient has consumed canned foods, mushrooms or fish, then it is necessary to hand over the remains of the consumed products for laboratory diagnosis. It is also important to know how this product was stored and how it was used.

The doctor should find out how long after the consumption of infected products the first symptoms appeared. It is known that the incubation period (the time elapsed from the moment the infection enters the body until the first symptoms of the disease appear) in botulism varies from several hours to days. A couple of cases have also been described in the medical literature when this period was extended to 2 to 3 days.

Next, it is important to know what the first symptoms were. Was there a period of intoxication and how long did it last. After collecting an anamnesis, the doctor proceeds to examine the patient. He notes a pronounced atony of the patient's muscles, a mask-like face. Due to dysphonic disorders, it is difficult for the patient to answer questions. The vocal cords at this point become dry, and the tongue becomes clumsy. Speech becomes incomprehensible and takes on the character of "porridge in the mouth."

During a neurological examination, the doctor notes motor paresis and paralysis. Unlike other neurological pathologies in botulism, paresis is always bilateral. Neurological symptoms, namely dysphagia and dysphonia, are of great importance in the diagnosis of botulism. The evolution in the voice change as well as the numerous ophthalmic symptoms play a decisive role in the diagnosis.

Microbiological diagnosis of botulism

This diagnostic method is based on the detection of Clostridium botulinum bacteria and their toxins in the patient's serum (or in other biological material). The detection of botulinum toxin is an absolute confirmation of the diagnosis of botulism.
Various reactions can be used for this purpose, such as a neutralization or gel precipitation reaction.

The material for the reaction can be the patient's vomit or swabs from the probe, blood or food debris. biological material inoculated on liquid nutrient media. The nutrient media inoculated with the material are incubated at a temperature of 80 degrees for 48 hours. After that, a study is carried out under a microscope. So, under a microscope, Clostridium botulinum looks like a movable stick, resembling a racket. Clostridia stick has from 5 to 20 flagella on its surface. On the surface of agar (a type of nutrient medium), these bacteria form small, shiny, dew-like colonies. Sometimes these colonies enlarge and become gray in color. On blood agar, growing clostridia produce an area of ​​hemolysis. In test tubes, the causative agent of botulism grows in the form of cotton balls (“fluff colonies”) or forms colonies in the form of lentils. If the diagnosis is negative, the analysis of cultures is repeated in a week.
To identify the toxin, a neutralization reaction is carried out with diagnostic sera.

Blood test for botulism

With botulism, a number of changes are noted in the blood test. Basically, they are not specific for botulism and more characterize the general intoxication process.

The parameters of a general blood test for botulism are:

• leukocytosis - an increase in the number of leukocytes more than 9 x 10 9;
• shift of the leukocyte formula to the left - the appearance in the blood of immature forms of neutrophils, for example, myelocytes;
• an increase in the erythrocyte sedimentation rate (ESR) - more than 15 millimeters per hour in women, more than 10 millimeters per hour in men.

parameters biochemical analysis blood for botulism are:

• increased concentration carbon dioxide;
• decrease in blood acidity;
• decrease in the concentration of chlorides;
• increased content potassium.

The parameters of a general urine test for botulism are:

• daily urine output less than 300 milliliters (oliguria) or less than 50 milliliters (anuria);
• the acidity of the urine is reduced.

What is the first aid for botulism?

At the first symptoms of this disease, it is necessary to call an ambulance team. Prior to the arrival of medical staff, a number of measures should be taken to reduce the harmful effects of the toxin that has entered the body.

At the prehospital stage, first aid involves gastric lavage and the appointment of sorbents available at home (most often activated charcoal).

Gastric lavage at home

The first symptoms of botulism appear 12 to 24 hours after eating contaminated food. The time when the first signs appear largely depends on the amount of toxin that has entered the body - the more poison, the sooner the symptoms appear. Occasionally, abdominal pain, nausea, and other symptoms may occur within 4 to 5 hours of poisoning. In such cases effective help is gastric lavage. Evacuation of gastric contents will help to partially prevent the absorption of poison into the blood.
To flush the stomach, the patient needs to drink 1.5 - 2 liters of pure boiled water. After that, if the patient's condition allows, he should be invited to induce vomiting on his own. Otherwise vomiting reflex the patient should be provoked by someone from the environment. To do this, press the root of the tongue with the middle and index fingers. After the first emptying of the stomach, half of the volume of vomiting should be left for analysis. Next, a second flush should be performed and repeated until the patient begins to vomit with clean water.
Gastric lavage should be performed only if the patient is conscious and clearly answers the questions asked of him. It is impossible to provoke vomiting if the patient has impaired breathing or swallowing function. When conducting this event it is necessary to monitor the patient's condition and be careful.

Reception of sorbents

After the gastric and intestinal lavage has been carried out, the patient should take drugs to absorb (absorb) the toxins remaining in the body. If the patient took a laxative, the sorbent should be drunk in half an hour. Activated carbon can be used as a sorbent (at the rate of 1 tablet per 10 kilograms of weight). Activated carbon can be replaced with enterodez (5 grams of powder per 100 milliliters of water). Any kind of carbon, polymer or silicon sorbents can also be used.

What can not be done with botulism poisoning?

When symptoms of botulism are detected, the only measure that can be taken, regardless of the circumstances, is to call an ambulance. In some cases, before the doctor arrives, the patient can do a gastric lavage or give sorbents to drink. All other attempts to alleviate the patient's condition can worsen the situation.

Measures that are prohibited for botulism poisoning are:

• taking painkillers;
• warm compress;
• consumption of carbonated drinks;
• provocation of vomiting under a number of circumstances.

Taking painkillers
The natural desire of many patients is to take painkillers, since severe abdominal pain is a characteristic symptom of botulism. It should be noted that the use of such drugs is not recommended. The absence of pain will not allow the patient to accurately describe all complaints, which will violate clinical picture disease and make it difficult to diagnose.

Warm compress
In order to reduce pain in some sources, it is recommended to put a warm compress on the stomach. Such measures must be abandoned, because the thermal effect on the abdomen will increase blood circulation, as a result of which the patient's condition may worsen.

Drinking carbonated drinks
Dryness of the mucous membranes is another symptom characteristic of botulism. You can quench your thirst only with clean drinking water without gases. Any carbonated drinks are prohibited. Also, you can not drink coffee, tea, broth.

Provoking vomiting under a number of circumstances
It is possible to provoke a gag reflex only to those patients whose age exceeds 5 years. Except age mandatory requirement is to keep the patient conscious. If a person is in unconscious he may choke on vomit. It is forbidden to induce vomiting in people who suffer from serious heart disease, as they may have a heart attack.

Treatment of botulism

Treatment of botulism should always be comprehensive and urgent. Regardless of the day of hospitalization, patients undergo intensive gastric lavage and detoxification therapy. After gastric lavage or wound treatment for wound botulism, detoxification therapy and specific treatment anti-botulinum serum.

Methods of therapy for botulism are:

• gastric lavage;
• carrying out siphon enemas;
• primary wound treatment for wound botulism;
• body detoxification;
• administration of anti-botulinum serum.

Gastric lavage in the hospital

Gastric lavage in a hospital setting is carried out with a gastric or nasogastric tube. The probe is a rubber tube with a length of 80 to 150 centimeters, a diameter of 5 to 13 millimeters. Washing is carried out with warm (not hot) water, which is poured through a funnel into a previously introduced probe. Depending on the patient's condition, two types of probe are used. So, if swallowing is not yet impaired, a thick gastric tube is used. If the patient's swallowing reflex is already impaired, then a thin nasogastric tube is used.

Gastric lavage with preserved swallowing reflex
In this case, a thick gastric tube with a diameter of 10-13 millimeters is used. In order to lead the probe into the stomach, the patient is given the correct position - lying on his side without a raised headboard. At the moment when the probe approaches the oropharynx, the patient must make a swallowing movement. As a result, the probe is swallowed, passes along the esophagus and enters the stomach. Beforehand, it is recommended to lubricate the end of the probe with petroleum jelly so that it does not injure the pharynx or esophagus.

