What is botulism?

What botulism is well known to doctors are infectious disease specialists, neurologists, surgeons, resuscitators, district therapists. On the one hand, botulism is an infectious disease, because it is caused by a specific microorganism and has its own ways of hitting a person.

On the other hand, the severity of the condition of infected people depends on the strength and amount of botulinum toxins produced by the pathogen. People who are unfamiliar with medicine should understand that the symptoms of the disease can not be called "botulism poisoning".

It is more correct to talk about the toxic-infectious nature of the nervous system in a person, the absence of a factor of transmission of infection from the patient to a healthy one. The complex mechanism of the violation of the innervation of the muscles responsible for supporting vital functions leads to impossibility of independent breathing and developing acute respiratory failure in botulism.

A bit of history

The name of the disease is associated with the most frequent identification of symptoms after eating sausage. The literal translation from Latin botulus - "sausage".Even in ancient Byzantium, the Emperor's order forbade the food of blood sausage, which was made by domestic means. In the XVIII-XIX century, epidemiological studies involved practitioners who were looking for an answer to the question of where botulism comes from.

In German princedoms, the love of sausage was accompanied by the deaths of several people at once at the general dinner

The first detailed guidance on botulism was published by J. Kerner in 1822.He described the clinical signs, suggested that botulinum toxin can be used for therapeutic purposes in the therapy of nervous diseases, manifested by excessive increased motor skills( hyperkinesis).

The famous Russian surgeon NI Pirogov compiled a description of the bodies of dead people he had uncovered from "poisoning with fish poison".It is interesting that in Russia, botulism was known as "Ichthyism," and salted and smoked fish was considered the main source of infection.

Finally, a bacteriological examination of infected musicians, conducted by the Belgian doctor Emil van Ermengem, made it possible to identify the causative agent of the disease. He was called a bacterium( wand) of botulism. In addition, the doctor found that the toxin is formed not in the body of a sick person, but in a ham.

In the XX century for the treatment of botulism created immune serum. In 1973, Alan Scott began testing the use of botulinum toxin for medicinal purposes. The more dangerous botulism in the XXI century, we try to explain the properties of the pathogen and the presence of the daily possibility of infection.

Pathogen of botulism and its damaging properties

Modern bacteriology has enough data about the causative agent of botulism. He is referred to the genus Clostridium. The botulinum wand is quite mobile, exists in anoxic environment( anaerobic), gives a positive result when stained by Gram. Vegetative forms do not contain controversy. Are arranged randomly or by chains, are capable of building a capsule.

When at one end a spore forms, clostridia of botulism under a microscope are similar to tennis racquets

Microbiological studies of botulism made it possible to isolate seven types of pathogen according to the antigenic structure of exotoxins, which are called the letters of the Latin alphabet. Pathogenic( infectious) are 4 of them: A, E, B, rarely F.

In the Russian Federation, the bacterium of botulism is represented by types A, E, B. It lives in the soil, vegetative forms are able to synthesize toxin. The best living conditions are considered to be almost anoxic environment, temperature within 28-35 degrees. Forms gas, which in cans is defined as bombing( bloating).

They fall into favorable conditions, where vegetative forms develop from them. Toxins are resistant to the effects of gastric and intestinal enzymes, do not break down from a concentrated solution of sodium chloride, from spices and seasonings.

Botulinum toxin is considered to be the strongest of natural poisons. A dose that is fatal for a person is 5-50 ng / kg of body weight. To completely destroy the clostridium of botulism, use alkaline medium, boiling for more than half an hour, a special mode of pasteurization.

How does a person get infected?

Botulism refers to rare infections. For the year, up to 1 thousand cases are recorded in the world. It should be borne in mind that not all countries have diagnostic capabilities. The reservoir of botulinum clostridium is found in soil, meat of animals eating spores. It reproduces well in the dead bodies of dead animals even after their death. Lives in water reservoirs, pits with fertilizers.

The person gets through the mucous membrane of the respiratory tract, the gastrointestinal tract, and damage to the skin. Occurs in the form of isolated cases. The transmission route is fecal-oral, with wound form - contact. Cases of group involvement of family members are not uncommon.

It is impossible to completely trust house preparations, it is very difficult to fulfill all conservation conditions.

The cause of botulism can be food products, dust particles( a feature of botulism in infancy), household contact. It is important that the disease is not accompanied by the formation of immunity. There are cases when botulism developed repeatedly in one person.

The causes of botulism are studied for rare outbreaks of the disease in different countries. Thus, it is established that most often they are caused by type A. Type D is not dangerous to humans, but causes disease in animals and waterfowl. A type C toxin is most dangerous for newborns and contamination of the wound surface with contaminated soil. Children suffer in connection with the peculiarities of the intestinal microflora.

