- What allows to suspect the development of botulism
- As confirmed by the diagnosis
- Laboratory methods
- Video on the topic
Botulism develops due to the ingestion of botulinum toxin, which belongs to one of the most toxic biological substances. The toxin is released during the life of the spore-forming rod, which multiplies in an airless environment.
Infection occurs in the human body when using canned food at home, because the poison for a long time exists in brines, canned food and food containing various spices. Foodborne toxicosis affects the nervous system, which can lead to the stopping of breathing or palpitation, so anyone who loves home canned food should know how to determine botulism.
What allows to suspect the development of botulism
Diagnosis of botulism begins with the study of the epidemiological history and clinical picture of the disease. Infection is transmitted by the fecal-oral route, that is, along with foods not sufficiently cleaned from the soil. In the vast majority of cases, the cause of the disease is the use of prepared at home canned foods that have been contaminated with clostridia spores.
The toxin can be found in cans with cucumbers, tomatoes, mushrooms and any other products containing brine. A necessary condition for bacterial growth is the absence of oxygen, so they accumulate only in tightly closed jars. If the sick person ate during the last 10 days canned vegetables, mushrooms, meat products or salted fish, it is likely that he contracted a toxicoinfection.
People are highly susceptible to botulinum toxin, which means that even small doses can lead to clinical symptoms. It is difficult to diagnose botulism that not everyone who ate cans from a can is infected because the toxin concentrates in a certain place and is sufficiently minimal to develop pathology.
However, there are often cases of family involvement by botulism after consuming long-preserved canned foods. In rare cases, botulinum toxin infection occurs when contaminated fluid contacts wounds and ulcers, so-called wound botulism develops. Therefore, you can not even open a suspicious can of canned goods.
Botulism occurs most often within 4-6 hours, but there are cases when the incubation period lasts for a week or 10 days.
Symptoms of botulism
Toxin at the onset of the disease can provoke the development of gastroenterological, eye syndrome or acute respiratory failure. Most often the gastroenterological variant develops, which proceeds as a food toxicoinfection. The patient feels pain in the upper abdomen, nausea, vomiting, diarrhea, the skin quickly becomes dry due to fluid loss, often the sick say that it has become painful to swallow.
In the prodromal period of botulism proceeding through the ocular variant, patients complain of visual impairment( appearance of black dots, fogging, loss of clarity and visual acuity, development of acute farsightedness).Even at the initial stage of the disease, acute respiratory failure can occur, which can lead to death within 3-4 hours, so if suddenly appeared and increases shortness of breath, the skin and mucous membrane become bluish, then urgent medical attention is needed.
At the height of the disease, botulism-specific symptoms appear: paresis and paralysis of muscles of different groups. Patients experience ophthalmoplegia( paralysis of the eye muscles), which can be manifested by pupil dilatation, strabismus, vertical nystagmus, and eyelid depression.
Because of the paresis of the muscles of the pharynx, dysphagia develops( swallowing), which leads to the inability to swallow food and liquids. Botulinum toxin provokes and weakening the innervation of facial muscles, which is manifested in the asymmetry of the face. The gait of patients is unstable, general weakness is noted. Paresis of the muscles of the intestine leads to the development of constipation.
Consistently broken speech. First, the patient's voice changes because of the dryness of the mucosal vocal cords. When the paresis of the muscles of the tongue develops, a person can not speak clearly. As the disease progresses, there is a paresis of the muscles of the palatine curtain, which makes the voice nasal, and when the vocal cords are weakened, the voice disappears altogether.
As a rule, botulism does not cause a rise in body temperature( rarely there is a subfebrile condition) or loss of consciousness
Thus, it is possible to suspect the development of botulism if the patient recently consumed canned foods, and the symptoms indicate a violation of innervation of various muscle groups( eye, facial, vocal).If you suspect a botulism, you should immediately call your doctor. Specialists will conduct differential diagnostics, and with the help of microbiology the presence of poison in the body will be confirmed or refuted.
As the diagnosis of
is confirmed Differential diagnosis is performed at the initial stage of the disease, when the clinical picture does not yet include the specific symptoms of botulism. The first signs of the disease, such as diarrhea, vomiting, nausea, weakness are characteristic of many intestinal infectious diseases and food poisoning.
Paralysis of the eye muscles can occur as a result of neoplasm, lead poisoning, alcohol, barbiturates, brain damage( TBI, stroke, encephalitis), infection with tetanus, diphtheria and other infectious diseases. Respiratory failure develops in diseases of the bronchopulmonary system and lesions of the central nervous system. What products cause botulism?