Water is poured in gradually so as not to provoke distension of the stomach, 300 - 500 milliliters each. When the rinsing water is poured in, the funnel is held above the level of the stomach. After the infusion, it falls below, and the entire contents of the stomach, together with the poured water, is poured into a basin prepared for washing water. It is recommended to send the first portion of wash water for laboratory diagnostics.
The procedure is recommended to be repeated until clean wash water appears. It is necessary to correctly calculate the required volume of water. So, for a single infusion, 5-7 milliliters per kilogram of body weight is recommended (that is, for a patient weighing 70 kg, 350-500 milliliters of water is needed for a single injection).

Gastric lavage with impaired swallowing reflex
With a disturbed swallowing reflex, a thin nasogastric tube is used, which is inserted into the stomach through the nose. The end of the probe pre-treated with petroleum jelly is inserted through the lower nasal passage, and from there through the nasopharynx into the esophagus and stomach. Thus, the stage of self-swallowing the probe is excluded. After the tube is inserted into the stomach, the doctor must make sure that the tube has got to the right place. To do this, he attaches a syringe to the end of the probe and pulls its piston towards himself. If the tube is in the stomach, gastric contents enter the syringe. Further, by connecting a syringe to the probe, the doctor injects a solution for washing into the stomach with it. After that, the syringe is disconnected, and the contents of the probe are poured into a container for washing water. The procedure is repeated until clean wash water appears.

Conducting siphon enemas

With intestinal paresis observed in botulism, siphon and hypertonic enemas are recommended. They are given to stimulate atonic bowel. The principle of conducting a siphon enema is the same as when conducting other enemas. The difference is that when conducting a siphon enema, much more large quantity water. So, on average, 10 to 15 liters of water are consumed. Also, the tip of a conventional enema is inserted into the rectum at a distance of 10 centimeters, while the siphon tube is inserted to a depth of 20 - 30 centimeters. Therefore, siphon enemas are also called high cleansing enemas.

With botulism, enemas with prozerin are also prescribed. Prozerin is a substance that leads to the accumulation of acetylcholine and the restoration of neuromuscular transmission. Since this transmission is blocked in botulism, it must be restored. Therefore, this drug is prescribed both systemically (in the form of injections and tablets), and is used during enemas.

Primary wound treatment for wound botulism

In the case of wound botulism, the primary treatment of wounds is carried out with the excision of all necrotic (dead) tissues. Dead tissue is removed as much as possible so as not to contribute to the creation of oxygen-free conditions in the wound. Antibiotic therapy is also carried out. Large doses of penicillin are prescribed - from 10,000,000 to 12,000,000 IU (action units) per day. The daily dose is divided into 4 doses, and the drug is administered intramuscularly every 6 hours. In addition to penicillin, other antibiotics can be used. But you should know that antibiotics from the group of streptomycins, aminoglycosides, tetracyclines are contraindicated.

Prozerin and other drugs in the treatment of botulism

The main goal in the treatment of botulism is to maximize rapid elimination toxins from the body and prevention of respiratory failure. For the purpose of detoxification, an intravenous infusion of enterosorbents (substances that adsorb toxins) is prescribed simultaneously with the stimulation of diuresis (urinary excretion).

