Botulism virus. Botulism: symptoms, causes and treatment. Collection of anamnesis and objective data

Botulism is one of the most severe, acute, saprozoonotic bacterial toxic infections, with a fecal-oral transmission mechanism, characterized by damage to the central and autonomic nervous system, with the occurrence of paresis and paralysis of striated and smooth muscles.

The name comes from the Latin word botulus - sausage, because the pathogen was discovered there, and it was also in the bodies of deceased people who consumed it. The occurrence of this disease is still associated with eating salted or smoked fish, as well as ham.

The causative agent of botulism

The causative agent is Clostridium botulinum, it is a rod with flagella along the periphery, therefore it is called peritrichous - they provide mobility. The structure of the pathogen has a small number of features that predetermine symptoms:

Botulinum toxin is the most powerful exotoxin (even in comparison with tetanus), i.e. a biologically active substance that is always released from the pathogen. There are several types of this toxin - proteolytic and non-proteolytic, i.e. they are divided according to their ability to ferment substances for self-activation and production of H₂S. People are most susceptible to 7 types of toxins (A, B, C, D, E, F, G) - but these are all variations of the same botulinum toxin, but the specificity and lethality are determined by various functional components, such as the presence of a neurotoxin and the ability to hemagglutination.

The peculiarity of botulinum toxin activation is under the influence of proteolytic enzymes (either their own or in the gastrointestinal tract), as a result of which the neurotoxin (botulinum toxin) is divided into 2 chains: the H-chain ensures the attachment of the toxin to the cell membrane receptor, due to binding to the synoptic membrane of neuromuscular cholinergic synapses (connections) innervating striated and smooth muscles. The L-chain has a blocking effect on cholinergic transmission by cleaving specific synaptic proteins (SNAP-25 and synaptobrevin - similar to tetanus), the connection of synoptic vesicles with the presynaptic membrane is disrupted, and blockage of the passage of the nerve impulse occurs with normal production of acetylcholine and cholinesterase.

Toxin types B, C, D, F are also dangerous because they can activate their own neurotoxin with their own enzymes without entering the gastrointestinal tract. In this case, not only is the incubation period shortened, but symptoms also appear even when the contaminated product was in the mouth but was not swallowed.

Specific activity:
- Leukotoxic (suppression of phagocytosis without damaging leukocytes, i.e. phagocytic cells),
- Hemolytic (destroys red blood cells);
- Leukocyte (breaks down phospholipids of the cell membrane).

The pathogen can be in two forms - vegetative (indicated by the yellow arrow in the figure below) and spore (blue arrow) - this is important for preventive measures, because vegetative forms are the most pathogenic and are not resistant to harmful factors. The spore form is the ability to form spores, that is, the emergence of almost unshakable resistance. The spore is formed terminally, that is, almost at the end, the pathogen takes the form of a “tennis racket.”

Stability:

1. The spore form - at a temperature of 6°C - persists for several months, at 100° - 1-2 hours, at 120° - dies within 30 minutes, but some strains can survive for several hours at this temperature. The spores are resistant to freezing and drying, even to direct UV radiation. When dried, they last for decades. The effect of disinfectant solutions is activated within a few hours: a 20% formalin solution kills the pathogen within 24 hours; ethyl alcohol for 2 months; 10% hydrochloric acid solution - after an hour.

2. The vegetative form is not very stable in the external environment and, at 80°C, dies within 30 minutes.

3. The toxin is destroyed at the same temperature as the vegetative form: 100°-10 minutes, well neutralized in alkali, but resistant to acid. In the gastrointestinal tract it reduces its activity, except for type E, which, on the contrary, increases its activity 10,000 times.

Botulism occurs in all regions, but is more often recorded in countries where the population consumes a large number of different canned foods (both plant and animal content); we can say that there are no territorial restrictions. All people are highly sensitive to the toxin, without restrictions on gender or age. Seasonality is also not noted.

Features of using botulinum toxin in everyday life:

1. As a biological weapon, by obtaining a pure toxin, where 1g = 1 million lethal doses, i.e. it can be used as a means of mass destruction.
2. As a drug for the treatment of muscle contractures in cosmetology (“Botex”)

Causes of infection with chatulism

The natural habitat and, as a result, the source is soil, therefore the pathogen is called saprozoonosis. Also the source is water, dust, food products contaminated with soil, intestinal contents of fish and birds, honey - but in these habitats, the pathogen is often in spore form and turns into vegetative when favorable conditions are created: t° = 28-35 ° C, anaerobic = oxygen-free conditions (canned food), activation by proteolytic enzymes in the gastrointestinal tract. Infection most often occurs in vegetative forms; infection with spores is possible only in two cases - with wound infection and with botulism in newborns. Paths – food and contact-household.

Symptoms of botulism

The incubation period is considered from the moment of introduction of the pathogen to the first clinical manifestations. It lasts up to a day, but can vary from 2-12 days, which is extremely rare and only happens with wound botulism and neonatal botulism. Penetrating through the gastrointestinal tract, the pathogen activates lecithinase and leukopenic activity (more details in the description of the pathogen) - they facilitate the penetration of the pathogen into the underlying tissues with parallel protection from phagocytosis. At the stages of implementation, the toxin begins to act due to activation by proteolytic enzymes of the gastrointestinal tract and, as soon as the toxin is activated, symptoms appear.

The period of clinical manifestations begins acutely and lasts for 3 weeks, with a gradual decrease in clinical symptoms. This period is characterized by the following:

Acute sudden onset in the form of general clinical symptoms (headache, dizziness, possible rise in body temperature to 38°C)

Symptoms of gastroenteritis in 90% of cases appear in the first place during the first day from the moment of consumption of the contaminated product, manifested by cramping pain in the epigastric area (approximately in the stomach area), vomiting, and diarrhea.

Within a few hours, neurological symptoms appear in the form of various combinations of myoneurological syndromes:

• ophthalmoplegic syndrome;
• bulbar syndrome in the form of paresis of the pharyngoglossal muscles with damage to the IX (glossopharyngeal), X (vagus), XII (hypoglossal) pairs of cranial nerves;
• damage to the parasympathetic system and changes in the cardiovascular system;

Explains neurological symptoms

• tropism (selective damage) to neurons of the medulla oblongata and motor neurons of the spinal cord;
• the peculiarity of the action of the toxin is that it increases the permeability of the affected tissues;
• First of all, muscles with high functional activity are affected, those that are in constant tension/movement (oculomotor, pharyngeal muscles, etc.)

It happens that there may be no symptoms of gastroenteritis, and the first manifestations are neurological symptoms.

Ophthalmoplegic syndrome:

• grid or fog before the eyes;
• inability to read and see nearby objects, but maintaining good foresight - this is explained by paresis of the ciliary muscles, those that change the configuration of the lens, as a result of their damage, the lens is in a constant relaxed state, which happens when concentrating on distant objects;
• strabismus (strobism);
• double vision (diplopia);
• drooping eyelids (ptosis);
• dilated pupils that do not respond to light (mydriasis);
• uneven pupils (anisocoria);
• nystagmus (involuntary movements of the eyeballs);
• in severe cases, immobility of the eyeballs may occur.

Bulbar syndrome is manifested by aphonia and dysphagia. Aphonia: slurred speech, with a nasal tint, paresis of the muscles of the tongue, hoarseness of voice. Dysphagia is caused by paresis of the muscles of the pharynx, epiglottis and soft palate, which results in: impaired swallowing of both solid and liquid food, the latter flows out through the nose, and choking is also noted when trying to swallow even saliva.

Bilateral paresis of the facial nerve is manifested by a “mask-like face” due to a violation of the facial muscles.

Paresis of the diaphragm and auxiliary respiratory muscles:

• limited mobility of the pulmonary edge occurs due to paralysis of the intercostal muscles, patients complain of a feeling of compression of the chest “as if by a hoop”;
• interruption of speech due to a feeling of lack of air;
• tachypneous (respiratory rates) and shallow breathing;
• respiratory failure can increase either gradually or suddenly - a sudden cessation of breathing occurs (apnea) and “death occurs immediately”;
• Bulbar syndrome contributes to the formation of respiratory failure.

Damage to the parasympathetic nervous system:

• dry skin and mucous membranes;
• decreased salivation;
• disruption of the innervation of the gastrointestinal tract up to the development of paralytic intestinal obstruction;
• urodynamic disturbance in the form of acute urinary retention or involuntary urination.

Changes in the cardiovascular system:

• bradycardia (decreased heart rate) alternates with tachycardia (increased heart rate);
• tendency to increase blood pressure;
• disturbance of the conduction of excitation, with the occurrence of atrioventricular block (AV block);
• increasing shortness of breath.

As the disease progresses, muscle weakness increases, at first it is most pronounced in the occipital muscles and therefore the head can hang, patients try to hold it. Muscle asthenia can persist for up to 6 months.

