Botulism

Botulism - poisoning with botulotoxin accumulated in food; Characterized by damage to the nervous system.

Etiology, pathogenesis. Pathogen-clostridia botulism - a strict anaerobic, forms spores and a very strong exotoxin (a lethal dose for humans about 0.3 μg). There are 7 antigenic types of pathogen, antitoxin against any type does not protect against the effects of other types. The toxin breaks down when heated. Disputes vydderzhivayut boiling until 5 h (with the domestic preservation of products, spores are not destroyed). Entered into the digestive tract, botulinum toxin is not destroyed by enzymes, absorbed through the mucous membranes of the stomach and intestines and hematogenously spreads throughout the body. With botulism of infants, toxin formation occurs in the intestine, and in wound botulism - in necrotic tissues. Botulinum toxin selectively affects the cholinergic parts of the nervous system. The cessation of the release of acetylcholine in the nervous synapses, causes muscle paralysis. The paralysis of the muscles of the larynx, pharynx, respiratory muscles leads to a violation of swallowing and breathing, which contributes to the emergence of aspiration pneumonia caused by a secondary microflora.

Symptoms, course. The incubation period ranges from a few hours to 2-5 days. Allocate the following syndromes: paralytic, gastrointestinal and general toxic. The latter is weakly expressed. Gastrointestinal syndrome is a fairly frequent manifestation of the initial period of botulism. It is characterized by nausea, vomiting, diarrhea and lasts about a day. Neurological symptoms develop against a background of gastrointestinal syndrome, and in some patients only after 1-2 days. There are general weakness, dry mouth, visual impairment (vague near vision, "fog", "mesh" in front of the pelvis, diplopia). Objectively, the pupils are dilated, their lingering reaction to light, anisocoria, insufficiency of any oculomotor muscles (with diplopia), ovulation of the eyelids and inability to lift them (ptosis), nystagmus. Often there is paralysis of the soft palate (speech with a nasal hue, while trying to swallow the liquid is drunk through the nose). The paralysis of the muscles of the larynx leads to hoarseness of the voice and even to aphonia. Violated swallowing because of paralysis of the muscles of the pharynx. Frequent paresis of facial muscles. Paralysis of chewing muscles, muscles of the neck and upper limbs is possible. In severe cases, insufficiency of the respiratory muscles develops rapidly. Sensitivity disorders do not happen. Consciousness is fully preserved. Fever is absent. In severe forms, death comes from paralysis of respiration on the 3-5th day of the disease. Complications-acute pneumonia, toxic myocarditis, myositis, neuritis, sepsis,

The diagnosis is based on a characteristic clinical symptomatology. Botulism must be differentiated from stem encephalitis, bupbar form of poliomyelitis, diphtheria, cerebral circulatory disorders, poisonings (atropine, bleached, fly agaric, ethanol, etc.), and in the presence of gastrointestinal syndrome - from gastroenteritis of another etiology. Take into account the epidemic prerequisites (the use of certain products, the group nature of diseases). Laboratory confirmation of the diagnosis is retrospective. Determine the presence of botulinum toxin (in food residues, contents of the stomach, intestines, blood serum) or pathogen.

Treatment. Patients with botulism wash the stomach with 2% sodium hydrogen carbonate solution, put a siphon enema, prescribe a laxative (30 g magnesium sulfate in 500 ml water). Probably earlier enter antibotulinum serums (A, B, E). Serum type A is administered in an amount of 10 000-15 000 ME, type B - 5000-7500 ME and type E - 15 000 ME. Serum is preheated to 37 g. C and injected intravenously (after a preliminary intradermal test with diluted 1: 100 serum). For severe forms of the disease, serum in the same doses is injected in / m 1-2 times with an interval of 6-8 hours. Assign also a 5% solution of glucose n / c or IV, isotonic sodium chloride (up to 1000 ml), diuretics facilities. With the growth of asphyxia due to paralytic closure of the upper respiratory tract, tracheostomy is produced. With paralysis of breathing, the patient is transferred to the artificial ventilation of the lungs.

The prognosis is serious. Even with modern methods of therapy, the mortality rate is 15-30%. Term of stay in the hospital 1-2 months.

Prevention. Checking canned food before use, removing "bomb" cans. Explain to the public the rules of home canning products. Warming up to 100 "C (for 30 minutes) rolled in the home in cans of mushrooms and canned vegetables before use (to destroy botulinum toxin) .Actually, people who use the infected product along with the infected are given prophylactic serums (w / m) A, B, E for 1000-2000 M E of each type and observe them for 10-12 days.