Drugs used in the treatment of botulism

Name of the drug	Mechanism of action	How is it appointed?
Refortan	Normalizes central and peripheral blood circulation. Eliminates oxygen deficiency and improves oxygen consumption by tissues.	At the rate of 30 milliliters per kilogram of weight, the drug is administered intravenously.
Hemodez	Binds toxins circulating in the blood and removes them from the body in the urine. It also increases blood flow in the renal vessels, thereby increasing diuresis.	The solution preheated to body temperature is administered intravenously at a rate of 40 drops per minute. A single dose is 400 milliliters.
Lactasol	Serum appointment After the test, they switch to the appointment of serum, the dose of which varies depending on the severity of the disease. Pre-whey is heated to a temperature of 37 degrees. The serum is then administered intramuscularly or intravenously. The dosage of the prescribed serum depends on the severity of the disease. With mild to moderate severity of the disease, one therapeutic dose of polyvalent serum is prescribed. Or a mixture of monovalent sera is prescribed - one dose of serum A, B, C, E and F. IN severe cases botulism, two doses of anti-botulinum serum are prescribed. Then the serum is administered in a similar dose on the second day. In severe botulism, repeated administration of serum is carried out after 8 hours. The regimen for the administration of anti-botulinum serum in severe cases of botulism is as follows: 1 injection - intramuscularly (or intravenously) 2 doses of polyvalent serum or a mixture of monovalent sera; 2nd injection is given 8 hours later at the same dosage; 3rd injection is given 12 hours later at the same dose; 4 injections 24 hours later; further serum injections are carried out for another 2-3 days every 24 hours. Carrying out specific therapy for botulism should be carried out until the first clinical improvements appear. The criteria for improving the patient's condition with botulism are: disappearance of dry mouth; restoration of the act of swallowing; voice restoration; disappearance of ophthalmic symptoms. Another specific therapy drug for botulism is homologous plasma or human immunoglobulin. Plasma is prescribed at 250 milliliters twice a day. Bioven mono is used as an immunoglobulin. This drug is a purified immunoglobulin and antibodies against various infections. The drug is prescribed intravenously drip daily for 3-4 days. The dose is calculated individually based on 5 milliliters per kilogram of body weight. This drug is recommended for severe forms botulism. Botulism care Full recovery from botulism occurs slowly. Some manifestations of the disease may persist for several months, despite the general satisfactory condition of the patient. An important step in the treatment of botulism is to provide proper care to the patient at home. During the entire period of treatment, the patient must comply with bed rest. During this time, it is necessary to carry out prophylaxis various complications which may develop due to long stay in a supine position. One common consequence of prolonged bed rest is congestive pneumonia. In patients who for a long time are in a horizontal position, the lungs are poorly ventilated. At the same time, it accumulates in the lungs a large number of sputum, which can cause inflammation. Other complications of prolonged lying are bedsores (tissue death) or muscle atrophy (muscle weakness and degeneration). Measures for caring for a patient with botulism are: To improve blood flow to the lungs and reduce shortness of breath, lying position the patient should sometimes be changed to a semi-sitting position. To do this, one or more pillows should be placed at the head of the bed to provide back support. Several times a day (from 3 to 5) the patient should do therapeutic massage. With light tapping movements, you need to massage the area of ​​\u200b\u200bthe chest and back, while not affecting the heart area. With cardiovascular insufficiency, massage is contraindicated. To develop the lungs, the patient is invited to inflate in the mornings and evenings air balloons. You need to start with 1 - 2 minutes, gradually increasing the time to 5 minutes. It is also recommended to carry out other breathing exercises(singing, blowing air through a tube). In the room where the patient is located, the air should be fresh and sufficiently humid. To do this, ventilate the room and use special devices to humidify the air. To prevent bedsores, body hygiene should be observed and the skin should be treated systematically. antiseptics. It is also necessary to control that the patient does not stay in one position for a long time. From the patient's diet, it is necessary to exclude saturated meat broths, spicy, spicy and fatty dishes. Vegetable soups and purees, oatmeal and buckwheat cereals, low-fat dairy products are recommended. Salt, sugar and spices should be kept to a minimum. Feed the patient carefully, because due to paresis ( flaccid paralysis) of the palatine curtain, there is a high probability of food entering the respiratory tract. When caring for a patient with botulism, it is necessary to constantly monitor his physical condition. Breathing should be even and without wheezing or gurgling sounds. Urination and stool regularity is also an important indicator to monitor. In addition, you need to check body temperature and blood pressure. If deviations from the standard norms are detected, it is necessary to consult a doctor. Prevention of botulism Prevention of botulism is to prevent the possibility of eating contaminated products. by the most effective method neutralization of bacteria is boiling. It is necessary to carry out this method of heat treatment in compliance with a number of rules. Botulism Prevention Methods When pickling, fermenting or salting foods at home, the possibility of contracting botulism is quite high. The likelihood of contracting this disease is also present when eating food products purchased in markets or stores. Therefore, a number of rules should be observed when buying, preparing and using potentially hazardous products. The main measures for the prevention of botulism are aimed at preventing the penetration of the pathogen into food raw materials. It is also necessary to prevent the germination of spore forms, the reproduction of vegetative bacteria and the formation of toxin in the finished product. Preventive measures must be observed in the following activities: home canning of fruits and vegetables; storage of meat and fish products for future use; storage and use of home preservation; buying some ready-made products. Rules for home canning vegetables and fruits Canned vegetables and fruits are the most common cause of botulism infection. In the absence of the ability to use an autoclave, in order to prevent the possibility of infection, strict rules must be followed at all stages of preparing homemade spins. How to prepare food for homemade preparations? The causative agent of botulism lives in the soil, so when collecting plant products, it is necessary to carefully clean it from the ground. Mushrooms should not be collected together with mycelium (a rhizome of thin filaments that is located above the ground), since it is in it that causative agents of botulism most often live. Therefore, mushrooms must be carefully cut with a knife. Old and overripe specimens should be left in place, because they are difficult to clear from the ground. It is recommended to collect mushrooms and other similar products in a wicker basket or other container with holes through which the earth will spill out. The collected products must be carefully sorted out, cleaned of blades of grass, leaves, soil fragments. Instances with signs of damage and rot should be discarded. Selected must be thoroughly washed several times in running water. Tubular mushrooms (boletus mushrooms, boletus mushrooms, boletus mushrooms) should be washed 3-4 times in a container, and then under running water. In all types of mushrooms, it is recommended to remove the upper skin from the cap. When preparing fruits that are prone to rapid spoilage (plums, grapes), it is recommended to keep them for some time in a weak solution of baking soda. Peaches and other fruits whose surface is covered with pile should be subjected to the same procedure. How to handle canned food containers? Glass containers used for canning should be thoroughly rinsed with water to which detergent has been added. After that, the dishes must be washed under running water and subjected to sterilization, which should last from 5 to 10 minutes. Lids (plastic or metal) should be boiled. Boiling should also go through spoons, ladles, bowls and other kitchen utensils that are used in the preservation process. Choosing a Canning Recipe When canning vegetables with a low acid content, it is imperative to use acid (acetic or citric acid). In an environment with an acidity of 1.6 percent, botulinum toxin dies. Inhibits the growth of microbes and the formation of toxin sugar at a concentration of at least 10 percent. The most preferred method of harvesting vegetables for future use are methods such as fermentation and salting in large containers. These methods involve the contact of products with air, which prevents the transition of bacterial spores into active form and toxin production. Procurement of meat and fish products In order to prevent botulism, it is not recommended to harvest any fish or meat products. Cooking fish or canned meat requires conditions that can only be observed in specialized workshops. Especially dangerous is the preservation of sturgeon breeds, since these fish are more often than others infected with botulism pathogens. The least dangerous (but not completely excluding the possibility of infection) method of preparing fish is salting. High-quality fresh carcasses without signs of spoilage should be chosen for salting. Gutting the fish must be done carefully so that bacteria from the intestines do not infect all the meat. The salt concentration in the brine must be at least 18 percent, and the temperature of the brine must not exceed 5 degrees. It is necessary to keep the fish in brine for 7-10 days in a container that does not interfere with air access. Storage and use of home preservation The botulism bacterium becomes active at a temperature of 22 to 37 degrees. Therefore, it is necessary to store home canned food of any kind at a low temperature. temperature regime. The best place is the cellar or the lower shelves of the refrigerator. Before use, the contents of a jar of home canned food should be transferred to a frying pan and heated for 15 to 20 minutes, bringing to a boil. You can also warm up an unopened jar by placing it in a container of water. This will not destroy the spores, but will neutralize the toxin if present in the product. It takes 10 to 12 hours for the spores to germinate and produce the toxin. Therefore, open and heated canned food must be consumed during this time. A distinctive characteristic of botulism is the fact that foods contaminated with the bacterium often do not differ in their appearance. In some cases, a symptom that bacteria are in the twist is a swollen cap, cloudy brine, or gas formation. In order to prevent botulism, the use of home preservation with such signs should be discarded. Also, do not eat canned food, the shelf life of which exceeds one year. Buying some ready-made products If the rules of technology are violated, industrial canned food (vegetable, fish, meat) can become a source of infection. Botulism bacteria may be present in fish or meat that are sold in vacuum packaging. The highest probability of purchasing products contaminated with botulism in places not intended for the sale of food products. When buying, you need to pay attention to the expiration date of the product, the quality and integrity of the container or packaging. Another food group that should be avoided is salted, smoked or dried fish sold by private individuals. This category also includes black pudding and other meat products purchased from individuals. In the manufacture of such products, not only the rules for their preparation, but also for subsequent storage are often violated. All this greatly increases the risk of botulism. Does boiling kill botulism? In foodstuffs, the botulism bacterium can be present in two forms - spore and vegetative. To neutralize the vegetative form, the product must be heated for half an hour, maintaining a mark of 80 degrees. When the boiling phase is reached, the vegetative botulinum bacterium dies after 5 minutes. The same conditions destroy the already formed toxin. The spore variety of the causative agents of botulism is highly resistant to heat. Spores die if the ambient temperature reaches 120 degrees, and this mode is maintained for at least half an hour. It should be noted that such conditions can only be arranged if special equipment called an autoclave is used. In this device, under pressure, the necessary temperature environment is created, which allows you to kill all forms of bacteria and the produced toxin. When using ovens, the temperature effect reaches only 100 degrees, which is not sufficient to neutralize the spore form of bacteria. Sealing jars with metal lids creates favorable conditions for the transition of spores into an active form. Therefore, in the absence of the possibility of using an autoclave, it is not recommended to harvest plant and animal products for future use by boiling or stewing. The best (but unsafe) method of preparing products with a long shelf life is pickling, pickling and salting. Precautions must be observed when using these preservation methods. Complications of botulism Complications of botulism are divided into specific and non-specific. Non-specific complications of botulism As a rule, specific complications in botulism are represented by secondary bacterial processes (pneumonia and bronchitis), as well as damage to the heart muscle. These complications develop as a result of direct action botulinum toxin (for example, myocardial dystrophy), and due to plegia (paralysis) of the respiratory muscles. Non-specific complications of botulism are: pneumonia; bronchitis; purulent parotitis. Pneumonia Pneumonia is an inflammation of the lung tissue with accumulation inflammatory fluid in the alveoli. Most often, pneumonia is infectious process associated with inhalation pathogenic microorganisms. In botulism, pneumonia develops for several reasons. First of all, it is stagnation and infection of the mucus. Normally, the respiratory epithelium produces a certain amount of mucus, which has a bactericidal effect. It removes pathogenic particles from the respiratory tract, and also moisturizes the respiratory tract. With botulism, the secretion of such mucus is impaired. The mucus becomes viscous and begins to stagnate. Pneumonia in botulism is characterized by the accumulation of this viscous mucus, which subsequently becomes infected. Due to paralysis of the respiratory muscles, this mucus is not drained, that is, it is not removed from the lungs in any way. The patient makes attempts to cough it up, but without success. The formation of a large lump of mucus and obstruction of the respiratory tract leads to acute respiratory failure with a fatal outcome. Diagnosis of pneumonia is to conduct an x-ray examination. On the radiograph, blackout fields are revealed (in the image itself, this light spots), which are accumulations of mucus. Treatment of such pneumonia involves the use of respiratory support. Bronchitis Bronchitis is an inflammation of the bronchial tree. The development of bronchitis in botulism occurs for several reasons. The first is associated with such invasive (traumatic) manipulations as tracheostomy and artificial lung ventilation (ALV). Due to the fact that botulinum toxin significantly reduces immunity, such procedures increase the risk of a secondary infection. The second reason is associated with the stagnation of thick mucus in the lumen of the bronchi. Thus, mucus stagnation and the addition of a secondary infection due to mechanical ventilation create the basis for inflammation of the bronchi. With bronchitis, moist rales of various sizes (medium and large) are heard. On the radiograph, an increase in the pulmonary pattern is visualized. It is important to note that both bronchitis and pneumonia are not accompanied by complaints characteristic of these diseases. Due to paresis of the respiratory muscles, there is no cough, shortness of breath, which complicates the course of the disease. Purulent mumps Parotitis is an inflammation of the parotid gland. With botulism, purulent parotitis is less common than other complications. It develops due to damage to the autonomic nerve fibers and, as a result, a violation of the secretion of saliva by this gland. Examination of the patient reveals swelling and induration in the projection area of ​​the salivary glands. Specific Complications Specific complications are those that are specific to the action of botulinum toxin and Clostridium itself. It is known that the toxin has a selective tropism (attachment) to nervous tissue, and also specifically affects myocardiocytes (cells of the heart muscle). Specific complications are myocarditis and various paresis. Botulinum myocarditis With myocarditis, the muscle fibers of the myocardium itself are affected. In this case, myocardial dystrophy develops, which is characterized by degeneration muscle fibers, violation of their structure. As a result, the contractile function of the heart drops significantly. This complication develops both as a result of the direct action of the toxin on the heart muscle, and as a result of metabolic disorders occurring in botulism. Myocardial dystrophy is characterized by a decrease in cardiac output, muffled heart sounds, and low blood pressure. Paresis and paralysis With botulism, complications such as paresis and paralysis are not uncommon. Paresis is a decrease in strength in the muscle, which is due to a violation of the neuromuscular transmission. With paralysis, voluntary movements are completely absent. There are various paresis at the level of the lower and upper limbs. A feature of paresis and paralysis in botulism is that they are always symmetrical. There are also paresis facial nerve peripheral type. The frequency of some complications in botulism Before use, you should consult with a specialist.