Hypoxia (↓O₂ in peripheral blood) of various origins is important in aggravating symptoms:

• respiratory (due to paresis of the diaphragm and auxiliary respiratory muscles);
• toxic (direct and indirect action of the toxin through inhibition of the enzymes of the pentose phosphate shunt and K-Na pump);
• circulatory (due to hemodynamic disturbances)

The duration of the disease is on average 3 weeks, provided that treatment is carried out. Neurological symptoms are restored in the reverse order: first breathing, and then swallowing. The remaining manifestations - headache, nasal tone, ophthalmoplegic, parasympathetic and other neurological symptoms - pass without a specific sequence and can persist for a long time (up to 1.5 months or more). In those who have recovered from the disease, all symptoms disappear without a trace and do not leave any disabling consequences. Without treatment, the most likely outcome is death.

The effect of botulinum toxin on the body.

Features of wound and infant botulism:

• Long incubation period;
• Infection is not vegetative, but spore-forming forms;
• No gastrointestinal period;
• Neonatal botulism manifests itself in the form of lethargy, weakness or refusal to suck, stool retention, ophthalmoplegic symptoms, hoarse crying, weakened swallowing or sucking reflex;
• In children, complications such as pneumonia occur more frequently and deaths are more common.

Diagnosis of botulism

1. According to epidemic data - consumption of home-made canned food.

2. According to clinical data - localization and symmetry of damage to the nervous system, absence of febrile / intoxication / cerebral and meningeal syndromes.

3. Laboratory diagnostics: aimed at detecting the pathogen in food products and biomaterials of the patient (blood, washing water, feces and urine), using RN (neutralization reactions) and ELISA (enzyme-linked immunosorbent assay) - these results can be ready within 8 hours.

The causative agent of botulism under a microscope (spores)

4. Determination of the level of cardiac-specific enzymes to determine the degree of compensation from the heart and blood vessels: MB-creatine phosphokinase, aspartic transaminase, hydroxybutyrate dehydrogenase, tropanine. For this, an additional ECG is performed.

Treatment of botulism

1. Antitoxic anti-botulinum horse serum mono/or polyvalent (in the case of an unknown type of botulinum toxin) or human anti-botulinum immunoglobulin.

2. Prednisolone is administered in parallel with a therapeutic dose of serum to avoid anaphylactic shock. For the same reasons, before introducing the serum, a test is carried out in small doses and, if an allergic reaction is observed, the dose of prednesone is increased.

3. Due to paresis of the pharyngo-lingual muscles, there is a high risk of aspiration (blockage of the respiratory tract), and due to paresis of the diaphragm and respiratory muscles, respiratory failure is formed - as a result of these two life-threatening factors, patients are transferred to tube and parenteral nutrition, and also connected to the ventilator.

4. In case of myocardial damage, cytoprotectors are prescribed.

5. For bacterial complications, broad-spectrum antibiotics are prescribed.

6. In the early stages, the pathogen is also affected through the gastrointestinal tract, by gastric lavage and cleansing enemas, and sorbents are also prescribed.

Nutrition during and after illness

Therapeutic nutrition involves the exclusion of dishes rich in extractive substances, spices and fatty foods. They also prescribe diet No. 10. It is preferable to switch to mixtures with high energy activity. Bed rest or semi-bed rest.

Complications of botulism

1. Specific: myositis (the femoral, occipital and calf muscles are often affected, this manifests itself in the form of swelling, pain and difficulty in movement) and damage to the nerve nodes of the heart with the subsequent formation of arrhythmias.

2. Secondary bacterial complications: pneumonia, atelectasis, purulent tracheobranchitis, pyelonephritis, sepsis.

3. Iatrogenic (post-treatment): serum sickness, hyperglycemia, hyperphosphatemia, intestinal atrophy.

Prevention of botulism

1. Specific – antitoxic anti-botulinum serum, polyvalent (from A, B, E types of botulinum toxin).
2. Nonspecific:

strict adherence to the rules of preparation and storage of fish/meat/vegetable semi-finished products;

heat treatment before consuming canned food by boiling in a water bath for 15 minutes, while let me remind you that only vegetative forms die, and the spores remain intact, therefore, before consuming the remaining contents of the canned food, it is necessary to boil again to destroy those spores that have sprouted into the vegetative form .

Consultation with a doctor on botulism:

Question: Is the patient contagious?
Answer: no

Question: Do bombed jars indicate the presence of botulism?
Answer: it is impossible to unequivocally reject the contamination of the product, since this does not manifest itself in any way, and is an inveterate myth about “blowing of lids, softening and unpleasant odor, rancid taste,” since this only speaks of a microflora that is more enzymatically active than the causative agent of botulism (in in particular Clostridium Perfringens - the causative agent of gas gangrene). The causative agent of botulism can only produce H₂S (hydrogen sulfide), which is a weak gas in density and is certainly not capable of creating such high pressure inside canned food. But still, a common source is homemade, unmodified and unremarkable canned food, because when twisted, favorable anaerobic (without O₂) conditions are created for the pathogen, where they multiply.

Question: Is immunity formed?
Answer: it is formed, but extremely rarely, because the immune dose corresponds to the lethal dose. But even if immunity has been formed, it is strictly type-specific, weakly expressed and short-lived.

Question: Do disabling post-infectious complications persist?
Answer: no, because the blockade of nerve impulses occurs at the synoptic, or rather at the subcellular level (features of the action of the L and H chains of the toxin), as a result of which the anatomical and tissue structures remain intact, the effect of the toxin is not paralytic, but pseudoparalytic and, it can be eliminate without a trace by inactivating the toxin, resulting in a complete restoration of neuromuscular excitation. All types of neuromuscular excitation are restored, in all organs and tissues, with the exception of the heart - if an ectopic focus has formed there once, as a result of uncoordinated movement, then it can only be removed surgically.

General practitioner Shabanova I.E.

Rehabilitation after botulism

Botulism is a serious infectious disease caused by exposure to botulinum toxin (neurotoxin) with damage predominantly to the nervous system and the development of a nerve paralytic syndrome (impaired breathing, speech, swallowing, damage to the visual organs). The severity of the changes largely depends on the dose of botulinum toxin, and the symptoms that arise (breathing, speech, swallowing disorders) can still be reversible with timely help. However, often visual disturbances (paresis and paralysis of accommodation, damage to the optic nerves with limited or decreased vision, narrowing of the visual fields) carry with them certain consequences in the form of atrophy of the optic nerves.
Features of the development of the disease determine the promptness of providing medical care to such patients, and also require a serious attitude towards compliance with the entire complex of rehabilitation measures during the period of recovery (or convalescence).

Rehabilitation (recovery) program after botulism

1) Regular measures (inpatient treatment until the 10th day after the disappearance of all neurological disorders, followed by the issuance of a sick leave certificate upon discharge, extended for another 7-14 days, depending on the severity of the disease).

2) Medical observation (dispensary examination) of patients involves observation of those who have recovered from the disease by a therapist in the patient’s area of ​​residence for 14 days after discharge and, if residual effects persist, consultation and observation by a neurologist and cardiologist (if there is myocarditis in the hospital), an ophthalmologist in case of consequences on the visual organs. Further observation is established until complete recovery with a frequency of once every 6 months. Drug therapy during the recovery period is prescribed according to indications depending on the residual effects and is determined by the attending physician (cardiovascular drugs, nootropics, vitamin therapy, drugs for the treatment of optic atrophy, and others).

3) Recommendations for physical activity include: restriction of physical activity for a period of 3 or more (if necessary) months, exemption from heavy physical labor, exclusion from specialized sports activities, and any work associated with stress on the visual analyzer. In other words, rational employment for a period of at least 2-3 months. The conclusion on rational employment is determined by the CEC (clinical expert commission) of the medical institution (clinic), including a therapist, neurologist or cardiologist, deputy. Ch. doctor and others.

4) Therapeutic nutrition during the recovery period should include a complete diet in composition and calorie content. However, several basic principles should be observed: adherence to the meal schedule (4 meals at approximately the same time); maintaining the principle of chemical sparing of the gastrointestinal tract during the period of convalescence after botulism (limiting spicy and fatty foods, limiting salt intake, predominance of vegetable fats over animal fats, sufficient protein intake); sufficient intake of vitamins with food intake or with the help of specialized multivitamin complexes (Vitrum, Centrum, Complivit, Alphabet and many others).

5) Physiotherapeutic procedures can be widely used after botulism. These include water procedures (baths, showers), hardening procedures, electrosleep, hyperbaric oxygenation (oxygen inhalation at excess or normal pressure), which will eliminate the residual effects of hypoxia in the acute course of botulism. General health procedures are shown (general massage, physical therapy, visiting the pool).

6) Sanatorium-resort treatment during the rehabilitation period with visits to institutions for patients with diseases of the nervous system.

Infectious disease doctor N.I. Bykova

Botulism is a toxic infectious disease caused by human infection with vegetative forms of botulinum clostridium with accumulated toxins. Microbiological studies revealed 7 varieties. The most dangerous types for humans are A, B, E and F.

