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Botulism - diagnosis, treatment, complications and prevention

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Botulism is a foodborne toxicosis caused by the bacterium clostridium botulinum, which is usually found in cans, bottles and the ground. Infection with botulism is dangerous because it causes paralysis, respiratory failure, abdominal pain, nausea and vomiting. If you become ill with botulism, detoxification is necessary. However, if you suspect botulism, you must seek medical help.

Diagnosis of botulism

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

Diagnostic methods for botulism are:

  • collection of medical history and objective data,
  • microbiological diagnosis.

Collection of medical history and objective data

The collection of medical history data (medical history) plays an important role in the diagnosis of botulism. What and when the patient ate is important. If the patient consumed canned foods, mushrooms or fish, then the remains of the consumed foods must be taken for laboratory diagnosis. It is also important to know how these products were stored and how they were used.

The doctor should find out how long after the consumption of infected foods the first symptoms appeared. It is known that the incubation period (the time elapsing from the moment an infection enters the body until the first symptoms of the disease appears) with botulism varies from several hours to a day. A couple of cases have been described in the medical literature when this period dragged on to 2 to 3 days.

Further, it is important to know what the first symptoms were. Was there a period of intoxication and how long did it last. After collecting an anamnesis, the doctor begins to examine the patient. He notes a pronounced atony of the patient's muscles, a masked face. Dysphonic disorders make it difficult for a patient to answer questions. The vocal cords by this time become dry, and the tongue becomes clumsy. Speech becomes incomprehensible and takes on the character of "cereal in the mouth."

At a neurological examination, the doctor notes motor paresis and paralysis. Unlike other neurological pathologies with botulism, paresis is always bilateral. Of great importance in the diagnosis of botulism is the neurological symptomatology, namely dysphagia and dysphonia. Evolution in voice changes, as well as numerous ophthalmic symptoms play a decisive role in the diagnosis.

Microbiological diagnosis of botulism

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

The material for the reaction can be the patient's vomit or washings from the probe, blood or food debris. Biological material is seeded on liquid nutrient media. Material-seeded culture media are incubated at a temperature of 80 degrees for 48 hours. After that, a study is carried out under a microscope. So, under a microscope, Clostridium botulinum looks like a movable stick, resembling the appearance of a racket. The stick of clostridia has from 5 to 20 flagella on its surface. On the surface of the agar (a type of growth medium), these bacteria form small, brilliant colonies in the form of dew drops. Sometimes these colonies grow and become gray. On blood agar, growing clostridia produce a hemolysis zone. In test tubes, the causative agent of botulism grows in the form of lumps of cotton wool ("fluff colonies") or forms colonies in the form of lentils. If the diagnosis is negative, then the culture analysis is repeated after a week.
To identify the toxin, a neutralization reaction is performed with diagnostic sera.

A blood test for botulism

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

The parameters of a general blood test for botulism are:

  • leukocytosis - an increase in the number of leukocytes over 9 x 10 9,
  • a shift of the leukocyte formula to the left - the appearance in the blood of immature forms of neutrophils, for example, myelocytes,
  • an increase in the erythrocyte sedimentation rate (ESR) - more than 15 millimeters per hour in women, more than 10 millimeters per hour in men.
The parameters of a biochemical blood test for botulism are:
  • increased concentration of carbon dioxide
  • lowering blood acidity,
  • reduction in chloride concentration,
  • high potassium content.
The parameters of the general analysis of urine in botulism are:
  • daily urine output of less than 300 milliliters (oliguria) or less than 50 milliliters (anuria),
  • urine acidity is reduced.

What is the first aid for botulism?

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

At the prehospital stage, conducting first aid involves washing the stomach and prescribing sorbents that are available at home (most often it is activated carbon).

What can not be done with botulism poisoning?

When botulism symptoms are identified, the only measure that can be taken regardless of the circumstances is to call an ambulance. In some cases, before the doctor arrives, the patient can be washed with a stomach or given sorbents to drink. All other attempts to alleviate the condition of the patient can worsen the situation.

Measures that are prohibited in botulism poisoning are:

  • taking painkillers,
  • warm compress
  • the use of carbonated drinks,
  • provocation of vomiting in a number of circumstances.
Taking painkillers
The natural desire of many patients is to take painkillers, as a characteristic symptom of botulism is severe abdominal pain. It should be noted that the use of such drugs is not recommended. The absence of pain will not allow the patient to accurately describe all complaints, which will violate the clinical picture of the disease and greatly complicate the diagnosis.