Diff.diagnosis of botulism requires the exception:
- of viral encephalitis;
- of dermatomyositis;
- of Guillain-Barre syndrome;
- syndrome Wernicke;
- poisoning with mushrooms or atropine.
Specific laboratory diagnostics of botulism at the initial stage of the disease is not developed, therefore, diffodiagnosis is based on epidemiological history( use of canned foods, alcohol, brain injury).
As botulism develops, characteristic symptoms appear that help differentiate the disease( preservation of consciousness and sensitivity, absence of fever and fever, muscle paralysis).Further diagnostics are performed to determine the type of toxin( A, B, C, E, F) and confirm the diagnosis. If a patient is suspected of botulism, a blood and urine sample is taken, and although the studies are not specific, they help to establish the severity of the course of the disease.
Toxication is indicated by an increase in the number of leukocytes and sedimentation rate of erythrocytes
Microbiological diagnostics of botulism can detect toxin in vomit, feces, blood, urine, gastric lavage, product residues. To determine the type of poison used bacteriological and biological method, as well as establish a phagocytic index.
When using the bacteriological method, the material is mixed in a sterile container with physiological sodium chloride solution. The material is then plated on a nutrient medium in four tubes. Two samples are heated at a temperature of 60 ° C for 15 minutes to detect a bacterium of the E.
type. The remaining two tubes are heated for 20 minutes at 80 ° C.Bacteria of type E and F are multiplied at 28 ⁰С, and type A, B, C at 35 ⁰С for 48 hours. After 1-2 days, the growth pattern is evaluated and the staining of Gram stains is performed. After isolation of the pure culture, its antigenic properties are studied by the agglutination reaction with typical sera.
The biological method involves determining the type of toxin by a neutralization reaction, which is important for a specific treatment. To detect the neutralization reaction, use dry diagnostic antitoxic sera, which are mixed with saline. If the serum acts, then the toxin is neutralized in the test sample.
The material for the study is placed in 6 tubes, five of them are added anti-butulinic sera type A, B, C, E, F, and in the sixth normal serum. The tubes are lowered into a thermostat for 30 minutes, and then 1 ml of liquid is injected into the white mice. Rodents, to whom a suitable anti-butulinic serum has been introduced, do not perish.
Laboratory diagnosis of feces in the detection of botulism does not always give an accurate result, since the vegetative forms of clostridium can be found in the intestine of a healthy person
Botulinum toxin reduces the phagocytic activity of leukocytes. To detect this property, the blood of the putative patient is mixed with sodium citrate, a polyvalent or typical serum is added to the tubes and placed in a thermostat for half an hour to kill the toxin. Then, staphylococcus enters the test material and is again lowered into the thermostat for 20 minutes to complete the phagocytosis.
Make a smear from each sample and count the number of staphylococci captured on average by one leukocyte. If botulinum toxin was present in the blood, then the phagocytic index is low. If the sample serum was added to test tubes, then where the serum corresponded to the toxin, neutralization would occur and the phagocytic index would be much higher.
In the midst of the disease, it is possible to detect a toxin in the blood with the help of ROPGA with an antiviral erythrocyte diarrhea. The fact is that red blood cells are sensitized by specific antibodies and adhesion occurs if there are antigens present in the sample of the material. The test makes it possible to detect even a minimum amount of toxin in the test material, since it has high sensitivity and specificity.
Antibodies that are labeled with enzymes are added to the blood taken from the vein. They react with bacterial antigens and form immune complexes with them, which causes a change in the color of the material. Specialists in the intensity of coloring conclude that the presence in the sample of specific antibodies to botulinum toxin.
The dot-immunoassay method makes it possible to recognize botulism within three hours of receiving the material for examination. With the help of the test, you can check for toxins not only the blood, but also the foodstuffs that are supposedly the source of the infection.
On the nitrocellulose membrane filter, on which the labeled antibotulin antibodies are placed, the test material is applied. After that, the filter is treated with a special compound, which darkens if toxins are present in liquids. The concentration of poison is determined when compared with the control school.
Laboratory diagnostics of botulism will confirm or disprove the disease that is necessary for the appointment of adequate treatment, which consists in taking anti-botulinum serum. To date, it is easy to determine the presence of botulinum toxin in the blood, but the disease is developing rapidly, so you need to know how to recognize the disease in time to see a doctor.