Symptoms of botulism consist of damage to internal organs (brain, spinal cord, gastrointestinal tract) and severe intoxication. Differences in the course in children and adults are due to the different state of the intestinal microflora and the advantage of lactobacilli in infants.

How does infection occur?

Based on the mechanism of infection, there are 4 variants of infection development:

• food - the causative agent of botulism with toxins accumulates in food products, enters the human body during meals, the most dangerous are canned meat, fish, mushrooms, vegetables, dry and smoked fish, lard;
• wound - accompanies open wounds contaminated with soil, while botulinum clostridia enter the blood from the soil; when wound treatment is delayed, favorable conditions are created for growth and the formation of toxins;
• for children - in addition to favorable microflora for bacterial growth, contamination of baby food through honey components plays a role;
• unspecified - confirms the name by the lack of data on the route of infection.

What disorders cause manifestations of botulism?

Botulism in humans is characterized by selective damage to motor neurons that transmit signals from the medulla oblongata along the spinal canal as part of the anterior horns to muscle groups. Therefore, the origin of some clinical symptoms can be explained by damage to specific neuromuscular formations.

The first signs of botulism are:

• difficulty swallowing, dry mouth, change in voice timbre, nasal speech, limited mobility of the tongue - this occurs due to damage to the nuclei of the cranial nerves in the medulla oblongata, which have paired numbers V, IX, XII in their anatomy;
• violation of joint and voluntary eye movement (convergence), strabismus, drooping eyelid, double vision - caused by damage to the central nuclei of cranial nerves III and IV;
• dilation of the pupils, decreased vision due to impaired accommodation (the ability to change the curvature of the lens by muscle tension and adapt to different distances to objects) - caused by stopping the functioning of the ciliary nerves and muscles;
• pallor - occurs due to spastic contraction of capillaries;
• decreased facial expressions - due to bilateral damage to the facial nerves.

Diarrhea, vomiting - with botulism indicate the onset of exposure to botulinum toxin, pathogenic microorganisms in the eaten product

In severe cases, the main signs are:

• muscle weakness, paresis and paralysis - first the transmission of the nerve impulse is blocked, then the mechanism of increasing oxygen starvation and metabolic disturbances, the process of energy synthesis in cells, is triggered;
• increased heart rate, increased blood pressure - caused by increased activity of the sympathetic-adrenal system, lack of oxygen (increased production of catecholamine hormones);
• atonic constipation, bloating - a sign of inhibition of the vagus nerve, an increase in the concentration of catecholamines;
• urinary retention - associated with a decrease in bladder tone, damage to the autonomic nervous system;
• frequent shallow breathing - caused by paresis of the intercostal muscles, diaphragm, lack of support for the abdominal muscles, oxygen deficiency in the blood.

Symptoms

The average incubation period lasts 18–24 hours from the moment of infection. Options range from several hours to 5 days. It has been established that the shorter it is, the more severe the course of the disease should be expected. The critical period is considered to be 10 days, so this is how long contact persons are monitored.

All signs of botulism are usually divided into syndromes:

• gastrointestinal;
• paralytic;
• general toxic.

The first symptoms are often patient complaints about unclear damage to the stomach and intestines. Nausea with vomiting, diarrhea, cramping pain in the epigastrium and around the navel appears. Signs resembling poisoning with botulism indicate the release of toxins into the blood.

An attentive doctor notices a discrepancy between infrequent diarrhea, therefore, moderate loss of fluid with severe dryness of the skin and mucous membranes. As well as the appearance of patient complaints of a “lump in the throat” and difficulty swallowing. This difference does not “fit” into the clinical picture of ordinary food poisoning.

Very quickly, diarrhea gives way to constipation, the pain becomes bursting, and bloating appears. This indicates the onset of paresis of the muscles of the intestinal wall.

Neurological symptoms are detected simultaneously with gastrointestinal syndrome or on the second day. The earliest signs are dry mouth, blurred vision, and muscle weakness. Patients feel a “grid”, “fog”, “flickering of flies” before their eyes and are unable to read due to impaired accommodation and double vision.

A face without facial expressions resembles a mask, one or both eyelids are drooping, asymmetrical wrinkles and folds are possible, the pupils are dilated, do not react to light or have a very weak reaction

Examination reveals lethargy; there may be different pupil widths in the left and right eyes (anisocoria). Nystagmus (twitching of the eyeballs) and strabismus are detected. It is difficult for the patient to stick his tongue out; the action takes time and occurs in jerky movements. General malaise and headache appear. In this case, the temperature is slightly elevated or normal.

Weakness in the muscles begins in the occipital region, so patients hang their heads and try to support them with their hands. The gait is unsteady. Intercostal muscles with paresis cause shallow breathing, imperceptible movements of the chest, the patient is not able to take a deep breath.

An important feature of the clinical manifestation is the preservation of sensitivity against the background of reduced motor activity of the muscles. This is used in differential diagnosis with paresis and paralysis caused by cerebrovascular accident.

Paresis of the pharyngeal muscles first causes difficulty swallowing solid food, then liquid food. Examination of the mouth and nasopharynx shows a bright red color, dry mucous membrane, and accumulation of thick mucus in the epiglottis area. The addition of infection causes cloudiness and purulent plaque. Therefore, the picture is mistaken for a sore throat.

Impaired speech is one of the typical signs of botulism in adults. The changes follow in stages:

• first, the timbre is disrupted, the voice becomes hoarse due to lack of moisture in the vocal cords;
• then paresis of the tongue occurs, which is manifested by complete dysarthria, nasal sound due to sagging muscles of the velum;
• when the process reaches the muscles of the vocal cords, the nasal sound disappears.

It is important that impaired innervation of the larynx causes the absence of a protective cough impulse to allow crumbs and mucus to enter the lumen. Therefore, patients may suddenly become short of breath. Disorders of the cardiovascular system are expressed in the expansion of the left border, tachycardia, arrhythmia, and muffled tones.

During auscultation, the doctor determines the emphasis of the second tone on the pulmonary artery

How is the recovery period going?

The recovery period is slow. The patient feels improvement after the appearance of saliva in the mouth. Then muscle strength returns. Vision treatment takes the longest time, sometimes for several months. Still, full recovery is coming. There are no residual manifestations.

How do the severity of the disease differ?

It is most optimal to begin the necessary course of treatment by identifying the patient’s symptoms of poisoning, even if there is still no certainty about the botulinum nature of the disease. The use of measures such as gastric lavage and intestinal cleansing, taking enterosorbents, and administering fluids can reduce the concentration of the toxin in the gastrointestinal tract and remove it from the body.

According to the severity of botulism, the course is divided into:

• to the lung - implies the development of paralysis only in the oculomotor muscles, signs of intoxication are mild, the voice changes moderately due to a decrease in saliva production, the disease lasts up to 2-3 days;
• moderate - paresis of the muscles of the larynx and pharynx is added to the damage to the eyes, but it does not reach complete impairment of swallowing and aphonia, there are no severe disorders, the duration of the peak period is 2–3 weeks;
• severe - a pronounced clinical picture with all the manifestations, paresis and paralysis, complications, a feeling of suffocation, a suppressed cough reflex, while the patients do not lose consciousness.

The usefulness of the act of breathing depends on the condition of these muscles.

Complications

Complications of botulism are most often associated with the entry of vomit into the trachea and bronchi. Develop: aspiration pneumonia, purulent tracheobronchitis, atelectasis in the lung tissue (blockage of the afferent bronchiole and collapse of part of the lungs).

The decline in immunity is accompanied by the development of purulent parotitis (inflammation of the parotid salivary glands), an inflammatory reaction to medical measures taken - bladder catheterization, saliva aspiration, artificial ventilation, tracheostomy.

The most typical complication is the development of serum sickness (observed in 1/3 of patients who were administered anti-botulinum serum). Myositis of the calf muscles appears 2–3 weeks after the onset of the disease. The patient complains of pain in the calves when moving.

The most severe complication is acute respiratory failure. It is called “ventilation” because it is caused by the impossibility of breathing movements due to damage to the intercostal muscles and diaphragm.

The face and body become blue. In contrast to lung damage, there is no significant shortness of breath or agitation of the patient. This disorder kills most patients with botulism.

Another fatal complication is paralytic cardiac arrest.

Manifestations of botulism in childhood

There are 3 forms of botulism in children: food botulism (the most common), wound botulism and infant disease. The clinical course is somewhat different from adults.

For food botulism

The incubation period lasts several hours or up to 12 days. It is determined by the dosage of botulinum toxin entering the child’s body. Initially, signs of unclear poisoning and increasing intoxication appear:

• abdominal pain is localized in the epigastric region;
• vomiting is observed, older children complain of nausea;
• diarrhea repeats up to 5 times a day; it is important that there are no impurities in the stool (mucus, pus, blood, fatty inclusions).

By the end of the day, signs of intoxication come first (severe headache, dry mouth, thirst, weakness), the temperature may rise to 39 degrees. After 24 hours, the diarrhea ends and constipation and bloating occur. Neurological symptoms appear.

