Botulism is an intestinal infection caused by a neuromuscular toxin produced by Cl.botulinum and characterized by damage to the nervous system.
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What is botulism?
Botulism is a life-threatening food poisoning. It is caused by the poison botulinum toxin. The name comes from the Latin word botulus, meaning sausage or intestines. So what causes botulism? The cause is toxins (poisons) produced by the bacteria Clostridium botulinum.
Botulinum toxin is a nerve poison that blocks the transmission of nerve signals to the muscle. The result is flaccid paralysis of the affected muscle. In addition, botulism toxin is the strongest natural poison. Even small amounts are lethal to humans.
Botulism was first described in 1820 by Justin Kerner, when an epidemic broke out due to the consumption of contaminated sausages.
The spore-forming, anaerobic, gram-positive bacillus Clostridium botulinum has 6 types, depending on the characteristics of the antigenic structure of the toxin they secrete. Poisoning usually occurs with toxins types A, B, C, D, E and F.
The causative agents of botulism live in the soil and are widespread in nature.
Under unfavorable conditions, they form spores and can persist in this form for a long time.
Botulinum toxin spores are very stable, can withstand several hours of boiling at a temperature of 100 degrees Celsius and are killed only in an autoclave. Toxins are easily destroyed by boiling for more than 15 minutes at a temperature of 80 degrees.
The optimal temperature for their reproduction is 35 degrees.
When entering the human body, toxins penetrate into organs and tissues, where they prevent the release of acetylcholine from presynaptic nerve endings. As a result, the transmission of excitation from the nerve to the muscle stops, and paralytic syndrome develops.
How does poisoning occur?
Clostridium botulinum accumulates in the intestines of herbivores, fish, waterfowl and mollusks, and is released into the external environment, where it persists in a spore state. Human infection occurs through food.
Since the disease occurs due to poisoning by a toxin, and is not caused directly by the bacterium itself, botulism is a poisoning and not an infectious disease. The toxin enters the body with food, so we are talking about food poisoning.
Most often, botulinum toxin poisoning occurs when eating canned food. This can be canned vegetables and fruits and other products.
Protein-rich canned food, which contains, for example, meat, fish or legumes, poses a particular danger. They may be infected with botulism bacteria. If the seal of the jar is broken and air gets in, bacteria begin to multiply and release toxins. Industrially prepared canned food has a lower risk of contamination than homemade canned food. In most cases of botulism, homemade canned food is to blame. Smoked meat and fish may also be contaminated.
Typically, products contaminated with botulinum toxin taste and smell like rancid oil.
Botulinum toxin spores are often found in honey. Therefore, you should be careful when feeding honey to children under one year of age.
Incubation period
The incubation period usually ranges from 18-36 hours, although it can range from 4 hours to 8 days.
The shorter the incubation period, the more acute the poisoning, and urgent measures should be taken. If little toxin enters the body, the incubation period can last up to ten days.
Signs of botulism
There are three types of symptoms: dyspeptic, eye, respiratory.
In the dyspeptic variant, the following symptoms predominate:
- dry mouth,
- thirst,
- nausea,
- vomit,
- cramping pain in the abdomen,
- diarrhea.
Then signs of bulbar paresis appear: speech disorder (dysarthria) and swallowing (dysphagia). Inhalation of food can lead to pneumonia and even suffocation.
The variant with ocular symptoms is characterized by bilateral symmetrical damage to the cranial nerves with subsequent paralysis.
Patients exhibit the following symptoms:
- feeling of double vision,
- “grid” before the eyes,
- photophobia,
- blurry images,
- unable to keep eyes open, eyelids drooping (ptosis),
- dry mouth,
- pupil dilation.
The most severe disease occurs with respiratory distress.
Paresis of the respiratory muscles and disappearance of the cough reflex develop, paralysis of the lips and larynx develops.
The person cannot speak or swallow. Respiratory failure and arrest are among the leading causes of death in botulism. Body temperature is usually normal, the patient remains conscious.
The main complications are associated with the development of severe pneumonia due to respiratory failure and paralysis of the diaphragm.
Diagnostics
Clinical blood and urine tests are usually normal.
Clinically, botulism is diagnosed based on the identification of neuromuscular disorders in the patient.
Most often, the patient consults a doctor with complaints of vomiting, abdominal pain and diarrhea, which can appear at the very beginning of the disease. The correct diagnosis in this case can be made if there is information about several sick people who ate the same foods.
Laboratory detection of Clostridium botulinum or toxin in suspicious products and in the patient’s blood or secretions is of great importance for the diagnosis. Samples are taken before the treatment serum is administered to the patient and stored in the cold without the addition of preservatives.
Differential diagnosis
Similar symptoms can occur with Guillain-Barré syndrome (a neurological disease), polio, myasthenia gravis (an autoimmune disease characterized by muscle weakness) and poisoning with henbane, methyl alcohol, poisonous mushrooms and belladonna alkaloids.
Early onset of respiratory distress in patients with polio may be mistakenly regarded as botulism. But unlike botulism, polio causes increased production of sputum and saliva.
When differential diagnosis with mushroom poisoning, it is necessary to take into account that botulism occurs when eating canned mushrooms, while mushroom poisoning occurs from eating freshly prepared mushrooms.
Treatment of botulism
The patient must undergo gastric lavage, cleanse the intestines and be hospitalized immediately.
Neutralization of the absorbed toxin is carried out using botulinum serums. Before determining the type of pathogen, all four types of sera (A, B, C, D) are administered intravenously or intramuscularly.
It is very important to begin treatment for botulism as early as possible, to administer serums as quickly as possible after botulinum toxin poisoning, preferably within 24 hours.
Antibacterial and detoxification therapy is also carried out (including glucose-salt solutions).
The greatest threat to the patient's life is respiratory problems and related complications. In case of breathing problems, the patient is transferred to controlled breathing. Proper treatment can reduce mortality to 10% or less.
Forecast
The prognosis for botulism is severe, but timely and correct treatment can save the lives of most patients. Recovery is slow and lasts for months. This is due to the slow recovery of paralyzed organs.
Prevention
Prevention of cases of botulism is achieved by proper canning of food and removal of canned food and other food products that cause suspicion (bloated lids, unpleasant odor).
Since botulinum toxin can be destroyed at high temperatures, in doubtful cases, food should be boiled for more than 15 minutes.
Use of botulinum toxin in medicine
The paralyzing properties of botulinum toxin are widely used in medicine.
Injections of this toxin can ease muscle spasms during torticollis, eliminate excessive sweating, and soften muscle spasticity during a stroke. Botulinum toxin is also used in plastic surgery.
It is very important that professionals work with this product.
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