The first signs, symptoms, prevention and treatment of botulism
Botulism – a disease with which humanity was officially introduced in the 18th century. It was in 1793 in württemberg was the first documented poisoning blood sausage and fish, 6 people were killed of the 13 victims. The author of the modern name of the disease was the bacteriologist from Hungary who learned in the late 19th century the pathogen from the intestines of deceased patients. The invention of the first immune serum against botulism belongs to the same time period.
What is botulism?
Botulism is a serious infectious disease that develops as a result of contact with human body waste product of the bacteria Clostridium botulinum – botulinum toxin. The disease is common in our days it is quite rare, recorded about 1000 cases per year worldwide. The disease remains deadly. Its main source of food, although stand out and others.
The incubation period
The average incubation period of the disease can last from several hours to one day. Its duration is determined by the amount of infection trapped in the body. The time from poisoning until the emergence of the first signs of botulism can reach up to 2-3 days and even up to 10 days, but such cases are rare. There were cases when the duration of the incubation period increased in connection with the use of patients of alcohol.
Manifestations of the disease often have a sudden character, and strongly resemble the symptoms of food poisoning. Toxin-contaminated products are rapidly absorbed in the intestine, enters the bloodstream and instantly spreads throughout the body. In this case, the targets become vital organs.
The sooner botulism makes itself felt, the more severe is the disease.
If botulism is killed by boiling?
It is customary to distinguish two forms of existence of bacteria of botulism – spore and vegetative. For the destruction of vegetative forms, it is sufficient to cook the product within five minutes. Greater resistance to boiling demonstrates spore species, it is able to tolerate this procedure about five hours. Only after that the spores of botulismdie if the temperature reaches the desired mark.
Vegetative forms of botulism even at low temperatures have the ability to produce spores, called the "dormant", germination which occurs approximately six months. Such disputes show resistance to drying, freezing, influence of ultraviolet rays. Optimal for their development of airless conditions.
It boiling is the most reliable way to protect canned foods for the human body. Bacteria do not subject to acidic environments, with them it is useless to fight the increased salt content and eliminate the enzymes of the digestive tract. Only boiling is an effective preventive measure.
The temperature at which botulism dies?
Temperature sufficient to destroy the botulism bacteria depends on what form it is conducted.
- Vegetative bacteria are not able to cope with the temperature equal to 80 degrees longer than an hour. Their complete elimination of missing five-minute boiling.
- Spores are more resistant. To get rid of them you must place the bacteria in terms of the 120-degree temperature to keep this figure at least an hour. For certain strains is not sufficient.
The first signs of poisoning botulism
The first symptoms of botulism are nonspecific, transient, reflect manifestations of infectious intoxication and acute gastroenteritis.
A person may be the following problems:
- severe abdominal pain, concentrated mainly in the Central part;
bouts of headaches;
symptoms of diarrhea (approximately 3-5 times a day, to 10);
- weakness, fatigue, malaise;
Towards the end of the day the temperature is normal, resistant constipation replacing excessive activity of the gastrointestinal tract. These "improvements"should not deceive, you should definitely consult a doctor.
The symptoms of botulism and their manifestation
Common symptoms of botulism characterized by variability determined by the course of disease, its stage. Decided to allocatethree options: gastrointestinal (most common),"eye", acute respiratory failure.
At the initial stage of development of botulism symptoms of the gastrointestinal version of the disease can easily be confused with symptoms of food poisoning:
- vomiting (single, double);
- cramping pain attacks, feel at the top of the abdomen;
- excessive dryness of the mucous membranes of the oral cavity, with no normal explanation.
Also this variant is characteristic of a normal or slightly increased body temperature, feeling of "lump" in the throat associated with poor passage through the esophagus products.
"Eye" variant of the beginning of botulism is less common characteristic manifestations are as follows:
- visual disturbances;
- the lack of clarity of the contours of objects;
- mesh, fog, flies floating before eyes;
- the effect of hyperopia, in which the patient difficulty seeing near objects, while distant are perfectly visible.
In acute respiratory failure there is a rapid spread of apparent violations of the respiratory process. The patient can be detected:
- respiratory faults (change in the number, rhythm, tempo);
- bluish discoloration of the skin;
- increased heart rate;
- shortness of breath.
In the midst of the disease may be a manifestation of a combination of symptoms from all groups, which are listed below.