Visual impairment is expressed in the loss of the ability to see distant objects, blurred contours, and a “grid” in front of the eyes. When trying to read, the letters cannot be distinguished and double vision appears. The pupils are dilated, without reaction to light. Strabismus, drooping eyelids appear, limited movement of the eyeballs, a symptom of nystagmus.

Disorders of swallowing (dysphagia) and speech (dysarthria) are caused by damage to the muscles of the larynx, palate, and tongue. First, the child complains of a sore throat when swallowing, a “lump” that prevents him from swallowing food. Noticeable choking when eating. In severe cases, swallowing is completely impossible; attempts to swallow water end with it flowing out through the nose. The tongue does not protrude. The voice becomes hoarse and nasal.

Frequent choking and coughing occur due to mucus and food entering the respiratory tract.

Facial asymmetry may develop due to paresis of the facial nerve. The child's gait is unsteady, coordination of movements is impaired, and weakness in the muscles of the arms and legs is detected. Heart sounds are sharply muffled, systolic murmur is heard, and the left border is widened.

Neurological symptoms in children manifest themselves in various combinations; some classic symptoms may be absent. The lethal outcome is characterized by suddenness and occurs at any severity of the disease.

For other forms of botulism

Wound botulism is accompanied by a longer incubation period in children. It is characterized by the absence of gastrointestinal signs. Only neurological symptoms appear. In infants, a feature is considered to be more favorable conditions in the intestines for the germination of vegetative forms and the formation of toxin.

The clinic develops slowly as it synthesizes and passes into the blood. The form is typical for ages from 2 to 6 months. Children who are bottle-fed are more often infected. The source may be dust from the ground with spores, beekeeping products. It is impossible to determine the incubation period.

The flow has a tendency to both mild forms and unexpected severity. Initial symptoms of botulism include:

• lethargy of the baby;
• refusal to eat;
• weakening of screaming and crying;
• lack of a smile on the face.

Subsequently, the development of all neurological manifestations is observed: drooping eyelids, choking, hoarse crying, lacrimation, dilated pupils, lack of stool. Acute respiratory failure is the main complication of botulism and the cause of death in babies.

Diagnostic methods

Unfortunately, in order to make a correct diagnosis, specific clinical diagnostic methods will not help the doctor if botulism is suspected. There are no characteristic changes in general blood, urine and stool tests.

Serological tests (detection of typical antibodies and antigens) are not carried out in conventional laboratories, since the disease is not accompanied by the production of characteristic antibodies. The dosage of the toxin is too small to detect, but sufficient to cause clinical manifestations.

Research at the bacteriological level is possible only in specialized laboratories where it is possible to work in an oxygen-free chamber. Toxins are released from feces and vomit obtained during gastric and intestinal lavage, the contents of wounds, and food products consumed by the sick person.

The analysis is carried out on experimental mice and guinea pigs. They are injected intraperitoneally with a solution obtained by mixing the patient’s blood with anti-botulinum serum (types A, B, E) followed by centrifugation. The entire study takes 4 days.

As a result, mice that are not protected by the antitoxin die, while those individuals who were injected with a serum similar to the toxin remain alive.

The specific type of toxin can be clarified by performing an indirect hemagglutination reaction, enzyme-labeled antibodies, and gel precipitation. The causative agent of botulism is isolated by inoculating the contents of the stomach and intestines on special nutrient media for anaerobes.

Hotinger's casein-mushroom medium is used for crops.

The existing hardware electromyographic study makes it possible to detect specific disturbances at the level of synaptic signal transmission in botulism.

What are considered reliable diagnostic criteria?

The diagnosis of botulism is aided by epidemiological analysis of data on possible routes of infection, examination of food products, and a set of clinical symptoms. The following factors are taken into account:

• information about the patient’s consumption of canned food suspected of being infected with clostridium botulism;
• absence of temperature as the severity of the condition increases;
• severe dry mouth;
• gradual increase in muscle weakness;
• characteristic diarrhea on the first day followed by constipation and bloating;
• eye symptoms;
• disturbance of voice timbre, swallowing;
• signs of ventilation respiratory failure.

What diseases must be distinguished from botulism?

Differential diagnosis of botulism requires extensive practical experience of doctors of various specialties. After all, the disease is rare. The following may be misdiagnosed:

• food poisoning (toxic infection), especially mushrooms;
• cerebrovascular accidents;
• encephalitis;
• consequences of hypertensive crisis;
• myasthenia gravis.

Foodborne toxic infections are caused by staphylococci, salmonella, and E. coli. They are more often associated with eating dairy and confectionery products, uncooked eggs, violation of shelf life, production technology and conditions of detention

They have a short incubation period, the clinical picture of gastritis predominates, the severity of the course is due to the large loss of water with diarrhea during enteritis. No respiratory failure. Typical signs of gastroenteritis include fever, abdominal pain, discharge of impurities with diarrhea, and foul-smelling stool.

The type of pathogen that causes the disease is detected in the stool using bacteriological analysis.

With encephalitis, headache, general malaise, and fever come first. Partial disruption of the oculomotor nerves is possible. There are no other neurological manifestations of botulism. Polyencephalitis is accompanied first by drowsiness, then transition to stupor and coma.

Ocular signs are observed in the form of upward gaze paralysis, speech impairment, cerebellar form of changes in movements, hand tremors. Important distinctive features are determined by analyzing cerebrospinal fluid from the spinal canal. There are no changes with botulism.

Cerebrovascular accident (stroke) occurs suddenly or with gradual development of symptoms. Usually the patient has predisposing factors (high blood pressure, stress, vascular damage by atherosclerosis, obesity and other endocrine diseases). A neurologist will clearly determine the focality of the disease by impaired sensitivity and pathological reflexes, which are not present in botulism.

Some people, unaware of the danger, grow henbane in the garden

An overdose of certain drugs, household poisoning, and negligent child care can contribute to the entry into the body of atropine and similar drugs based on belladonna, datura, and henbane (nightshade plants). Children can eat berries in the forest, in the country.

The clinic is similar to botulism: the patient has severe dizziness, dry mouth, vomiting, difficulty speaking and swallowing, dilated pupils, impaired vision. The disease can be distinguished by identifying the origin of the symptoms, the patient’s typical psychomotor agitation, the presence of delirium, visual hallucinations, epileptiform seizures, and pronounced signs of damage to the cardiovascular system (tachycardia, arrhythmia, drop in blood pressure).

In adult patients who abuse alcohol, poisoning with methyl alcohol is possible. It also causes progressive visual impairment, dilated pupils, poor reaction to light, dry mouth, vomiting, bluish skin, rapid breathing at normal temperature.

There is no change in voice, choking or swallowing problems characteristic of botulism. The patient in serious condition falls into a coma, there is no acute respiratory failure. It is easy to find out the connection with the use of substitute alcohol.

Myasthenic bulbar palsy occurs in patients with severe myasthenia gravis crisis. The patient has pronounced bulbar and oculomotor changes (dysphagia, loss of voice and speech, drooping eyelid, impaired breathing, double vision).

But there is no food or wound type of infection. Exacerbations are caused by a history of acute respiratory viral infection or another disease. There is paralysis of the limbs, weakened tendon reflexes. The difficulties of diagnosing botulism require the patient to urgently seek medical help at the slightest manifestation.

The topic of botulism is most relevant in the summer and autumn months. At this time, people most often engage in canned food, and canned food in most cases is the main cause of infection with this disease.

Therefore, it will be useful for everyone to learn about the exact symptoms and manifestations of botulism, what routes of infection, and, most importantly, how to protect yourself and your loved ones from such a serious disease.

Botulism is a disease that occurs in response to the penetration of botulinum toxin into the body and is characterized by severe damage to the nervous system.

Etiology of pathology

The causative agent of the disease is the clostridium bacterium, namely Clostridium botulinum. This is a fairly widespread microorganism in living nature. The spores of this pathogen are found in the soil, where they fall along with the excrement of warm-blooded animals (birds, domestic and wild animals), as well as on the bottom of seas and lakes (in silt) from shellfish and fish. They are the natural reservoir for this type of clostridia. The pathogen itself is not dangerous to human health, but its toxin can cause irreparable harm. The spores are extremely resistant to environmental factors; for example, they do not die even when boiled for five hours.

The pathogen multiplies in an oxygen-free (anaerobic) environment, releasing botulinum toxin. The toxin is less resistant to elevated temperatures. When heated to 80°C, it partially disintegrates. If the toxin is boiled for 10-15 minutes, it is completely destroyed. Botulinum toxin is one of the most powerful poisons found in nature. The causative agent of botulism is capable of producing three types of toxins - A, B, E.

In most cases, Clostridium botulinum can be found in canned mushrooms, vegetables, fruits, home-cooked smoked and salted fish, and homemade ham. Canned mushrooms are especially dangerous; according to statistics, they are the most common cause of botulism.