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

Drinking Carbonated Drinks
Dry mucous membranes is another characteristic of botulism, a sign. You can quench your thirst only with clean, gas-free drinking water. Any carbonated drinks are prohibited. Also, you can not drink coffee, tea, broth.

Provocation of vomiting in a number of circumstances
It is possible to provoke a gag reflex only to those patients whose age exceeds 5 years. In addition to age, the patient must remain conscious. If a person is in an unconscious state, he may be choked with vomit. It is forbidden to induce vomiting to people who suffer from serious heart diseases, as they may have a heart attack.

Botulism treatment

Botulism treatment should always be comprehensive and urgent. Regardless of the day of hospitalization, patients undergo intensive gastric lavage and detoxification therapy. After washing the stomach or treating the wound with wound botulism, detoxification therapy and specific anti-botulinum serum treatment are performed.

Botulism treatment methods are:

  • gastric lavage,
  • siphon enemas
  • primary wound treatment for wound botulism,
  • body detoxification
  • prescribing anti-botulinum serum.

Gastric lavage in a hospital setting

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

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

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

Gastric lavage with impaired swallowing reflex
With a disturbed swallowing reflex, a thin nasogastric tube is used, which is inserted into the stomach through the nose. The end of the probe pretreated with petroleum jelly is inserted through the lower nasal passage, and from there through the nasopharynx into the esophagus and stomach. Thus, the stage of independent swallowing of the probe is excluded. After the probe is inserted into the stomach, the doctor must make sure that the probe is where it is needed. To do this, he attaches a syringe to the end of the probe and pulls his piston towards himself. If the probe is in the stomach, gastric contents enter the syringe. Then, by connecting a syringe to the probe, the doctor introduces a washing solution into the stomach with his help. After that, the syringe is disconnected, and the contents of the probe are poured into a wash tank. The procedure is repeated until clean rinsing water appears.

Conducting siphon enemas

With intestinal paresis observed with botulism, siphon and hypertensive enemas are recommended. They are prescribed to stimulate the atonic intestines. The principle of conducting a siphon enema is the same as with other enemas. The difference is that when carrying out a siphon enema, a much larger amount of water is used. So, on average, 10 to 15 liters of water are consumed. Also, the tip of a conventional enema is inserted into the rectum at a distance of 10 centimeters, while the siphon tube is inserted to a depth of 20 - 30 centimeters. Therefore, siphon enemas are also called high cleansing enemas.

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

Proserine and other drugs in the treatment of botulism

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

Drugs used in the treatment of botulism

What is child botulism

Botulism is a serious infectious disease caused by exposure to the human body of botulinum toxin. This rare disease is very serious and can be fatal if symptoms are not detected in time.

The disease develops rapidly - its symptoms can appear as early as two hours (and up to 36 hours) after the poisoning with botulinum toxin has occurred.

The toxin that secrete the botulinum bacillus (Clostridium botulinum) in the process of life is one of the most dangerous neuro-paralytic poisons, which can cause disorders of the musculoskeletal system and nervous system in the form of paralysis, as well as the death of a person if the toxin injured respiratory muscles and heart.

Causes of Botulism

Botulism can be of several types, but its nutritional form is more characteristic for children, when the stick enters the children's body along with food and breast milk.

Of the food products that can get a stick of botulinum, experts distinguish homemade canned food and preparations, as well as meat products: ham, sausages, sausages. Insufficiently processed meat, vegetables and fish, seeded with bacteria, become potentially dangerous in an environment devoid of oxygen, because all the canned goods and blanks in glass jars are a vacuum with the product. The bacterium is also able to multiply in an oxygen-free environment, releasing a toxin impregnating products.

Infant botulism also occurs due to the multiplication of botulinum that has been ingested with mother’s milk or an artificial mixture directly in the intestines of the baby. In older babies, the bacterium in the body dies, but children under one year old do not have the necessary level of protection.

Of course, from many potentially dangerous food products, the child will not be able to get botulinum, because they should not be in his diet. But a stick can enter a child’s body with mother’s milk, which ate potentially dangerous foods.