One of the most dangerous forms poisoning is considered botulism. Although this is a rare and almost forgotten disease, it still affects people every year, regardless of gender, status, age and nationality, as well as living standards. Therefore, it is better to know in advance as much as possible about what botulism is and how dangerous it is, what factors lead to infection, how to treat it and methods of preventing it, so that you can warn yourself and your loved ones from potential danger.

Description of the disease

Clostridium botulinum is the bacterium that causes botulism, a disease that is deadly. Botulism is classified as a disease infectious nature causing acute damage to the body by toxins and poisons.

The bacterium botulism, also called coli, clostridium and botulinum. This is an anaerobic bacterium (using an environment without air for life), which forms many spores. The stick itself can be vegetative or spore.

Vegetative botulinum lives for years in a warm (20-37 degrees Celsius) environment devoid of oxygen. When boiled, it dies within half an hour. If the vegetative form of the bacterium is subjected to thermal heating, then sporulation can be provoked. This process is characterized by the "awakening" of inactive spores, which begin to actively multiply. These disputes do not respond to any Sun rays, to any other temperature differences, like a bacterium, they feel great in an oxygen-free environment.

Botulinum spores are products that the bacterium produces in the course of its life. It can live for several decades. Neither freezing, nor drying, nor salt, nor acid, nor prolonged boiling kills it.

The only way to destroy it is to subject it to a half-hour heat treatment at temperatures above 120 degrees Celsius.

Types of disease

Depending on the method of infection, there are several forms of botulism - definitions of what it is, or rather, where it can enter the body. Each of them has its own specific features.

food

It is characterized by the fact that the bacterium and its waste products accumulate in food. Moreover, in order to become infected with food botulism, the bacterium needs to produce toxins even before the affected foods are eaten. At the same time, bacteria need an environment with a lack of oxygen to produce harmful spores. For example, canned food can be such products. home cooking prepared by light preservation. Industrial canned food can also contain active botulinum if the technology was violated during preservation.

Products in which botulinum toxin can develop: mushrooms, green beans, beets, spinach, sausages and ham sausages, smoked and salted fish products, canned fish.

The list of "dangerous" products varies from country to country and depends on the traditions of cooking and processing dishes.

wound

The botulism bacterium lives everywhere, including in the environment. Under favorable conditions, it is activated. In itself, it is not harmful, but the danger is the disputes that arise in the process of its activity. If they fall into open wound, then a person becomes infected with botulism through it, and not through food. This rarely happens and after infection it should take about two weeks before the first symptoms of infection appear. The risk group includes drug addicts who use injections to take drugs.

Children's

From the name you can understand that this type of disease affects mainly only children, and usually only the smallest - newborns and under the age of six months. The children in this age group the intestine has not learned how to defend itself against most bacteria, its environment does not yet perform all the necessary protective functions, and immunity has not had time to form either.

Botulinum penetrates the intestines and distributes its poisons there. For babies whose intestines have got live botulinum, it is life-threatening, for other children and adults - no. Infection often occurs through honey. For this reason, it should not be given to such young children. Dust as well as soil can also be a hazard. The first symptoms do not appear immediately. The disease progresses to pneumonia and is fatal.

Respiratory

This type of disease is rare. It can only become infected through a deliberate biological attack, such as a terrorist attack, as well as as a result of the accidental release of a toxin from aerosols. The disease manifests itself 1-3 days after infection.

Uncertain

This type of disease is, in fact, a diagnosis when doctors could not establish the source of infection.

Water is a source through which the risk of infection through which is minimal, but still exists. Therefore, it is highly recommended to drink only purified and boiled water.

Reasons for the development of botulism

Eating unwashed vegetables and fruits, sausages of unknown origin and production, homemade sausages and sausages, fish, canned fungus is a risk of contracting botulism, despite rare cases occurrence of the disease.

To better understand what botulism is and why it is dangerous, what are the causes of the development of the disease, you need to know the mechanism of development of botulinum. First, it penetrates into the intestinal environment of wild animals, then into stool Ah, it's multiplying. Then, with a bowel movement, the masses of feces enter the soil, and with them clostridia, which can live in the soil for many years. Then they move into vegetables and mushrooms, which are then eaten by a person who has cooked them incorrectly. Accordingly, after taking such food, he becomes infected.

The cause of the development of the disease is the improper processing of food ingested. insufficient washing, heat treatment and conservation, sterilization.

Interestingly, in terms of its toxicity, botulinum toxin is more dangerous than rattlesnake venom, and it’s not immediately possible to believe how many times - 370,000. This means that the faster a sick person goes to the hospital, the higher his chances of surviving, since such a powerful poison is quickly and irreversibly strikes vitally important features organism.

Also, various marine mollusks and fish, birds or soil at the place where the corpse of an infected animal lay could become a source of infection.

The tin can, where botulinum multiplied, swells, but there is no specific smell or taste. This canned food should be thrown away!

Who can get sick

Despite the extremely rare foci of the disease on a national scale, cases of botulism are recorded annually. Certain categories of persons most susceptible to infection are statistically identified:

• Members from disadvantaged families with low social status, the poor. Such representatives of society tend to be careless about the rules of cooking and processing food. The low financial situation makes them eat canned food when it is clear that the jar with this product is swollen. They just hate to throw it away.
• Fans of buying dubious canned home-made products in the markets, from the hands of grandmothers selling on the streets, train stations, or through acquaintances. Such behavior of quite financially prosperous consumers is extremely careless. The idea of ​​eating homemade preparations is quite understandable and understandable, but no one knows what method of preparation was used and under what conditions the whole process took place. The same applies to smoked fish bought from the hands.