It is also characteristic that Clostridium botulinum spores are not distributed evenly in the product; there is a concentration in certain areas. Thus, it may happen that when the whole family consumes smoked fish from one jar, in the end, only one or several people who tasted those parts of the fish where there was the greatest concentration of the pathogen spores and, accordingly, the botulinum toxin itself, will be sick.

List of products that most often can become a source of poisoning:

poorly washed potatoes that were baked in foil;

sometimes the cause of infection may be garlic or seasoning, doused with vegetable oil for preservation, but without acidification;

fish and meat products – ham, canned, dried, smoked fish;

about 50% of all poisonings in Russia are caused by canned mushrooms.

Pathogenesis of the disease

Botulinum toxin enters the human stomach with food, and clostridia themselves penetrate there, and in the stomach they continue to multiply and synthesize botulinum toxin. Hydrochloric acid, which is normally present in the stomach, is not capable of destroying the toxin. The toxin is then absorbed into the bloodstream in the stomach and small intestine. With the help of the bloodstream, it is transported throughout the body, including to the brain and spinal cord. Botulinum toxin affects the nerves of the skull; special sensitivity to the toxin is observed in motor neurons of the spinal cord and medulla oblongata, which causes severe complications.

Clinical picture of the disease (symptoms of botulism)

The incubation period of the disease ranges from several hours to five days. The shorter this period, the more severe the degree of poisoning. In the most severe cases, the incubation period lasts no more than 24 hours. There is a rapid increase in symptoms, some are quickly joined by others, and the intensity of the manifestations also increases quite quickly.

Among the first symptoms of botulism it is worth noting:

diarrhea, loose and frequent stools, no foreign matter in it;

uncontrollable vomiting, nausea;

sharp pain in the abdominal area, which is cramping in nature.

Most victims associate these early symptoms of botulism with ordinary food poisoning and, for this reason, neglect to visit a doctor, counting on taking measures to cure themselves, which ultimately only aggravates the condition and makes the prognosis less favorable.

Such symptoms are observed for 24 hours, after which bloating develops, diarrhea gives way to constipation, and a feeling of “bloating” increases in the abdomen. Such symptoms are caused by the onset of intestinal paresis. Damage occurs to motor neurons that are responsible for intestinal motility. This ultimately causes the disappearance of peristalsis, passage through the intestines is not observed, and accumulation of gases and feces occurs.

Neurological symptoms develop after gastrointestinal ones. In particular these are:

weakness of the intercostal muscles, which leads to breathing problems, it becomes superficial, weakness in the limbs gradually appears and increases;

the first to be affected are the motor neurons that innervate the occipital muscles, which leads to their paralysis, the head begins to hang and, in order to fix it in a normal position, the patient must support the head with his hands;

the face takes on a frozen appearance (like a mask), facial expressions are absent, attempts to stick out the tongue are doomed to failure;

muscle weakness is separately noted, which manifests itself in almost all muscle groups;

the patient becomes lethargic, suffers from a diffuse headache, weakness, dizziness, most often there is no increase in body temperature;

Among the neurological symptoms, weak convergence, nystagmus, strabismus, sluggish or completely absent reaction of the pupils to light are characteristic;

double vision, difficulty reading, inability to see small details, a feeling of fog before the eyes, this occurs against the background of paralysis of accommodation.

An important diagnostic feature is the fact that, against the background of serious motor disorders, sensitivity is completely preserved.

There are also other symptoms of intoxication of the body, botulism is manifested by dryness of the oral mucosa, it acquires a bright red tint, and there is a dry mouth. In the space above the larynx, there is an accumulation of transparent mucus, which after some time becomes whitish in color. There are also changes in the voice, it becomes muffled, the patient complains of a “lump” in the throat.

There is also a disturbance in the functioning of the cardiovascular system; upon auscultation of the heart, muffled sounds are noted. Due to respiratory disorders, hypoxia develops (lack of oxygen levels in the blood). If respiratory failure occurs, the chances of a favorable prognosis drop significantly, since these disorders are the leading cause of death in people who become infected with botulism.

Botulism in children

Infant botulism occurs in babies up to 6-12 months of age. The difference from food-borne botulism, which is discussed above, is that it is not botulinum toxin that enters the child’s body, but the Clostridium botulinum spores themselves. The latter begin to multiply freely in the baby’s intestines and synthesize a toxin. Older children and adults have specialized protective mechanisms in the stomach and intestines that prevent the proliferation of Clostridium botulinum, but children under one year old do not have such a mechanism.

Signs of botulism in young children:

lack or loss of ability to hold the head;

loss of body weight as a result of loss of appetite;

constant crying, constipation.

The most common route of infection is through the introduction of Clostridium botulinum through honey. Some parents experiment with feeding their newborns or dip their baby's pacifier in honey. Such actions are strictly prohibited, since there is a significant risk of infection for the child, in addition, honey can cause the development of a severe allergic response.

Wound botulism

It develops very rarely. Its essence lies in the fact that the causative agent of botulism begins to multiply under anaerobic conditions directly in the wound. Clinical manifestations correspond to the signs of food-borne botulism, but their peculiarity is that the onset of symptoms is recorded 2 weeks after the wound becomes infected. Wound botulism is directly related to the use of injecting drugs.

Diagnostic methods

When botulism occurs, routine laboratory tests do not provide any specific data. CSF examination and lumbar puncture help to make a differential diagnosis with other neuroinfections. There are no changes in cerebrospinal fluid with botulism.

To diagnose the disease, a special method is used, which allows one to determine which serum is effective to use as therapy for each specific patient.

First, blood is drawn from the patient, which is subsequently centrifuged. The resulting serum is administered to three laboratory mice, having previously mixed each with three types of anti-botulinum serum, respectively, A, B, E.

Taking into account the fact that the patient can have only one of the three types listed above, over the next 4 days two mice die, while one survives; it was she who was injected with an antitoxin that is able to overcome the type of botulinum toxin that present in the patient's blood.

Treatment of botulism

To reduce hypoxia, hyperbaric oxygenation is used.

Gastric lavage using sodium bicarbonate, which is administered through a nasogastric tube, is performed to remove food debris from the epigastrium that caused the disease. Along with food, part of the Clostridium botulinum spores is removed from the body, and with them a certain part of the botulinum toxin.

Siphon enemas with sodium bicarbonate are also used to remove toxin residues from the body.

Administration of antitoxic serum depending on the type of pathogen (A, B, E). Once the results of the mouse study are available, only one type of serum is administered.

The body is detoxified through infusions of water-salt solutions.

The use of antibiotics that can eliminate Clostridium botulinum.

Prevention of pathology

When canning food at home, you must follow hygiene rules.

It must be remembered that any canned or hermetically sealed foods are potentially dangerous. This is especially true for canned mushrooms, since they are quite difficult to clean from soil particles, which contain Clostridium botulinum spores.

Before consuming such canned food, you need to boil the contents of the jar for 15-20 minutes in order to destroy the botulinum toxin.

Those products that cannot be subjected to such heat treatment should be stored at temperatures below 10 degrees Celsius.

Forecast

If treatment of the pathology is started in a timely manner, the prognosis for botulism is favorable. The rehabilitation period after therapy is several months. Without the use of modern specialized methods of therapy, death is observed in 60% of cases. Death develops as a result of respiratory failure or severe inflammatory complications.

Eating low-quality food in some cases leads to botulinum toxin entering the body, which causes serious damage to internal organs. Botulism is a deadly disease. Therefore, it is necessary to remember its main symptoms and features of the clinical picture.

What is botulism

Botulism is a serious infectious disease that is caused by the activity of pathogenic microorganisms. The disease has pronounced severe symptoms. If not treated promptly, complications may develop. In some cases, the damage is so severe that the person dies.

The causative agent of botulism is the bacterium Clostridium botulinum. This is an anaerobic microorganism characterized by mobility. Outwardly it looks like a rod, the length of which does not exceed 9 microns. Has the ability to form disputes.

In living nature, microorganism spores are found in the soil. Source of infection - animal excrement, fish, shellfish. It is in them that the bacterium develops and multiplies.

The microorganism itself does not pose a danger to humans. Poisoning is caused by botulism toxin, which is a waste product of bacteria.

Under what conditions does bacterial activity occur?

In order to understand the mechanism of the disease, it is necessary to understand how the bacterium develops. Favorable conditions for its existence are considered to be the complete absence of oxygen, as well as an ambient temperature in the range from 20 to 35 degrees.

Clostridia is characterized by increased survivability. It does not die in conditions of high concentrations of salts, spices or acids. It can live in spore form for decades. It is not killed by frost or drying. Only long-term boiling for more than half an hour helps to get rid of it.

These properties of the botulism bacillus, which cause food poisoning, make it dangerous to human health. Most often, infection occurs through consumption of poor-quality food, in which the microorganism can settle.

Mechanism of disease development

The pathogenesis of the disease is quite simple. Once in the human body, clostridia begins to lead active life activities. At the same time, it releases a large amount of toxin. Hydrochloric acid, which is contained in the human stomach, has no effect on the microorganism and does not destroy the toxin.