A great danger to infants is honey, which caring grandmothers like to treat their children to. In honey, the bacterium does not multiply, but it perfectly retains its properties in spores and begins to germinate and secrete toxin, once in the intestines of children (mainly in the large intestine). It is noteworthy that babies who are breast-fed are more susceptible to botulism, since manufacturers use honey to make some mixtures.

How to recognize childhood botulism

The sooner botulism is detected in a child, the higher the chances that the disease will pass for him with minimal consequences. Toxicity can be recognized by the following signs.

1. constipation

If the child did not go to the toilet for more than three days, he has constipation. Usually this symptom manifests itself within a day after infection. But at the same time, constipation can be caused by an unbalanced diet, when fats predominate in food, or other diseases that are not related to the activity of botulinum.

2. Vomiting

Botulinum toxins upset digestion, one of the symptoms of the disease is profuse vomiting.

3. Respiratory failure

Botulinum toxin affects the functioning of the respiratory muscles, disrupting the rhythm of breathing. Because of this, the child can breathe faster or, conversely, slower than usual. This is a very formidable symptom, because intoxication can lead to respiratory arrest.

4. loss of appetite

A child can refuse food or breast milk not only because of loss of appetite, but also because of a violation of the sucking reflex. Watch out if attempts to capture a nipple are unsuccessful, although before that the baby confidently sucked milk.

5. Excessive salivation

With botulism, salivation in a child becomes uncontrollable - the baby simply can not swallow saliva, no matter how hard it tries.

6. Eyelid prolapse

Due to the toxin's defeat of the third pair of cranial nerves in a child, his eyes may involuntarily close as if he wants to sleep.

7. Uncontrolled movements and lethargy

Lack of coordination of movements - the child suddenly began to move awkwardly and clumsily like a rag doll - and also a general lethargic state may indicate muscle weakness due to exposure to the body of botulinum toxin. Moreover, the occurrence of muscle lethargy occurs from top to bottom, that is, from hands to feet.

If you find at least one or two symptoms in a child, do not hesitate and urgently call an ambulance. Even if later it turns out that you were worried in vain, in this case it is better to play it safe. It is important to tell the doctor as detailed as possible about what you have eaten in the last few days, if you are not breast-feeding a baby and he is not receiving other food, and also about what the child himself could eat.

Для выявления ботулизма врач может сделать несколько анализов — кала, крови, рвотных масс и других биологических жидкостей — на наличие токсина в организме, а также другие диагностические исследования — электромиографию, люмбальную пункцию, КТ, МРТ.

Disease treatment

Botulism treatment should be started as early as possible. First of all, first aid is needed.

While waiting for the “ambulance”, wash the stomach to reduce the absorption of botulinum toxin into the intestines and remove the remnants of dangerous food. For this, an enema should be given to the child, a laxative and a sorbent preparation (enterosgel, activated carbon, smectus) should be given.

Botulism treatment is carried out strictly in a hospital. The doctor carries out detoxification of the body, oxygen and physiotherapy (to restore the functions of swallowing and sucking). Also, in case of violation of the functions of swallowing, the baby is fed through a probe.

It is extremely important to remember that even with the timely detection of botulism, treatment and recovery will be long. In addition, there are frequent cases of irreversible changes in the body - paresis (incomplete paralysis) and paralysis.

Botulism Prevention in Children

To prevent infection with botulinum, it is important to carefully monitor the diet in the family: eat only high-quality foods, avoid suspicious canned food (for example, with signs of bloating) and any homemade preparations for children under 4-5 years old.

In addition, to exclude honey and corn syrup from the child’s diet for up to a year, and it’s better to completely postpone familiarity with these products until 2-3 years old.

Gastric lavage

The standards of first aid for poisoning with botulism at the prehospital stage include the release of the digestive system from toxin residues: gastric lavage and a cleansing enema.

For washing use:

  • 5% soda solution,
  • tannin,
  • weak solution of potassium permanganate.

The procedure is performed with a thick probe inserted directly into the stomach. After inside, sorbents are prescribed: coal, Enterosgel for binding of botulinum toxin.

In no case should you wash the stomach of a patient in an unconscious state!

Bowel cleansing

At this stage, you can choose from two options:

  • give the patient a saline laxative and wait for an independent stool (for example, 30 g of magnesium sulfate),
  • make a high siphon enema with boiled water.