• Various holidays where representatives of several families bring food at once. It is not known how it was stored and prepared.
• People who do not disdain to eat the contents of a swollen jar, and especially if mold has already formed there. Many have a prejudice - if you remove a layer of mold, then you can eat it. Or, if the jar is swollen, but the smell and taste are normal, you can eat it. Such motives are dangerous to life, and behavior regarding one's health is ignorant.

First symptoms

The symptoms of botulism vary by early stages and depends on the type of disease.

The first signs are short-term and similar to acute intoxication or gastroenteritis:

• Acute pain in the epigastric region and in the middle of the abdominal cavity;
• Severe and sudden pain on the background of abdominal pain;
• Diarrhea, debilitating frequency of attacks - can be up to 10 times a day;
• Vomit;
• Loss of strength;
• Fever with a temperature reaching 40 degrees.

The complex of the listed first signs subsides by the end of the first day, but does not mean that the disease has passed. The first signs, even at the very beginning of their onset, should prompt the patient to call ambulance.

There are also other symptoms, namely:

• Dry mouth for no apparent reason;
• The temperature is slightly elevated;
• "Lump" in the throat;
• Visual impairment (blurred contour of visible objects, "flies", double vision, sudden farsightedness);
• A sharp change in breathing (with a respiratory type of illness, not to be confused with an asthma attack);
• Blueness of the skin;
• Tachycardia;
• Dyspnea.

These were the first signs of the disease, which in varying degrees and combinations appear at an early stage.

The period of exacerbation

During the peak of the disease, other symptoms are observed:

• Difficulty swallowing food (diseases of the stomach and esophagus should be excluded);
• Immobility of the tongue located in the pharynx;
• Low mobility of the tongue;
• omission of the eyelids;
• Inability to fix the gaze for a long time, strabismus;
• Reduced Functions vocal cords, as a result - the inability to speak;
• A nasal or hoarse voice;
• Distortion of her gait as she becomes less confident;
• muscle weakness;
• Inability to defecate normally, urination is also disturbed;
• pale skin;
• Inability to show a grin;
• Feeling of tension in the muscles of the face;
• Change in facial expression, distortion.

In the final period of the development of the disease, symptoms associated with breathing come to the fore. Pneumonia develops.

Muscle weakness is so pronounced that the patient is unable to independently raise his head or arms. After that, the body becomes paralyzed, breathing stops and death occurs.

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As a result, treatment is necessary and it should be started as early as possible. It is impossible to diagnose botulism on your own, as its symptoms are similar to manifestations of other diseases. They are easy to confuse and miss the opportunity to recover. If you feel alarming, then you need to call an ambulance - you should not wait until you can still endure pain in the abdomen.

Development of the disease and its treatment

Incubation period for each type of botulism is different, but on average it ranges from 1 to 10 days. Moreover, the faster the first symptoms occur, the more severe the course of the disease and treatment.

Treatment is carried out only under conditions of full hospitalization and round-the-clock monitoring. No self-healing options!

The hospital uses the following methods:

1. Gastric lavage;
2. Use of anti-botulinum serum;
3. Detoxification;
4. Taking antibiotics;
5. Artificial ventilation of the lungs;
6. Probe feeding;
7. Installation of a catheter;
8. Rehabilitation therapy;
9. Additional specific therapies for emergency situations in conditions heightened danger for the life of the patient.

Prevention

In order not to get sick, you need to observe hygiene, thoroughly wash fresh food, properly heat them and not eat questionable food. Unfamiliar canned food, even seemingly normal, should be used with caution.

This article describes what botulism is, its causes and symptoms. Varieties of the disease, the first signs. Diagnosis and treatment of botulism is also described.

Description of the disease

Botulism is an acute, deadly infection caused by a toxin from the microorganism Clostridium Botulinum. By itself, the bacterium poses no threat. However, the toxin it produces is one of the deadliest in the world. It affects the autonomic and nervous system of the body, causing death.

Botulism was first discovered in the 18th century. The first immune serum was produced only in the 19th century. Botulinum toxin is considered the most powerful of biological poisons. It can be compared to sarin in terms of its effect. Botulinum toxin stronger than poison rattlesnake 375 thousand times.

According to statistics, now this disease is rare. Around the world, only up to 1000 cases of poisoning are recorded every year. However, botulism is still one of the deadliest. Sometimes the progression of the disease in the first stage can stop on its own, until recovery. Since a person does not go to a doctor, these cases are not included in the statistics.

The causative agent of the disease

Its causative agent is the anaerobic spore-forming microorganism Clostridium Botulinum. Bacteria can only live in airless space. The spores of the microorganism are in the soil, from which they enter plants, water, animal intestines, and then into the human intestine.

Bacteria exist in nature in two forms, vegetative and spore. Microorganisms of the first type of botulism die when boiled for 5 minutes and for half an hour at 80 degrees. Spore form to chemical or physical impact on the contrary, it is very stable.

The bacterium can remain viable even with a 5-hour boil, and even at a continuous exposure temperature of 120 degrees, the microorganism dies only after half an hour. That's why food products can cause botulism.

The vegetative form is dangerous due to the formation of "sleeping spores" that germinate only after 6 months. These bacteria are not afraid ultraviolet radiation, freezing and drying. These conditions can persist for decades. In airless conditions (canned food, homemade products, meat, etc.) are activated. The release of the deadly botulinum toxin begins. For severe poisoning even a small amount of poison is enough.

The incubation period for botulism is usually a few hours but can be up to 10 days. On average, its duration is 18-36 hours.

Causes of the disease

The main cause of botulism is food contaminated with bacteria. The soil is their reservoir. From it, microorganisms enter the stomachs of birds, animals, penetrate into plants. Clostridia contamination of the environment occurs along with the feces of animals, during the decay of their infected corpses.

Other causes of botulism depend on the ways of transmission of the disease - through wounds, the respiratory system. The food chain is the main route of transmission of bacteria to humans. Most often, botulism is found in homemade preparations for the winter, canned food, devoid of air.

When infected through ulcers, cuts, damaged skin, wound botulism can develop. The toxin can be absorbed into the blood through the eyes, digestive system, and respiratory tract. Poison spores do not form. It appears only when they germinate. A number of combined factors lead to the release of the toxin:

• anoxic environment;
• the presence of other microorganisms;
• sufficient temperature;
• the required level of acidity of the environment.

Most often, all conditions are met when preserving products for the winter. Spores fall into right conditions, sprout, and only then does the deadly poison begin to stand out.

Attention! Poisoning is impossible when eating fresh food. With it, you can only get Clostridial spores, but they are not toxic-producing in themselves.

Classification by type

The classification of botulism is presented in four forms. Some of them have a short incubation period. The form of botulism differs according to the causes of occurrence.

food

The main type of disease is food. The production of venom from spores requires a combination of preservation and storage conditions. Most often, these are light homemade blanks that have not undergone lengthy processing. For example, in sauerkraut, the spores are not destroyed, but the acidic environment does not favor the release of the toxin.

Botulism is found in foods:

• mushrooms;
• spinach;
• sausage;
• green beans;
• in fish (including canned);
• sausages;
• smoked meats, etc.

Canned food is the biggest danger. Also, spores can be in tomatoes, pickles, pickled mushrooms.

Wound

Wound botulism is rare. Infection occurs through open skin lesions. Spores are introduced into the body of a healthy person and carried with the bloodstream. It manifests itself similarly to the food form, a couple of weeks after infection. This risk group includes mainly drug addicts, the most dangerous are those who are on heroin, which is injected in the form of injections.

Children's

Botulism in children mainly appears in newborns up to six months. During this period, the body's defense system is still very weak. Toddlers swallow spores, from which bacteria appear that settle in the intestines. This is where the production of the deadly botulinum toxin begins.

After six months, this form of the disease practically does not occur. The germination of pores begins to be hindered by the strengthened defense systems of the body. There can be many sources of the disease, honey becomes the main one, so it is not recommended to feed them to children for up to a year.