Toxic substances enter the bloodstream and spread throughout the body. They also reach the brain. Therefore, the disease manifests itself in numerous symptoms from all internal organs.

The incubation period of the disease can vary from a couple of hours to a day. How quickly the disease manifests itself depends on how much infection has entered the body. The length of the incubation period may also be affected by the consumption of alcoholic beverages.

The characteristics of the disease indicate that it appears suddenly. At the very beginning, it can easily be confused with simple food poisoning. The rate at which complications develop is astonishing. The poison is instantly absorbed through the intestines into the blood and spreads throughout the body. In this regard, it is necessary to diagnose the problem as early as possible and begin treatment.

What types of disease exist

The disease can be classified according to several parameters. If we talk about the severity of the lesion, the following forms of the disease are distinguished:

1. Easy. Most often, only the organs of vision are affected.
2. Moderate weight. The toxic effect is on the muscles of the eyes and larynx.
3. Heavy. Accompanied by serious deviations in the functioning of internal organs.

The severe form of the lesion is especially dangerous. If untimely or incorrect treatment is used, it can lead to death.

Epidemiology identifies several main types:

1. Food botulism. This type is the most common. The disease is associated with eating foods that have formed botulinum toxin.
2. Wound botulism. Occurs when particles of contaminated soil enter open wounds on the skin. It often occurs in people suffering from drug addiction due to the use of unsterile instruments when injecting. It does not develop as rapidly as the food form. The incubation period can be up to two weeks.
3. Infant botulism. It most often occurs in children under 6 months of age when clostridia spores enter the body. This is due to violation of hygiene rules, as well as sanitary standards in the premises where the child lives. Clostridia can enter the body through unwashed hands, house dust, and dirty toys. Honey can be a source of infection, so its use is not recommended at an early age.
4. Respiratory botulism. Infection occurs through inhalation of clostridia spores. In order for the process of disease development to begin, there must be quite a lot of spores. This is possible when using bacteriological weapons.
5. Of unknown nature. The disease is classified in this group when it is not possible to accurately determine the factors of transmission of the pathogen.

The clinical picture of the disease will depend on its form. That's why Before developing a treatment program, specialists identify the source of infection.

Methods of infection and how to prevent the proliferation of clostridia

Most often, the etiology of the disease lies in the consumption of low-quality or processed food.. Since clostridia live only in the absence of oxygen, infection occurs from certain foods, for example, canned food prepared at home.

The causes of the disease may also lie in the consumption of seafood. Clostridia feel good in the body of fish and shellfish. The list of dangerous products includes the following:

1. Canned mushrooms.
2. Any canned food, including vegetables.
3. Sausages.
4. Dried, salted or smoked fish.

Any food that has not undergone sufficient heat treatment can lead to poisoning.. Microorganisms do not affect the color or smell of food in any way.

As bacteria live, they release large amounts of gas, so canned goods infected with botulism can be identified by a swollen lid on the jar.

If you like homemade canned food, then when preparing them you must adhere to some rules:

1. Microorganisms do not survive well in high sugar conditions. Therefore, jams and preserves must be prepared very sweet. Then they can be considered relatively safe.
2. Clostridia cannot live in the presence of oxygen. Therefore, it is safer to salt cucumbers, tomatoes and some other vegetables in tubs rather than in tightly sealed jars.
3. Pickled products are best stored at low temperatures. A cellar or refrigerator is best suited for this. When exposed to such conditions for a long time, the toxin is destroyed.

First warning signs and symptoms

As soon as the incubation period ends, the first signs of botulism in humans begin to appear. The onset of the disease in adults can be either gradual or acute.. It is important not to try to self-medicate, but to immediately contact a specialist before precious time is lost. The following early symptoms are distinguished:

• Feeling of dry mouth.
• Visual impairment. It becomes difficult to read the text, it is not possible to carefully examine nearby objects.
• A grid appears before your eyes.
• Objects may visually appear in two.
• Voice change. He becomes hoarse and rough.
• Speech is impaired.
• There is a feeling of weakness in the muscles.
• The functioning of the intestines is disrupted, constipation appears.
• Problems with urination.

Wherein intoxication is not accompanied by fever or loss of consciousness, as happens with ordinary food poisoning. There is no loss of sensitivity.

Symptoms in adults

The manifestation of the disease can be different, depending on which system of the body is attacked. Several scenarios are possible:

1. Gastroenterological. Toxins primarily affect the digestive system. In this case, pain is observed in the epigastric zone. They are of a cramping nature. Vomiting and diarrhea may occur. Signs of the disease strongly resemble toxic infection. Food has difficulty passing through the esophagus.
2. Acute respiratory failure. This option develops if the toxin affects the lungs and respiratory tract. This is the most dangerous condition, as it can lead to asphyxia. Accompanied by the appearance of shortness of breath, tachycardia, cyanosis.
3. Ophthalmic. Expressed in visual disturbances. A grid appears before your eyes, all objects are seen in the fog, and it is not possible to clearly identify their contours. An attack of farsightedness may develop.

As the disease progresses, the clinical picture becomes more serious. Possible development of paresis and paralysis of various muscle groups. During this period, the following symptoms may appear:

• damage to the muscles of the larynx. Accompanied by difficulty swallowing;
• paralysis of facial muscles. The face becomes asymmetrical;
• paresis of the diaphragm. Subsequently, paresis of the diaphragm leads to oxygen starvation of the tissues;
• bradycardia alternating with tachycardia;
• increased blood pressure.

In order for treatment to be successful, it is necessary to diagnose the problem as early as possible. Therefore, if you notice such symptoms, you should immediately seek help from a doctor. Self-medication in this case is especially life-threatening.

Features of the disease in children

If sanitary standards and rules of personal hygiene are violated, bacteria can enter the baby’s body. In rare cases, the cause of infection is low-quality milk formula. The disease affects babies under six months of age. A case of botulism in newborns is determined based on the following criteria:

1. The child refuses to eat.
2. Vision deteriorates. This can be noticed by the way the child lowers the upper eyelids, and squint may appear. The eyes become motionless.
3. The child cries a lot and wheezing can be heard.

Such symptoms are a good reason to immediately call an ambulance. This is the only way to avoid serious health consequences.

At a later age, the disease may manifest itself with other symptoms. These include:

1. Difficulty swallowing.
2. Speech becomes slurred, the child drawls out his words too much, and his voice becomes hoarse.
3. An irresistible thirst appears.
4. The swallowing reflex decreases.
5. As the disease progresses, a decrease in respiratory activity is observed.

If a sufficiently large amount of toxin enters the child’s body, then signs of dyspeptic disorder appear. With a minimal dose of toxic substances, symptoms may be limited to nausea, pain in the abdominal area, and dry mouth.

Accurate diagnosis

If signs of the disease are detected, you should consult a doctor as soon as possible. Only a specialist can help you make an accurate diagnosis and develop appropriate therapy.. Diagnosis of botulism includes the following measures:

1. Patient interview. The doctor must identify all factors that could lead to infection. For example, he asks the victim about recent consumption of canned food.
2. Visual inspection. The specialist identifies the presence of neurological symptoms, asymmetry of facial muscles, visual acuity, and speech functionality.
3. Blood samples are taken for subsequent laboratory testing. This is the only way to reliably determine the presence of toxic substances in the body. The victim's stool and urine are also taken for analysis.

Botulism can be easily confused with polio, encephalitis, and atropine poisoning. Therefore, a wide range of laboratory tests are required.

Only correct and timely diagnosis will make it possible to make the correct diagnosis.. The therapy program will be developed based on the severity of the disease and the characteristics of the patient’s body.

Therapy for the development of botulism

First aid

As soon as you notice the first signs of botulism, you must immediately call an ambulance. If the injury is serious, hospitalization will be required. But in some cases, the waiting time for a team of doctors to arrive may take longer. At the same time, the loss of precious hours is costly for the patient. The following first aid measures are recommended:

1. Gastric lavage. This the procedure will remove from the body the remains of contaminated food that have not yet had time to be digested. At home, you can use a solution of soda or salt for this procedure. But the most effective is potassium permanganate diluted in water. The resulting liquid should have a pale pink tint. Make sure that the particles of the substance are completely dissolved. If they enter the stomach in undissolved form, they can cause a burn to the mucous membrane. The victim should drink as much of the prepared solution as possible. After this, vomiting is induced. To do this, it is enough to exert a slight impact on the base of the tongue. This operation is repeated at least three times.
2. After gastric lavage, the victim must be given an adsorbent drug. This can be simple activated carbon or one of the modern products, for example, enterosgel, polysorb and others. Such medications will help bind botulinum toxin and prevent it from spreading throughout the body.
3. A cleansing enema will help remove toxic substances from the intestines. For this, clean boiled water is used. You can use any laxative.
4. If the victim’s condition deteriorates very quickly and symptoms from the respiratory system develop, artificial ventilation will have to be started without waiting for doctors to arrive. To do this, use the “mouth to nose” or “mouth to mouth” technique. A portion of air is blown into the patient's lungs at intervals of 5 seconds. Before this, the airways must be cleared. If cardiac arrest is observed, perform chest compressions.