The listed procedures for cleansing the stomach and intestines should never be neglected. This is the first aid for botulism and is very effective. These measures will significantly improve the well-being of the patient and stop the flow of botulinum toxin into the blood.

Cardiopulmonary Resuscitation (CPR)

If the patient worsens, paralysis of the respiratory muscles and respiratory arrest, it is necessary immediately (before the arrival of the ambulance team) to begin artificial ventilation of the lungs and indirect heart massage. This is the first aid for botulism.

If there is a pulse on the carotid artery and there is no breathing, only mouth-to-mouth or mouth-to-nose ventilation is performed by blowing air into the patient’s lungs approximately once every 5 seconds. First you need to prepare and clean the airways of saliva, vomit, foreign objects (if any).

If respiratory arrest and palpitations occur, resort to cardiopulmonary resuscitation. Sometimes it is possible to restore the work of the heart by performing the technique of precardial shock on the chest. The disadvantage of this method is a likely fracture of the ribs.

The CPR procedure is performed 1: 5 (one injection every 5 pressures on the chest), with the help of two people and 2:15 - if one. The effectiveness of resuscitation can be judged by the appearance of independent breathing and pulse.

Anti-botulinum serum

There are three types of anti-botulism serum: A, B and E. There is also a multivalent serum containing immunoglobulins of all bacterial serotypes.

As a rule, when signs of botulism appear, the last or 3 drugs are administered simultaneously (A, B and E), and when specifying the type of infection, treatment is continued with a certain type of monovalent serum.

Anti-botulinum serum is a solution of specific protective immunoglobulins (Jg) of horse blood infected with botulinum toxin. The drug is extremely allergic, so a sensitivity test is required.

Diluted 1: 100 serum in an amount of 0.1 milliliter is injected subcutaneously into the elbow, and the reaction is monitored. If, after 20 minutes of swelling and redness, more than 1 centimeter appears, the sample is considered positive. Nevertheless, such a result is not a contraindication to the intravenous administration of the drug. The whole serum ampoule is diluted in 200 ml of sodium chloride solution and injected into a vein dropwise. In case of a positive skin test, prednisolone 60–90 mg is prescribed intravenously before treatment, in order to reduce the risk of allergies.

The only contraindication to the prescription of anti-botulinum serum is a severe allergic reaction to an intradermal test in the form of anaphylaxis!

It is important to note that the sooner treatment with serum is started, the more effective its action will be. All medical measures are carried out in a medical office equipped with an anti-shock kit. During the procedure, the doctor carefully monitors the patient's condition.

Parenteral detoxification

This term refers to the intravenous and intramuscular administration of drugs, the action of which is aimed at binding, neutralizing and eliminating the toxin, as well as the correction of arising disorders of organs and systems.

It is possible to carry out detoxification at the prehospital stage - by emergency doctors with the necessary equipment of the brigade with all medicines, and in a hospital.

  1. Hemodez N, Reopoliglyukin, Gelatinol, Neocompensan and other solutions are administered dropwise as indicated. The choice of drug and dose is determined by the attending physician based on the severity of the condition of a particular patient. The listed solutions improve microcirculation, saturate tissues and cells with oxygen and glucose, normalize the water-electrolyte balance, improve blood exchange and fluidity, neutralize and remove poisons and waste.
  2. To provide cells with energy and normalize the work of the cardiovascular system, glucose-potassium-magnesium mixtures, Riboxin, Mildronate are prescribed.
  3. In case of hypotension, Cordiamine 1 ml is injected subcutaneously to stimulate breathing (especially with developed paresis of the intercostal and diaphragmatic muscles) Strychnine, Corazole 1 ml of 10% solution or Lobelin.
  4. To replenish the water balance (loss of fluid with vomiting, urine and intestinal contents) isotonic sodium chloride solution and glucose are infused intravenously.

Forced diuresis

It is one of the ways to quickly release the body of toxins by eliminating them through the kidneys.

To stimulate diuresis, apply:

  • hypertonic 40% glucose solution,
  • Mannitol
  • Furosemide.

To summarize. Botulism is a rare, but very dangerous disease. Sometimes the development of complications occurs rapidly, therefore, before hospitalizing the patient in the infectious ward, you need not to get confused and use all possible methods to provide him with first aid.