Respiratory

IN respiratory form botulism disease is very rare. It does not occur in natural conditions. Appears during the release of toxins from aerosols, random events, specially directed biological attacks. Clinical manifestations are similar to food poisoning. The first signs of botulism in humans appear on average within three days.

Other forms of botulism

Sometimes the diagnosis is "indeterminate botulism". This happens when the cause of the disease cannot be identified. Infection is possible through water, when a toxin already produced earlier enters the body with it. However, this variant of infection practically does not occur, since the causative agent of botulism is destroyed during wet cleaning.

First symptoms

After the incubation period, the first symptoms of the disease appear. They are short-term, in many respects similar to infectious intoxication and gastroenteritis in acute form. The first symptoms most often appear suddenly, in the period from 2 to 12 hours, less often - after a few days. The patient first feels general weakness, malaise. Then they appear:

• sharp pains in the center of the abdomen;
• constant vomiting;
• diarrhea (loose stools happen from 5 to 10 times a day);
• headache;
• dry mouth;
• double vision, a grid or flies appear in front of them;
• it becomes difficult to see objects at a close distance.

Sometimes the body temperature rises to 39-40 degrees. The first signs may appear gradually. Their severity may be different shapes. You can not engage in self-diagnosis, otherwise the body will receive an even larger dose of toxins in lost time. Botulism must be treated immediately, otherwise the antitoxin will be ineffective.

Important! The elevated temperature drops to normal values in the evening, and diarrhea is replaced by persistent constipation.

Main features

After the first symptoms of botulism in humans, the disease most often worsens, additional signs appear:

• voice coarsens, becomes hoarse;
• speech loses clarity, words are slurred;
• in the throat there is a tickle and a lump;
• there is a deficiency of salivation, which aggravates dysphagia;
• severe muscle weakness is felt;
• paralysis of the intestinal muscles develops, accompanied by constipation;
• urination is difficult.

In botulism, neurological symptoms dominate in adults, and their manifestation affects all the muscles of the body. Rolling weakness can turn into paralysis. With increasing intoxication, aspiration syndrome develops, accompanied by pneumonia and purulent tracheobronchitis. The patient has a certain appearance:

• one- or two-sided omission of the eyelids appears;
• adynamic;
• the face is devoid of facial expressions, becomes like a mask;
• wandering glance;
• dilated pupils (while they do not react to light);
• severe dry mouth;
• pallor of the skin due to low pressure;
• wobbly gait;
• immobility;
• bloating;
• rapid, weak breathing;
• strabismus.

At first, patients cannot swallow solid food, then even liquid does not pass. Shortness of breath and respiratory failure are considered very dangerous signs. This can lead to the appearance of cyanosis, shortness of breath, disruption of the heart. As a result, a person dies after 3-4 hours. Signs of botulism poisoning in infants:

• violation of the chair;
• hoarse crying;
• violation of the swallowing and sucking reflex;
• the baby cannot hold his head on his own;
• weakness;
• poor appetite or lack of it.

Dust is very dangerous for babies. In children, bacteria have a long incubation period. Additionally, signs of pneumonia may appear, which can lead to the death of the child.

Diagnostics

Diagnosis of botulism begins by finding out what kind of food and at what time he ate. Then the patient is examined, the reaction of the pupils to light, the work of the respiratory system are checked, skin. This is followed by laboratory diagnostics. For analysis, blood, vomit, swabs from the probe, food debris can be taken. Materials are first incubated at 80 degrees for two days. Then they are checked under a microscope for the presence of botulism sticks, which look like a racket with flagella (a photo of the microorganism is in this article).

In a blood test, the level of leukocytes is determined, the appearance of immature neutrophils, the erythrocyte sedimentation rate is noted. Biochemistry in botulism shows an increased content of carbon dioxide, a decrease in chlorides and acidity of the blood. Potassium, on the contrary, there is an increased concentration.

IN general analysis urine, attention is focused on the daily excretion of urine and its acidity. With botulism, it is lowered. Before treatment, the source of infection is determined.

Treatment

Treatment of botulism is carried out in the intensive care unit or infectious diseases. General scheme: bed rest required. If botulism is caused by eating food, then everyone who has tasted it should be observed for ten days. Hospitalization of those infected is necessary, as there is a high probability sharp drop pressure and respiratory failure.

If necessary, the patient is connected to a ventilator. Diet number 10 is prescribed. Spicy and fatty foods are excluded from the menu. A gastric lavage is done, a drug treatment regimen is carried out.

First aid for botulism

Botulism develops rapidly, therefore, at the first signs of the disease, before the ambulance arrives, it is necessary to provide first aid, since there is a risk of respiratory arrest even with a mild form of intoxication.

First aid for botulism begins with gastric lavage 2 percentage solution baking soda. With it, an alkaline environment is created that destroys botulinum toxin. Gastric lavage can be effective only in the first two days after intoxication. The patient should be given one of the enterosorbents:

• activated or white charcoal;
• Enterosgel;
• Polysorb.

First health care consists in the additional holding of a siphon enema. The patient is placed on the left side, bending right leg. The end of the probe is lubricated with Vaseline and inserted into the anal passage to a depth of 30-40 cm.

Then a funnel is placed on the tube and 0.5-1.0 liter of water is poured through it. Then it gradually rises and all the fluid that has come out of the intestine merges into the pelvis. The procedure is repeated until 10 liters are used up. soda solution. If possible, a dropper is placed. One of the following solutions may be used:

• Gemodez, Laktosol, Trisol;
• Reopoliglyukin;
• Reamberin;
• Furosemide with 5% glucose.

Hospital treatment

In the clinic, the patient is immediately injected with two types of antitoxic serum, are applied in the first 72 hours after the onset of intoxication. Only during this period they are effective. At moderate diseases, drugs are administered twice a day, in a severe stage - with an interval of 6-8 hours. You can cure a person with antitoxin in a day, in difficult cases- for four.

Before the introduction of serum (for example, Sextaanatoxin, Pentaanatoxin), a test is done for a foreign protein. If there is no growth of redness at the injection site, then an injection of 0.1 ml of serum is made without diluting it. Half an hour later, the full therapeutic dose is added.

If there is a negative reaction of the body to the protein, then the serum is indicated only in severe forms of the disease, along with the use of antihistamines and glucocorticosteroids. In addition, broad-spectrum antibiotics are prescribed:

• Ampicillin;
• Levomycetin;
• Third generation cephalosporins;
• Chloramphenicol.

Cytorotectors Trimetazin and Meldonium are used to eliminate congestion. Homologous plasma is made (250 ml twice a day), human immunoglobulin. The patient recovers very slowly. The first positive symptom is the normalization of salivation. Muscles and vision are restored last.

If necessary, a pressure chamber is used, in which the cells of the body are saturated with oxygen. For seriously ill patients, this is sometimes the only way to avoid death.

Features of home treatment

After the hospital treatment continues at home. The patient with special care should monitor the diet and hygiene. Can be assigned vitamin complexes, cardiovascular drugs, nootropics. For at least three months, physical activity and work that strains the eyes should be avoided. At the same time, physiotherapy is prescribed - electrosleep, inhalations, healing showers, massage.

Complications

Atrophy Bladder or intestines - not the worst thing about botulism is dangerous. The consequences of the disease are divided into two types. Nonspecific include bronchitis and pneumonia, lesions of the heart muscle, purulent parotitis. Specific complications include:

• myocarditis;
• paralysis;
• paresis.

Complications may appear in the form of phlebitis, reactive hepatitis or pancreatitis. However, more than a third of percent of cases are due to pneumonia. Most dangerous complication- respiratory failure, which in a few hours can lead to lethal outcome.