First aid measures should never be neglected. Such actions turn out to be very effective. They will help contain the development of the disease and avoid serious consequences for human health.

Therapy technique

In the vast majority of cases, hospitalization of the patient is required. Only timely treatment of botulism in a hospital setting guarantees recovery. Therapy includes the following activities:

• Within one to two days after infection, the patient undergoes gastric lavage. This helps to completely remove the remnants of poisoned food.
• In order to neutralize the effect of the toxin, anti-botulinum serums are used. They are administered intravenously or intramuscularly. Most often, a single administration of the drug is sufficient. But if this turns out to be not enough and the symptoms do not subside, then the medicine is administered again.
• Infusion solutions help remove poison from the body. They are administered intravenously. The most commonly used drugs are rheopolyglucin or hemodez. They cope well with botulinum toxin. The remains of the drug, along with the poison, are excreted in the urine.
• Botulism, like other infectious diseases, is treated with antibiotics. These drugs can destroy the pathogen. In this case, chloramphenicol works well.
• If there is a serious violation of the swallowing function, it will be necessary to install a probe, with the help of which liquid food will be supplied to the victim’s stomach.
• If breathing stops, the patient is connected to a ventilator.
• In case of problems with urination, the installation of a catheter is recommended.
• If the poisoning is severe, then the methodological recommendations include the use of hyperbaric oxygenation.

In order for the treatment to be successful, it is necessary to strictly follow all clinical recommendations of the specialist. After the symptoms subside and the disease subsides, the patient is recommended to undergo a course of physiotherapeutic procedures. As a rule, the duration of treatment is no more than four weeks. Asthenia after botulism can persist for up to six months.

Smart nutrition

One of the mandatory components of the treatment of botulism is proper nutrition. Diet is especially important in severe cases. If the swallowing function is impaired, the victim is fed exclusively liquid food, which is fed directly into the stomach using a tube.

After the symptoms begin to subside, the patient is transferred to a gentle diet. His will have to be adhered to during the entire treatment and for three weeks after. Experts recommend creating a menu of the following dishes:

1. Lean meat and fish. It is better to turn them into minced meat and steam them.
2. Vegetable soups.
3. Fermented milk products with reduced fat content.
4. All kinds of cereals.
5. Fruit and berry compotes without added sugar.
6. Boiled eggs, steam omelet.
7. Jelly and mousses.

Such nutrition will help provide the body with the necessary substances and not overload it. Any deviations from such a diet can lead to negative consequences..

Traditional methods of recovery after illness

Traditional medicine has developed several of its own remedies for the treatment of botulinum toxin poisoning. But remember that you can use them only after consulting with your doctor and completing a full course of traditional medicine therapy. Such products are allowed to be used only during the rehabilitation period. They will help improve health and eliminate the effects of intoxication.

The use of traditional medicine as the main treatment for botulism is strictly prohibited. This will lead to negative consequences, including death. Do not try to heal yourself; at the first symptoms, consult a doctor immediately.

Among the most effective means to recover from botulinum toxin poisoning are the following:

1. Steam a teaspoon of ground cinnamon with a glass of boiling water. Place the mixture on the fire and wait until the boiling process begins. Cook for no more than three minutes. The filtered decoction is taken in a glass before breakfast and after dinner.
2. Pour three tablespoons of dried chokeberries into a thermos. Pour in 300 ml of boiling water. Seal tightly and leave for 6 hours. Filter the product and divide it into two equal parts. Drink one part before breakfast, and the second before bed.
3. Cranberries are great for recovery. A glass of frozen berries must be steamed with six glasses of boiling water. Then boil the mixture for about 10 minutes. Using a masher, crush the berries and cook for another 5 minutes. The slightly cooled drink is filtered and drunk in small portions throughout the day. The duration of such treatment is at least one and a half weeks.
4. Crush three tablespoons of dried rose hips using a masher. Place in a thermos. Pour in three cups of boiling water. Leave for at least six hours, preferably overnight. Drink a glass of this infusion every morning for two weeks.
5. Raspberries will help improve your health and speed up the recovery process. Pour four tablespoons of dried berries with half a liter of boiling water. Cover with a lid. After three hours, filter the product. Take 120 ml four times a day. You can add a little honey, but only if the poisoning is not caused by this product.
6. Herbal tea will also benefit the body. The collection consists of sage, licorice root, mint, calamus root, flaxseed, and sumoch leaf. All components must be taken in an amount of 100 grams. Add 50 grams of geranium root. Mix all ingredients well. Steam two spoons of the composition with three glasses of boiling water. After an hour, the infusion is ready for use. Drink it three times a day, dividing it into equal parts.
7. If complications such as numbness of the limbs or muscle paralysis are observed after an illness, rubbing with special oil will help. To prepare it, pour 100 grams of laurel leaves with half a liter of vegetable oil. For the product to be effective, it is necessary to use fresh leaves. The product must be infused for at least two weeks. This product is used to rub the limbs and lower back.

The use of such drugs is contraindicated in the presence of allergic reactions to individual components. Therefore, consult your doctor before starting treatment.

What complications may arise

If you attempt to treat botulism on your own and waste precious time, you are likely to develop serious complications. These include:

1. Pneumonia. It is caused by impaired respiratory function and a decrease in lung volume. Such complications are possible even with the use of antibacterial therapy.
2. Botulinum myositis. This is muscle damage. Pain in the calf muscles is more common.
3. Anaphylactic shock. Manifestation of an allergic reaction to the toxin.
4. Purulent parotitis.
5. Tracheobronchitis of purulent type.
6. Sepsis.
7. Arrhythmia.
8. Intestinal atrophy.
9. Hyperphosphatemia.

The consequences of botulism require separate therapy, which is prescribed by a specialist m. However, for one and a half months after the end of the main treatment, some symptoms may remain, for example, headache or nasal voice.

Forecast

If anti-botulinum serum enters the human body in a timely manner, the prognosis is favorable. Modern treatment methods have reduced the mortality rate to 10%. The recovery period lasts about three months, after which complete recovery occurs. e.

If help is not provided in time, the probability of death is quite high. Death is most often associated with paralysis of the muscles of the respiratory system. In the absence of ventilation, about 60% of victims die.

Botulism during pregnancy

It is impossible to get rid of botulism without the use of potent medications. This negatively affects the condition of the fetus. Most often the pregnancy is terminated And. If the child survives, he will be born with developmental disabilities and numerous pathologies.

In this regard, while expecting a child, a woman needs to carefully monitor her health and be attentive to the products she eats. It is better to avoid smoked products and canned food altogether and follow all preventive measures.

Preventive actions

Damage to the body by botulinum toxin is fraught with serious health consequences. Therefore, it is easier to prevent infection. Prevention of botulism should include the following measures:

1. All vegetables and fruits must be thoroughly washed before consumption. in clean running water. You can rub their skin with a brush. This is especially true for products intended for making home canned food. They must be thoroughly sterilized before they go into the jar.
2. When making preparations for the winter, carefully ensure that all instruments are sterilized. The jars and lids must be thoroughly rinsed and steamed over steam or baked in the oven. This will prevent microorganisms from entering the dish.
3. When filling jars with the finished product, try to do it so that no air gets inside. The presence of even a small air gap creates a favorable environment for the life of clostridia.
4. Using proven home-canned recipes will help you avoid poisoning. Due to the specific storage requirements, experts do not recommend harvesting mushrooms and herbs, or making homemade meat products.
5. Never eat food that shows signs of spoilage. If you doubt the quality of a dish, it is better to throw it away.
6. Products that will not subsequently undergo heat treatment, such as sausages, must be stored refrigerated. The temperature should not exceed 10 degrees.
7. Never buy canned goods secondhand from unknown manufacturers.. When purchasing such a product in a store, carefully study the expiration date. If canned food is packaged in iron cans, check their integrity. Never accept dented or deformed cans.
8. If you notice that the lid of canned food is swollen, dispose of it without opening it along with the container.
9. Strictly adhere to the rules of personal hygiene and sanitary standards. Wet clean your house several times a week and prevent debris from accumulating.
10. If you receive an injury that results in an open wound, immediately wash it and treat it with an antiseptic. This is the only way you can prevent infection with clostridia and other dangerous microorganisms.

Disease prevention measures must also be observed at the state level. They include control over the production of canned products, sausages, meat and fish semi-finished products. Particular attention should be paid to the expiration date and storage conditions of products.

Botulism is a dangerous disease that requires competent, timely treatment. Only the use of all therapeutic measures can guarantee recovery. Otherwise, there is a high probability of death. Therefore, do not self-medicate under any circumstances. If you notice symptoms of illness in yourself or your loved ones, immediately call an ambulance. Always remember about preventative measures.