The patient is experiencing the following difficulty swallowing:
- he defies first solid food, then liquid products;
- the uvula in the throat retains the absolute immobility;
- language also becomes inactive.
The patient can be observed at the ocular symptoms of botulism in full swing:
- seeing double;
- the eyelids are lowered;
- appears squint;
- the sight is difficult or impossible to keep in one direction.
This stage is characterized considered violations zvukoproiznoshenija. Among them, the possible existence:
- loss of speech associated with immobility of the vocal cords;
- the feeling of "porridge in the mouth;
Botulism, inswing, can testify to themselves and indirect manifestations:
- unsteady gait;
- pronounced muscle weakness;
problems with urination, constipation;
- sensation of dryness in the mouth;
- blanching of the skin;
- rapid pulse.
Rare, but still encountered symptoms are: inability to show teeth, to make the grin, the tension of the facial muscles, perekusyvaete face. In this patient, not the body temperature rises, it remains in the order of the hearing, retained the clarity of thought, there is no problem with skin sensitivity.
When the disease is entering the final phase, disorders of respiratory function dominate. Patients feel shortness of breath, forced to interrupt the conversation pauses, in the chest there is a feeling of pressure or tightness. Increases respiratory failure due to frequent development of pneumonia.
For the final period is characterized by complete relaxation of skeletal muscles, her testoobraznoj. Patients are not able to hold his head, their movements become very limited. In spite of clear consciousness there is complete immobility, respiratory paralysis causes death.
If the diseased is not getting proper treatment, following him threatening complications and consequences.
- Iatrogenic complications (post). Among them, hyperglycemia, atrophy of the intestine, serum sickness, hyperphosphatemia.
On average, the illness can last 3 weeks if the patient receives proper treatment. Recovery of neurologic symptoms occurs in reverse order, first normal breathing, then restored swallowing. Other manifestations of the disease – twang, headache and so on, you can stay up to 1.5 months. People who recover from botulism, symptoms disappear without a trace, there is no fear of disabling complications.
Causes of botulism
Causes of botulism in humans depended on what form it is. The disease can be:
Clostridium botulinum is known as an anaerobic bacterium, its development occurs only when oxygen is absent. Food form is threatening, if the bacteria grow and produce the malicious toxins in food before consumption. The bacteria produce spores, which are common in the environment, including sea and river water, and soil.
The formation of bacteria, toxin production observed in the products under the condition of low oxygen concentration, require a certain combination of conditions of preservation and temperature of storage. In most cases, this involves food easy preservation, not subjected to appropriate treatment prepared at home.
An acidic environment is not conducive to the production of toxin, however, the toxin produced earlier, can not be destroyed in it. To prevent the growth of bacteria capable of storing at low temperature, achieving a certain concentration of acidity and salt.
Botulinum toxin has been found in many foods. Among them canned low acid vegetables – beets, mushrooms, spinach, green beans. Danger sausage and ham, fish, smoked and salted, canned tuna. The list of "forbidden" foods depends on the state, local nuances preservation and nutrition. There are known cases of detection of bacteria in results of industrial production.
This form of the disease occurs much less frequently foodborne. It is caused by spores that penetrate into the open wound of the patient, able to reproduce in such conditions. The symptoms are much like symptoms of food forms, can occur two weeks later. The risk presented by people suffering from drug addiction, especially heroin injection.
This form is threatened mainly by infants under six months of age. The"infant" botulism becomes the result of the child swallowing spores, which are bacteria, exciting intestines and producing toxins. After 6 months, the children with similar shape practically did not face, she is not dangerous and adults. This is because the germination pores hamper the natural protective mechanisms that the bodyacquires later.
Sources of infection there are several, the most famous and dangerous of them honey. That is why doctors do not recommend feeding this product to children under the age of years.
The symptoms of the disease in infants also differ:
- the inability to hold the head;
- a hoarse cry;
- lack of appetite;
- problems with the chair;
- the deterioration of sucking, swallowing reflex.
Also for children are a threat to house dust and soil. For children form characterized by a long incubation period, kids are more prone to complications like pneumonia, increased risk of death.
This form of the disease develops very rarely. Its occurrence under natural conditions is not possible, affected by intentional (bio-terrorism) and accidental events associated with the release of the aerosol toxins. Characterized by the same clinical manifestations that can be observed when food botulism. The rate of appearance of the first symptoms depend on the level of poisoning, the average is about 1-3 days.