The most dangerous product is canned food, creating conditions for tightness and lack of access to oxygen. They should accumulate a significant dose of toxin.

Modern factory conditions of conservation allowed to minimize cases of botulism. People are infected with infection after consuming home preparations of meat, fish, mushrooms, vegetables.

There were cases among fishermen after eating whale meat, chili, pickled garlic, insufficiently washed baked potatoes, dried fish. On the territory of Russia, the most common food form of botulism, caused by pickled mushrooms, the next in the frequency are homemade canned meat.

Particular alertness is caused by cases of botulism in children with artificial feeding, if in the nutritional mixtures are products of beekeeping. It is believed that spores are entered by bees with pollen of flowering plants in the nectar.

What changes in the body cause botulotoxins?

Botulinum toxins play a major role in the defeat of the body. They act on the centers of the brain and spinal cord, the autonomic nervous system. When food contamination, the vegetative forms of clostridium enter with the toxin into the stomach.

Hydrochloric acid does not destroy or neutralize toxins. Absorption into the blood takes place along with the food components through the wall of the intestine. With the bloodstream, the toxin is spread to all organs and systems. The nerve cells-impulse transmitters to the muscles, the neurons of the spinal and medulla oblongata, are most sensitive to its action.

First of all, the functioning of the muscles of the eyes, larynx, pharynx, respiratory in the intercostal spaces

is disrupted. Isolation of acetylcholine in synapses occurs. The activity of the disrupting enzyme cholinesterase does not change. Neurological manifestations are called paralytic and bulbar syndrome.

Depression of respiratory muscles with the development of oxygen deficiency causes a block at the level of neurons in the spinal structure, called the "front horns".Here lie the fibers of the motor nerves.

Paresis of the muscles of the larynx, pharynx promotes flowing into the trachea and bronchi( aspiration) of saliva, food masses. Lack of saliva causes additional inflammation of the parotid glands( parotitis), mucous in the mouth.

The total drop in the level of oxygen in the blood( hypoxia) disrupts the biochemical processes of energy production, the work of a potassium-sodium pump that provides myocardial contraction, why there are life-threatening arrhythmias. A fatal outcome is observed when the heart muscle is affected.

When infected through the wound and botulism of infants, in contrast to the food mechanism, the main one is germination in anoxic conditions or with the support of intestinal flora and enzymes. Appear vegetative forms. Gastroenteritis and symptoms of intoxication are absent.

While it remains unclear the mechanism that contributes to germination of spores in the gastrointestinal tract. How botulism manifests, what specific clinical and diagnostic signs are most likely during the course of the illness, you can learn from this article.

In case of death, pathologists do not find specific changes in organs. There is fullness, hyperemia, edema of the brain tissue with a violation of microcirculation. On the mucous membrane of the intestine and stomach, pinpoint hemorrhages are revealed. Destruction in nerve cells is moderately expressed. Vascular walls are susceptible to the process of dystrophy.

Classification of botulism by forms

The modern classification provides for the mechanism of infection, the severity of the disease. It is accepted to allocate:

• a food form - the disease is preceded by the ingestion of foods with accumulated sufficient dose of botulinum toxin;
• childhood infants disease - typical for infants up to six months old, infected with spores;
• wound - is associated with the ingress of soil into the wound on the skin of botulinum clostridia and creating the necessary conditions for the growth of the pathogen and the formation of toxins;
• , unspecified form - this conclusion is made if the epidemiological investigation does not allow establishing the method of infection.

Depending on the degree of severity, the course of botulism is divided:

• into the lung - paralysis is confined to the oculomotor muscles;
• moderate - the muscles of the larynx and pharynx are connected to the lesion;
• severe - accompanied by severe respiratory failure, bulbar paralysis.

In addition to respiratory hypoxia and subsequent lethality, the patient may experience aspiration pneumonia, myocarditis, heart rhythm disorders

Requirements for the treatment of botulism

The treatment of botulism is very rigidly and specifically reflected in clinical recommendations for physicians. It is necessary to act quickly according to the scheme:

• rinse the stomach with a probe to remove infected food residues( expediently in the first 2 days of illness);
• repeated siphon enemas with soda solution to neutralize toxins, delay absorption;
• administration of an antitoxic serum for type B 5000 IU, A, C, E - 10 000 ME;
• intravenously injected solutions to reduce the concentration of toxin in the blood, add protein preparations;
• correction of electrolytes, especially sodium and potassium, is necessary to support contractile function of the myocardium;
• enhanced antibiotic therapy;
• Combating increasing hypoxia by supplying oxygen under pressure( hyperbaric oxygenation);
• elimination of saliva aspiration with suction from the larynx and trachea;
• transfer to artificial ventilation of the lungs with paralysis of the respiratory muscles.