Botulism is an infectious disease that poses a direct threat to the life of the patient and occurs as a result of the penetration of botulinum toxin into the human body. The first case of the disease was officially registered in 1793, when, after eating blood sausages, a massive infection occurred, in which 6 out of 13 victims died. As a result of this case, the disease received the name botulism, which means sausage in Latin. Today, about 1 thousand people suffer from this disease every year in the world. An interesting feature of the disease is that it is caused not by a pathogen, but by its waste products. Botulinum toxin is currently considered the most poisonous substance in the world, and a very small dose is enough for severe poisoning. The disease affects men and women equally at any age. In the absence of timely medical care, the mortality rate from botulism can range from 60% to 80%, depending on the degree of intoxication and the health status of the patients.

Causes of botulism

Infection with botulism occurs through contaminated food. Most often, according to doctors, damage to the body is caused by the following reasons:

• eating canned food from jars with bulging lids;
• eating homemade canned mushrooms;
• eating artisanal smoked fish;
• consumption of artisanal smoked meat;
• consumption of artisanal sausages;
• consumption of infected honey (extremely rare).

Infected products are especially dangerous for the reason that their appearance, taste and smell do not change under the influence of botulinum toxin. Thus, it is impossible to distinguish a safe product from one containing botulism without laboratory testing.

Symptoms of botulism

The disease begins after eating contaminated foods within a period of 2 to 12 hours, depending on the condition of the body and the amount of toxin received. In very rare cases, the disease may appear three days after the poison enters the body. As isolated cases, the occurrence of the disease was noted only on the 10th day after consuming the infected product. The earlier symptoms of poisoning appear, the more severe it will be.

Doctors today divide the symptoms of the disease into specific and nonspecific. Nonspecific symptoms of botulism include manifestations of the disease that are common to different types of food poisoning and appear immediately after the process of intoxication of the body begins. These include:

• acute abdominal pain;
• diarrhea no more than 10 times a day;
• repeated vomiting;
• headache;
• severe pallor of the skin;
• increased body temperature of varying intensity;
• weakness.

If such symptoms appear after consuming foods that could be carriers of botulism, you should immediately seek medical help, as delay can cost the patient his life.

Specific symptoms of the disease include body reactions that occur only when poisoned with botulinum toxin. These symptoms come in several types and, as a rule, are combined with each other.

Symptoms from the visual system

Disturbances in the visual system are one of the very characteristic signs of botulism, which helps to quickly make a correct diagnosis. Similar specific symptoms of the disease include:

• rapid decline in vision;
• impaired mobility of the eyeballs;
• grid before eyes;
• blurred vision;
• strabismus;
• double vision;
• drooping upper eyelids.

When such symptoms are added to the nonspecific signs of botulism, there can be no difficulty in making a diagnosis.

Symptoms of speech and swallowing

These symptoms appear as follows:

• severe dry mouth;
• disturbance in the process of swallowing or complete absence of swallowing function;
• nasality;
• change in voice pitch;
• change in voice timbre;
• feeling of a foreign body in the throat.

Respiratory symptoms

As a rule, these specific symptoms occur when the patient’s condition is serious and indicate that a serious threat to a person’s life has arisen. Such manifestations of the disease include:

• frequent shallow breathing;
• lack of air;
• feeling of tightness in the chest;
• chest pain.

In this condition, the patient needs urgent hospitalization and a course of intensive care.

Symptoms from the motor system

Since botulinum toxin poisoning also affects the central nervous system, symptoms of impaired motor functions of the body also arise. Such manifestations of the disease include:

• particularly severe muscle weakness;
• incoordination of movement;
• absence of any facial expressions;
• inability to perform simple movements that require a certain concentration.

Regardless of how severe the symptoms of botulism are, you should immediately seek medical help, since any delay will lead to worsening intoxication of the body and an increased likelihood of death.

Degrees of botulism and their symptoms

Today, doctors distinguish 3 degrees of severity of botulism. Self-medication (as a last resort) is possible only in the first, mild stage of poisoning, since it is not prone to worsening and almost never leads to death. However, even with it, if it is possible to seek medical help, you should immediately take advantage of it.

Mild botulism

In this state, there is practically no threat to the patient’s life, and the symptoms are not very pronounced. The victim usually complains of being bothered by:

• general symptoms of poisoning;
• minor visual impairment;
• moderate weakness;
• slight change in voice.

A maximum of 5 days is required for complete recovery. On average, healing occurs on the third day.

Moderate degree of botulism

In this condition, the patient needs qualified medical care. He has all the symptoms of botulism. However, the swallowing function is practically not impaired, and he does not feel a lack of air. The patient needs at least 3 weeks to recover, even with medical care.

Severe botulism

With this form of poisoning, the full symptoms of botulism rapidly develop with rapid suppression of swallowing function and breathing. In this case, the patient’s condition is assessed by doctors as extremely serious, requiring immediate resuscitation measures. If left untreated, the patient dies within 6-48 hours from the onset of botulism. Recovery of the body after such poisoning takes up to 6 months.

Complications of botulism

Even with a mild form of the disease, if treatment is not carried out correctly, the patient may experience dangerous complications of botulism. Most often, doctors observe the following consequences of the disease:

• severe forms of pneumonia;
• damage to the heart muscle;
• meningitis;
• loss of vision (partial or complete).

Complications of the disease can only be avoided if treatment is carried out in a timely manner.

Folk remedies to combat botulism

Folk remedies can only be used during the recovery period after illness when, thanks to medical actions, the threat to life has already been eliminated and it is simply necessary to get rid of the consequences of poisoning as soon as possible. Taking this into account, various traditional medicine recipes can be used only after discharge from the hospital. The use of the following medications as the main treatment for botulism is strictly prohibited.

Cinnamon decoction is an excellent remedy for speeding up recovery. To prepare it, take 1 small (teaspoon) spoon of ground cinnamon and pour it with 200 milliliters of just boiled water. After this, bringing the composition to a boil again, boil it for 3 minutes. During the cooking process, the medicine should be stirred constantly. After straining, take this remedy warmly, 200 milliliters in the morning and evening throughout the entire rehabilitation period.

For a speedy recovery from botulism, you should use a medicine prepared from chokeberry. To obtain it, you need to take 3 teaspoons of dried berries and pour 300 milliliters of boiling water, and then leave in a thermos for 6 hours. After this, after straining the medicine, it is divided into 2 portions. Take the drug in the morning and evening, 1 serving. Such auxiliary treatment is carried out throughout the entire period of recovery from botulism.

Cranberries are an ideal remedy for cleansing the body of toxins. In order to get rid of the consequences of botulism, you should prepare a fruit drink. You need to take 1 glass of fresh or frozen berries and add 6 glasses of water. After this, putting it on the fire, bring the product to a boil and boil for 10 minutes. Next, the berries are crushed and the composition is boiled again for 5 minutes. After cooling slightly, the drink is strained and drunk throughout the day. Drink this fruit drink for at least 10 days after the illness. If there are no objections from the attending physician, then you can take the medicine as soon as swallowing function is restored.

Rosehip drink is also an effective medicine. To prepare it, pour 3 tablespoons of ground rose hips into 3 cups of boiling water and leave in a thermos for 6 hours. After straining, drink 1 glass of the medicine in the morning, afternoon and evening. The duration of this therapy is at least 14 days.

Raspberries will also help improve the patient's condition. To prepare the medicine, take 4 teaspoons of dried raspberries and pour 500 milliliters of boiling water. After this, the composition is infused in a thermos for 3 hours. After straining the drink from the soaked berries, use 120 milliliters 4 times a day. This remedy should be drunk warm. If botulism was not caused by honey, then it is useful to add 1 dessert spoon of this natural medicine to the drink. Treatment lasts at least 10 days.

Diet for botulism

In order to avoid the consequences of the disease, it is important not only to undergo qualified treatment, but also to adhere to a certain diet for the next 3 weeks after the disease. Doctors recommend the following products for consumption by people who have suffered from botulism:

• various cereals;
• vegetable soups;
• lean fish;
• lean meat;
• low fat dairy products;
• low fat fermented milk products;
• green tea;
• compote without sugar.

Such nutrition has a gentle effect on the patient’s body and at the same time provides him with everything he needs. Diet violations are extremely undesirable and can lead to unpleasant sensations in the gastrointestinal tract.

Prevention of botulism

In order to protect yourself as much as possible from botulism, you should follow certain rules of prevention. If they are followed, infection is almost impossible. To prevent botulism, doctors recommend:

• thoroughly wash food products that need it;
• do not consume products prepared by an unknown person in artisanal conditions (home-canned food and smoked meats sold by hand);
• properly store food at the right temperature;
• carry out complete sterilization of jars and products during preservation.

If you follow these preventive measures, you can protect yourself not only from such a terrible disease as botulism, but also from ordinary food poisoning, which also brings undoubted harm to the body. If a person is forced by his professional duties to regularly come into contact with botulinum toxin, then he needs to be vaccinated against this disease in a timely manner, which is done in 3 doses.