Prevention

How to avoid botulism? The growth of spores is hindered by food storage and preservation at low temperatures, high acidity and salt concentration. Prevention of botulism has a number of necessary rules:

• before preservation, fruits and vegetables should be thoroughly washed;
• you can not eat vegetation, berries and vegetables directly from the beds;
• to prevent botulism in pickles or other preparations, jars must be sterilized for at least 10 minutes;
• the same time you need to boil any lids;
• the toxin is destroyed at very high temperatures, so fish and meat should only be harvested using an autoclave;
• spoiled or overripe fruits and vegetables are not allowed for conservation.

Prevention measures also apply to berries. If you collect unwashed, then after seaming, botulism may appear in the jam. All products that are not processed at high temperatures must be stored in the refrigerator. Avoid being around raw meat, fish and ready meals.

Signs of botulism in preservation are swollen lids. The contents of such jars must be thrown away and cannot be recycled. Especially often in such cases, botulism is found in mushrooms. Before preservation, they must be cooked for at least five hours.

Even if you know at what temperature botulism dies, you cannot determine the type of bacteria at home. To secure the workpiece, it is advisable to do it in an autoclave. This unit creates the most destructive conditions for the toxin, including temperatures from 120 degrees. With a vegetative-type disease, spores of bacteria die at a temperature of 80 degrees.

Botulism can be deadly if not treated right away. Initially, symptoms may be confused with simple disorders stomach. However, you can not self-medicate, as improper therapy or lost time for it can lead to death.

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Timely diagnosis is at least 50% of the success of the treatment of any disease. The complexity of this step is that many diseases begin in approximately the same way and have similar symptoms - botulism, for example, is initially easy to confuse with ordinary eating disorder. If you self-medicate for too long, especially due to an incorrect diagnosis, then the consequences can be very complex, up to death.

What is botulism

In order to correctly recognize the signs of botulism, you must first know what it is. Otherwise, even noticing certain symptoms, it is difficult to associate them with a specific diagnosis.

The cause of the disease is the bacterium Clostridium botulinum - it is not dangerous in itself, but in the process of life it releases a toxin that blocks the work of nerve endings. Such substances are called neurotoxins - they prevent the release of acetylcholine - a substance that transmits nerve impulses.

The incubation period after which detrimental effect on the body, ranges from two hours to ten days - depending on whether the toxin or botulinum spore immediately entered the body.

When a large amount of toxin is released into the body, paralysis of the respiratory muscles or even the heart muscle occurs.

How the infection enters the body

Botulism is divided into three main groups, which differ in the way they enter the human body. If signs of botulism are observed, then we must remember what preceded them from the following list:

food botulism

The bacterium that causes the disease is anaerobic, which means that it needs an oxygen-free environment to thrive. The ideal place for them is jars with canned vegetables or meat products. Under favorable conditions, bacteria begin to secrete a toxin, which then enters straight into the gastrointestinal tract. Most often, the bacteria themselves are also there, for which the most comfortable conditions- lack of oxygen and heat.

The danger here is that most often it is not possible to recognize food spoilage - they do not change their color or smell when infected with a toxin. Even swelling (bombing) of cans does not always occur.

Infant botulism

As with conventional canned food, hermetically sealed baby food can also be a source of infection, but it still belongs to the previous category. Infant botulism in its pure form is formed as a result of the spores of bacteria germinating in the intestines of a child, to which he does not yet have immunity. The incubation period can be somewhat longer, because the bacteria still need to develop the toxin. The spores themselves can be swallowed along with particles of dust or other dirt that may be on the child's fingers.

After 6-12 months of age, a protective environment is formed in the intestines that does not allow such spores to germinate, but if they get there earlier, then the development of botulism in humans is almost inevitable.

wound botulism

If a bacterium enters an open wound, which then begins to heal, then conditions arise for it no worse than in the intestines - to some extent, it is even better there, because the acidic environment of the stomach will be absent here. Symptoms of the disease appear after about four days from the moment the bacterial spore enters the wound (in some cases, they may not be for almost 3 weeks). Since the spread of the toxin does not occur through the digestive tract, the symptoms of the disease often do not include gastrointestinal disturbances, as is the case with foodborne botulism.

Undefined type

Is not separate view botulism - such a classification is assigned to the disease in the event that it was not possible to determine for certain the causes of its occurrence. Although, in fact, infection could only occur by any of the listed methods, the need for additional classification arises when processing statistical data - this allows you to pay attention to the emergence of new strains in time.

Perhaps this is additional reinsurance in case of a bacteriological attack - there is evidence of attempts to create such weapons of mass destruction - if they are used, disease vectors are sprayed into the air.

When and how the symptoms of the initial stage appear

There are certain difficulties in the diagnosis of botulism, primarily due to the fact that this disease is quite rare. Even many doctors do not have enough experience to diagnose it, especially in the early stages. In addition, an accurate diagnosis can only be made on the basis of laboratory tests, so the onset of the disease always goes unnoticed. It should also be borne in mind that the symptoms of botulism and their manifestation in different people will differ. The general picture of development and the emerging signs of the disease are as follows:

First manifestations

When the toxin begins to act on the body, the symptoms of developing botulism are characteristic of food poisoning. Since the acidic environment of the stomach prevents the action of the toxin, its main effect is on the intestines, which is accompanied by pain in the lower abdomen, vomiting and diarrhea (diarrhea). Additional signs of the disease are dry mouth, which should not occur with ordinary poisoning.

"Eye" symptoms

In some cases, the result of exposure to the toxin begins to appear immediately in the nerve endings that regulate the work of the eye muscles. These can be both the first signs of the disease, and the following after the initial stage.

Since the effect of the toxin comes on the rise, the exact movements are blocked first of all. As a result, visual impairment occurs - the contours of objects become blurred, fog or a grid appears in the eyes - the photo shows how the eyelids fall.

The eyes are usually tense when considering close objects, and when the gaze is transferred to distant objects, then eye muscles relax. Accordingly, the result of the action of the toxin will be the “farsightedness effect”, when a person cannot focus on nearby objects.

With the development of these symptoms, double vision and convergent strabismus begin. Because nerve endings work intermittently, it becomes very difficult or impossible for a person to look at one point - while the signals that are still breaking through interfere with the precise focusing of the eye muscles.

Breathing problems

Although breathing is a reflex process, beyond the control of the person himself, it is controlled by the nervous system, which is hit by a neurotoxin. As a result, the number of breaths per minute, their strength and duration change.

The result of a lack of oxygen can manifest itself in blue skin and shortness of breath. In an attempt to saturate the body with oxygen, the heart rate rises.

Symptoms of the active stage of botulism

With the further spread of botulism, new symptoms become the development of previous ones from the initial stage, depending on where the neurotoxin got to. If the previous manifestations of the disease have not yet forced the patient to go to the hospital, then this should be done immediately if his condition worsens.

Botulism is not treated at home - even in a hospital, it takes about 4 days just to understand which strain should be treated. Until this time, the patient is general prevention without the use of anti-botulinum serum. The exception is severe patients in the last stages.

When the toxin seriously "gets" to the nerve endings, then botulism has the following symptoms:

Swallowing problems

If a badly chewed piece of hard food gets stuck in the throat, then this is already enough. serious problem in itself, but also one of the signs of the disease. In the future, the person cannot swallow liquid food and even ordinary water. Blocking of the swallowing reflex is also accompanied by complete immobilization of the uvula in the pharynx and immobility of the entire tongue.

Feelings of dryness and "porridge" interspersed in the mouth, which makes it difficult to move the tongue.

Speech disorders

Due to respiratory failure, the first noticeable side effect it turns out to be a nasal voice and its hoarseness. Sounds that require good articulation (synchronization of the movement of the facial muscles and tongue) will be pronounced with a noticeable effort or “blurred”. Subsequently, the voice may disappear completely due to the toxin blocking the mobility of the vocal cords.

General deterioration

First of all, it is characterized by a pronounced weakness of all the muscles of the body. This manifests itself in unsteady gait and greatly weakened muscle tone, when a person cannot even hold his head on his own. In some cases, a blockage of the facial muscles occurs, as a result of which a person cannot show his teeth or make other facial movements. Excessive tension of the facial muscles is also possible, due to which the face warps and becomes asymmetrical.