Methods for the treatment of botulism

The attending physician should provide for 2 purposes in his appointments: measures to prevent formation, neutralize the damaging effect of toxins in the body and eliminate poison, restore the disturbances caused by botulinum toxin. When swallowed, patients are fed through a gastric tube, nutrient solutions are added intravenously.

The drugs of the mandatory list include:

• enterosorbents - contain substances that allow the collection of toxic products of bacteria and lead them through the intestine( Polyphepanum, microcrystalline cellulose, Polysorb, Enterodez);
• for excretion of toxins with urine is used Lactasol, diuretics( Lasix intravenously or Furosemide in tablets);
• broad-spectrum antibiotics are needed to remove inflammation in the intestines, mumps, to prevent aspiration pneumonia;
• hormonal preparations of the group of corticosteroids are prescribed by short courses to relieve inflammation and prevent a reaction to the introduction of serum;
• for electrolyte balance support, a mixture of potassium and magnesium salts is injected intravenously on a glucose solution;
• restoration of neurological disorders requires a long-term use of B vitamins, physiotherapeutic methods of activating muscle tone.

Features of the application of antitoxic serum

Botulism is not treated without specific detoxification of toxins. To provide antitoxic action, special sera are made by immunizing horses. The resulting activity of the drug is dosed in international units( IU).For each unit there is a certain amount of toxin.

After administration of the patient, the contact of botulinum toxin and serum antibodies occurs. Formed safe complexes, which are derived by natural ways. Any sera create passive immunity with ready-made antibodies, used when there is no time to wait for the formation of their own protective reaction.

Before the appointment, the patient's sensitivity to the protein components of the serum is checked by subcutaneous administration in a diluted dosage. If there is an increased sensitivity, it is still implied that the drug can be administered in a severe condition of the patient. In practice, polyvalent serums are used.

Serum dosage regimens and dosages depend on the severity of the patient's condition. The course of treatment may require 5 to 15 doses. Intramuscular or intravenous use is possible. When dripping into a vein, the serum is first dissolved in a physiological saline heated to 37 degrees.

In practice, the injured person is more convenient to vaccinate against botulism and tetanus

. Active immunization is carried out with the probability of infection, for example, if a wound is contaminated with soil. For this purpose, a purified sorbed anatoxin, called pentaanatoxin( initiates the production of antibodies to five types of toxins) is used.

When serum can not be used to treat botulism, intravenously native human homologous plasma is used. The appointment is limited to a shelf life of up to six months. In therapy, anti-botulinum immunoglobulin is used.

What determines the prognosis of treatment?

The experience of the use of the botulinum therapy regimen showed that if the serum was administered in the presence of early symptoms, then the injured person completely recovered. With fuzzy organization of therapy, late introduction of serum, the frequency of lethal outcomes from paralysis of the respiratory muscles reaches from 30 to 60% according to different sources.

The lack of the possibility of switching to mechanical ventilation increases the mortality rate to 65%.In specialized departments, with full compliance with treatment requirements, mortality is reduced to 3%.The rehabilitation process provides a complete recovery, lasting up to several months.

How to avoid infection?

Prevention of botulism hampers the high spread of the pathogen in nature, its resistance to environmental factors and unfavorable conditions. It has been established that botulism occurs most often in persons of 20-30 years of age. This indicates that it is the young people who lack control over security measures and knowledge about the probability of infection.

The main measures should be aimed at maintaining the cleanliness of food units, meat and fish processing shops, observance of conservation technology. The most dangerous products are those manufactured by the domestic method.

In conditions of home preservation it is impossible to achieve complete sterility. Especially it concerns pickling mushrooms. It is difficult to achieve complete washing from soil particles with botulinum spores. Another way of entering the dispute with food is salted and smoked fish, lard, homemade sausages.

"Bomb" cans of canned food can often be seen on the shelves of

. Measures for the prevention of contamination through canned food are:

• close monitoring when buying over the expiry date, breaking the shape of the can( bloating);
• heating the exposed contents of the can for half an hour at 100 degrees or using canned food only for cooking hot dishes;
• prevention of the conservation of overripe, spoiled or stale products;
• providing storage of smoked and dried fish, sausages, lard in the refrigerator, so that the temperature is maintained no more than plus 10 degrees.

In order not to develop a wound form of botulism, it is necessary to ensure sufficient treatment of all wounds with antiseptics. The problem of botulism concerns almost everyone. Nobody is immune from small contaminated wounds when working in the garden, in the garden.

The presence of a sufficient number of sausages, smoked products, pickles in shops and markets does not exclude any violations during production, so it is better to limit the use or use for cooking fried and boiled dishes.