Theoretically, it eliminates the spread of disease through water, if swallowed previously produced the toxin. However, the danger is minimal, since the wet processing causes the destruction of bacteria. The diagnosis "unspecified botulism" doctors put, if you are unable to set the source that triggered the patient's wound or nutritional disease.
Prevention of botulism
In recent years, cases of botulism in Russia is mainly associated with poisoning canned home-made products. Therefore preventive measures relate primarily to this area. Safety "cans" cannot be installed on the eyes, botulinum toxin does not change color, smell or taste of food.
- Products that serve as the basis in the manufacture of canned pet food, shall be thoroughly cleaned from dust and dirt. The soil particles it is advisable to remove with a brush.
- The same applies to utensils for canning – jars, caps. Goods are carefully washed, get burned and dried. Tin lids need to be boiled.
- There are products from the canning of which at home doctors advise to refuse. It is meat, fish, mushrooms and greens. Especially dangerous mushrooms, which account, according tothe statistics, approximately 70% of all cases of botulism. Meat and fish are preserving only under condition of use of the autoclave, the products must be fresh.
- Overripe, stale, spoiled fruits and vegetables cannot be used.
- Immediately before use, the kind of food it is desirable to boil for half an hour, it eliminates the toxins that might have formed. This rule is especially important for children who are sensitive to botulinum toxin.
- Storage temperature of products which cannot be heat-treated should not exceed 10 degrees. We are talking about fish, salted and smoked, sausages, bacon.
- Swollen banks certainly selected are destroyed.
- Vegetables or mushrooms, rolled up in banks established in the home, it is strictly forbidden to buy in the markets of strangers.
- If one family member gets sick, all members of the household who ate the same food, require the introduction of prophylactic serums and medical observation for 10 days. Be sure to disinfect the bowl from which to eat the patient, his clothes.
If we are talking about wound botulism, the only prophylactic measure is the careful treatment of the wound in the hospital.
Treatment of botulism
Every person suspected botulism of any severity, be immediately hospitalized because the possibility of complications and the nature of the disease the prognosis can not be. For others, these patients are not dangerous, the disease is not airborne.
The probability of a sudden drop in blood pressure, pronounced muscular weakness, the reasons for which the patient shows a strict bed rest. If the case is severe, the patient is fed intravenously nutritionai mixes or use a nasogastric tube. Menu treatment in mild cases involves a rejection of products, rich of extractive elements, fatty and spicy dishes. The patient is prescribed a diet №10.
The question of whether the patient needs admitted with botulism in the immediate ventilation of the lungs, is solved by the doctor in the emergency Department. It is the respiratory "failures" represent the maximum risk to the lives of these patients, so adequate ventilation is important.
If there is a threat of development of acute respiratory failure, patients need to establish lung capacity, continuous pulse oximetry. Frequent development of acute respiratoryfailure with incredible speed. The question of the usefulness of ventilation and intubation occurs if the lung capacity is reduced less than 30% paralysis progresses rapidly, the presence of hypercapnia and hypoxemia. The patient may experience the need for ventilation and intubation of from several days to several months.
If the patient has urinary retention, he prescribed catheterization, which is performed through catheters Foley. This avoids the development of ascending urinary infection.
If the patient no obvious respiratory distress, the doctor uses the technology of urgent detoxification. Lavage of the intestines and stomach – the procedure is of paramount importance, they help to destroy the toxin to get rid of the not yet absorbed substances. The first washing is done on the basis of pure boiled water, its samples are then subjected to specific analysis.
The patient is not appointed laxatives in order to avoid activation of paresis of the intestine, development of the neuromuscular disorders. Flushing of the stomach probe is used, the portions of liquid should be small, especially if the patient has respiratory distress. Otherwise there is a risk of reflex respiratory arrest.
If the patient has bulbar disorders are present, the introduction of the probe should be conducted as carefully as possible, in this case, the laryngoscope. This gives you the opportunity to avoid penetration of the probe into the trachea, which is important in connection with an absent gag reflex, paresis of the muscles of the sky.
Gastric lavage is appointed for any term of hospitalization of the patient. However, a serious condition in which there are serious respiratory disorders, can cause a doctor to be limited only to colonic irrigation and ventilation. In this case, the flushing starts with the setting siphon enema, which reduces bloating and provides the necessary conditions for the excursion of the lungs. In the end gastric lavage tolerated by patients with botulism is easier. Siphon enemas are daily, the procedure is repeated twice a day, if there is marked abdominal distension.