All this happens against the background of maintaining the sensitivity of the skin and the absence of fever. The person is fully conscious and can hear everything that is happening around.

Symptoms of the end stages of botulism

If a sick person is not given timely help, then the symptoms associated with breathing become predominant. This is a lack of air, a feeling of squeezing the chest and the inability to take a full breath. Possibly developing pneumonia.

The last stage is characterized by the almost complete cessation of signals to the muscles from the nervous system. As a result, the skeletal muscles completely relax and become pasty - a person is no longer able to move his limbs and hold his head. First, complete motor paralysis occurs, after which nerve signals to the respiratory muscles are blocked and death occurs from suffocation.

What is botulism and its symptoms in the following video:

Treatment of botulism

Even if the symptoms are correctly recognized and it would seem that treatment can be started immediately, the first few days will have to be spent on finding out which serum should be used to treat the sick person.

The whole problem is that a bacterium can produce eight various types toxin - A, B, C1, C2, D, E, F, G. A person is affected by A, B, E, F, G and for effective treatment it is necessary to find out exactly against which of them the serum is needed. This can only be done in the laboratory and in the only way - by conducting experiments on white mice. Each of the animals is injected with material obtained from the patient and one of the types of serum - the mouse that was injected survives the right drug. The whole procedure takes 3-4 days.

Since the result of botulism is a fatal outcome, even with the slightest suspicion of it, the patient is immediately admitted to the hospital:

• First urgent measures sent to extract the remains of food contaminated with toxin, washing the stomach and intestines.

• If the patient arrives already in severe form, with signs of impaired respiratory function, he is connected to a ventilator as soon as possible.
• The toxin that has entered the body is neutralized by the simultaneous administration of all types of anti-botulinum sera. This is a rather risky procedure that requires a preliminary assessment of the possibility of development anaphylactic shock. Serum is injected subcutaneously, first with a solution of 1:100, in the absence of allergic reactions 0.1 ml of the undiluted drug, and if everything is in order, then the therapeutic dose is already used. If the samples show a positive reaction, and the patient's condition is severe, then the sera are administered under the supervision of a doctor using antiallergic drugs.
• Further, solutions are applied that bind toxins and remove it from the body with urine.
• To prevent the transition of botulinum spores into a vegetative form, a course of antibiotics is prescribed.

Full treatment takes 3-4 weeks. The symptoms of the disease disappear into reverse order- First, breathing and swallowing reflexes are normalized, then all other functions. Vision and muscle tone are restored the longest. The positive point is the disease's complete disappearance - when all the symptoms disappear, then only an entry in the former patient's medical record reminds of the transferred botulism.

Botulism in conservation, the signs of which can be very difficult to notice at first glance, can seriously affect human health and in many cases lead to death. The microbe that causes its development can grow perfectly even without air. That is why most often this terrible diagnosis can be obtained after eating canned food. The insidiousness of botulism lies in the fact that very often its symptoms resemble simple poisoning and correct diagnosis not set immediately. At this time, the disease can affect the human brain and lead to irreversible consequences. Questions about what is the treatment and diagnosis of this disease will be discussed in detail in our article.

In order to protect yourself from infection, you must always remember that, in addition to conservation, a microbe can get to a person after drinking milk, meat, and even vegetables if they have not undergone proper heat treatment.

Botulism: symptoms, diagnosis, treatment, prevention of botulism

This disease has infectious origin and its causative agent is a microbe (Clostridium botullini), which is able to multiply even in the absence of oxygen. Once in the body, it begins to produce a special poison - botulinum toxin, which is 400,000 times stronger and more dangerous than a bite rattlesnake. Botulism, in conservation, the signs of which are very difficult to recognize, can affect the human brain and cause paralysis of absolutely all muscles in the body.

The symptoms of this disease are very similar to the usual alcoholic or Botulism may be accompanied by:

• nausea;
• pain in the abdomen;
• vomiting;
• diarrhea.

Specific Symptoms

The first signs may occur between 2 and 24 hours after ingestion of contaminated food. The body temperature rises, but only slightly. When referring to a doctor with such complaints, the patient can often be given an incorrect diagnosis - namely, food poisoning. It is worth noting that canned food, which can cause botulism, is very often used as a snack when drinking alcohol. Therefore, the appeared nausea, vomiting, diarrhea can be perceived as

If no measures are taken in time, the microbe that enters the body begins its toxic effect. A person may develop new, specific syndromes:

• feeling of dryness in the mouth;
• blurred vision;
• difficulty swallowing;
• voice change;
• severe weakness;
• speech change.

Due to the fact that botulinum toxin begins to act on the nerve endings and muscles of the eyes, in some cases strabismus may occur. When such signs appear, the doctor must be called very quickly.

Mandatory hospitalization for suspected botulism

Botulism, in conservation, the signs of which can be completely invisible, entering the body, can very quickly affect the nervous system and lead to irreversible consequences. For this reason, at the slightest suspicion of infection with botulism, the patient is hospitalized in a hospital. In the hospital, the first thing they do is blood tests for Clostridium botullini, and in order not to aggravate the situation without waiting for their results, they begin to take appropriate measures. First of all, it is necessary to detoxify the body and for this, the stomach cleansing procedure is urgently carried out. The patient is given a large amount of laxative in order to hasten the discharge of feces and thus reduce intestinal intoxication.

If a person's swallowing function is disturbed, then it is started. At the same time, it is very important to prevent respiratory distress in a patient. In case of pulmonary spasm, a person is connected to a ventilator.

After the type of toxin is determined by the results of the tests, the patient is urgently injected with anti-botulinum serum. With timely access to medical institution and with proper treatment, full recovery occurs in 3 weeks.

How to recognize danger in conservation

Unfortunately, there is still no unambiguous answer to the question of how to determine whether there is botulism in conservation. Sometimes you can contract this disease after eating a canned food that had absolutely no signs that something was wrong with it.

The fact is that the microbe that provokes the development of the disease often lives in the soil and its spores are very tenacious and resistant to external factors. If at least one small grain of sand from this contaminated soil remains on a berry, vegetable or fruit that was used to prepare preservation, then infection of a person after he tastes such a product will be inevitable.

Signs of botulism in preservation are sometimes simply impossible to notice; it does not affect the taste, smell or color of the product at all. Externally, the tin may not be deformed, but, alas, this does not always mean that the product in it is safe.

External signs

Despite the fact that there are no exact instructions on how to recognize signs of botulism in conservation, there are certain tips that will help you avoid the danger of infection:

Proper heat treatment

In fact, it is very difficult to kill the botulism germ at home. Even if the product is boiled at a temperature of 100 ° C, there is no guarantee that it will die. In the conditions of industrial production, many products, especially meat and fish, undergo long-term processing in autoclaves before conservation. But, in any case, with home preservation, it should last no less than 15 minutes.

If, nevertheless, preservation is carried out at home, before rolling it up with a lid, it is necessary to boil it for at least 20 minutes. Also, after the workpiece has been opened, it can be boiled again before use.

Vinegar and salt are helpers in the fight against botulism

One way to protect against botulism is to add table vinegar to the preservation. It is believed that it is able to level Clostridium botullini. For this reason, it is very important to strictly adhere to the recipe and observe the indicated amount of vinegar and salt when canning. Especially this product is recommended to be added when harvesting vegetables that do not contain their own acid (cucumbers, eggplants, zucchini, squash).

How to protect yourself from illness

Really, dire consequences human health can be affected by this rare disease- botulism. Preservation rules and precautions that must be observed during the preparation process can save you from unpleasant problems:

Botulism in conservation, the signs of which are almost imperceptible, is terrible because there are no vaccinations against it, and the body absolutely does not develop immunity against its microbes. In the context of this disease, a person's health depends solely on his responsibility and eating proven products.