The next task is the neutralization of circulating toxin. At any stage of the botulism patient are heterogeneous introduction protivobotulinicheskoy serum. For the introduction of PBS is used, the catheter supraclavicular veins.
Anaphylactic shock is the most dangerous complication that can occur in a patient during the treatment of botulism. The condition can occur immediately, regardless of strict adherence to all the important rules. In addition, somepatients who had serotherapy, 7-10 days later, developing serum sickness.
If the disease is severe, instantly progresses, PBS is introduced drip intravenously. After 12 hours is carried out intramuscular administration of the same dose. You can enter the serum and for the third time at the end of the day. More than 4 times to prescribe the drug.
Hyperbaric oxygen therapy is an effective treatment technology that enables fabrics to be under high partial pressure, including severe histotoxic hypoxia. For the administration of funds is distributed from a Central access catheter used supraclavicular veins. Be sure to use hypocoagulation drugs as a tool for prevention of venous thrombosis.
There are secondary methods of treatment that are considered additional in the fight against botulism. In order to avoid development of patient secondary infections (pyelitis, pneumonia), it may be prescribed penicillin, clindamycin, chloramphenicol and other antibiotics. In terms of eradication of the causative agent of the disease they are useless if we are not talking about a wound or a baby form. A patient with wound botulism, it is sure to surgical treatment of the wound.
Treatment of botulism in home
Botulism – a deadly disease that cannot be fought alone. A number of actions you can take prior to arrival of the ambulance, if it is delayed. The patient can take a laxative, say sulphate of magnesia, half a Cup of vegetable oil, which has a binding effect on the malicious toxins. Helps cleansing enema with herbal decoction or very diluted potassium permanganate.
Also feasible washing stomach, it is advisable to choose this 2% soda solution. This tool provides an alkaline environment, has a devastating effect on the botulinum toxin. This procedure is especially effective in the first two days, the stomach is still possible to save the infected product.
However, the success of rehabilitation after hospital treatment depends on the patient. Stay in hospital on average lasts up to 10 days until the disappearance patient of all neurological disorders. The severity of the disease determines the duration of the sick leave which may be granted for 1-2 weeks.
People suffered from botulism, should within 2 weeks be monitoredfor a primary care physician after discharge. If he has there are residual effects, be sure to also follow-up by a cardiologist (with myocarditis), neurologist, ophthalmologist (if impacts associated with the organs of vision).
If there is evidence in the recovery period your doctor may prescribe drug treatment drugs are atrophy of the optic nerve, vitamins, nootropics, cardiovascular drugs.
For 3 or more (according to indications) months, the patient should avoid strenuous physical activity. Under the ban are specialized athletic training, hard physical labor, work that involves a strong stress falling on the visual analyzer.
Special attention to the patient, suffered from botulism should be given to its diet, its caloric content and composition. It is recommended to eat 4 times a day, making it within the established time intervals. Not allowed to include in the menu of fatty and spicy food, you must limit the intake of salts. From animal fats, it is desirable to withdraw in favour of the plant, to ensure a sufficient amount of protein. Lack of vitamins can be replenished by the administration of specific complexes, Complivit, Vitrum, alphabet, and so on.
Also man, ill with botulism, may be appointed physiotherapy. This includes water manipulation (therapeutic shower, bath), hardening, oxygen inhalations, electrosleep. This is necessary for getting rid of the residual effects of hypoxia, if the disease was leaking badly. Benefits and Wellness treatments that are of a General nature, among them, therapeutic gymnastics, massage, swimming in the pool. All this together will accelerate the process of restoring normal functions of the muscular system.
Your doctor may recommend the patient to carry out rehabilitation in sanatorium establishment, specializing in diseases of the nervous system.
As a rule, doctors do not object to the treatment of the patient during rehabilitation to folk remedies of treatment, however, it is worth to consult a specialist before using them. If the acute manifestation of the disease is over, you can apply the decoction of plantain, Echinacea, nettle.
Cinnamon is also highly regarded folk healers in the fight against botulism. To prepare the broth you will need to mix the 200 grams cold water with a teaspoon of crushed cinnamon. The mixture is brought to a boil for three minutes boil, stirring. If you encounter studneobraznogo weight you need to removecomposition with fire. Drink a decoction of cinnamon slightly chilled. If it is used for the treatment of the child, allow the addition of sugar.
With timely treatment to the doctor and proper treatment, the prognosis for patients with botulism is supportive.