Botulism

Botulism (synonym allantois) - heavy foodborne diseases resulting from ingestion of food containing toxins and anaerobic Bacillus Clostridium botulinum, characterized by symptoms of nervous system.
Etiology. The causative agent of botulism anaerobic Bacillus. You know the five types of pathogen: a, b, C, D, E. Often, the disease is called sticks types A, Century Pathogens botulism live in the soil, found in the intestines of humans and some animals. All types of pathogen form sporesthat are resistant to physical and chemical factors. Vegetative forms of germs die at a temperature of 80 degrees during 10-15 minutes, disputes also withstand boiling for 5 hours. In the dried state spores can remain viable for decades. Pathogens produce botulinum toxin type a, b, C, D, E, which by force of action on the human body are superior to all other bacteriological and chemical poisons.
Epidemiology. The reservoir of infection - cattle, pigs, horses, rodents , etc. in which the causative agent botulinum is harmless parasite intestines. The infection of reservoirs carriers become fish.
Human infection occurs by eating infected food.
More often poisoning occur by eating smoked, red fish, canned goods, in particular vegetable, fruit and mushroom, especially home-prepared with violation of requirements of hygiene. The greatest danger is the contamination of food by land and faeces. In sealed canned vegetables, mushrooms and fruits, poorly treated thermally, sticks botulism when stored at room temperature germinate and produce exotoxin. Infected canned food, usually blown up due to the formation of gases (Bombay).
Pathogenesis. In the development of the disease the main role belongs to the toxin, but matter and bacteria, which reproduce in the digestive tract and, penetrating into the blood, spread throughout the body. Botulinum toxin is rapidly absorbed in the stomach and intestines, affecting the smooth muscles causes bowel paresis. Circulating in the blood of patients, the toxin damages the endothelium of capillaries and precapillaries, increases the permeability. Particularly sensitive to the toxin Central nervous system.
The immune system. Transferred disease immunity does not leave.
The clinical picture. The incubation period is from 2 hours to 5 days, more often 12-24 hours. The shorter the incubation period, the harder flows disease and more often fatal. The disease is acute. Appear headache, weakness, abdominal pain, nausea, repeated vomiting, a feeling of awe of the heart, dry mouth, or Vice versa, salivation. First, there are usually constipation and bloating. After a few hours or after 1 to 2 days marked characteristic of botulism the disorders associated with damage to the internal and external muscles of the eyeball. Ill see things blindly, often double vision (diplopia). Then you may receive ptosis, mostly bilateral, uneven dilated pupils, their sluggish reaction to light, full immobility of the pupils, nystagmus. At the same time or a little later joined disorders, swallowing, speech becomes nasal, illegible, develops hoarseness or loss of voice (aphonia). Possible complete paralysis of the pharyngeal muscles and soft palate. There may come a breathing disorder. In mild cases patients complain constrained breath, chest tightness. In heavy over there shortness of breath with difficulty breathing, rhythm disturbance ihania, anxiety, distress, death can occur from suffocation. Slow in the beginning of the disease pulse replaced tachycardia, progressing cyanosis and pale skin. By the end of the acute period or in the period of recovery may develop myocarditis. Along with the muscles of the eyes, throat, larynx, intercostals muscles and the muscles of the digestive tract are affected muscles of the neck and extremities. Early appear and persist for all diseases fatigue and weakness. Body temperature remains normal or even lower. Consciousness is maintained even in severe disease.
Complications. Sometimes develop pneumonia, myositis. Recovery is slow: in light form - 2-3 weeks, with heavy - 2-3 months or more. The case fatality rate ranges from 15 to 70%.
The diagnosis is based on typical symptoms taking into account history (eating canned fish). From food poisoning and poisoning, botulism is distinguished by the absence of diarrhea at the beginning of the disease in the presence of nausea, vomiting, abdominal pain, flatulence and normal body temperature. For bacteriological and biological confirmation studied blood (in the laboratory directed not less than 6-8 ml), vomit, or the washing water of the stomach, urine and excrements of the patient, as well as products that caused the poisoning. In the absence of sterile glassware samples taken in any of the dishes after preliminary boiling within 15 minutes


Treatment. Patient with suspected botulism must be urgently hospitalized. Regardless of the stage of the disease need to start with gastric lavage 5% solution of bicarbonate of soda. Even at the slightest suspicion on botulism urgently intramuscularly (in severe cases, part of serum and intravenous) warmed up to temperature 37-38° antitoxic polyvalent protivopodagricescuu serum (mixture of antivenoms type A, b, C, D, E) in the amount of 20 000 - 40 000 ME depending on the severity of the disease. Prevention of serum sickness (see) therapeutic serum is administered by the method of Besedki (see Besedki method). After 5 to 10 hours should re-enter the serum in the same doses. In the following serum impose daily prior to the clinical effect. After the establishment of the type of the causative agent use only the appropriate serum. Along with serum treatment used and the toxoid. Serum and toxoid is administered simultaneously or with a break, but be sure to distant from each other parts of the body, different syringes and needles. Dose native toxoid: 2 ml (0.5 ml of the types A, B, C, E) if the first injection and 4 ml (1 ml of each type) when the second with an interval of 5-7 days.
Patients with botulism provide peace, prescribe strict bed rest. Because of the possible death of the patient as in the first hours of the disease, and at the time of relapse even in the period of apparent recovery for patients with botulism requires observation and careful maintenance.
Due to paralysis of the muscles of the intestine develop flatulence and persistent constipation. Laxatives may be ineffective. In such cases, necessary mechanized enema, discharge of gases through the exhaust pipe. When a swallowing disorder - feeding through a tube, drip nutritional enema, the infusion of isotonic solution of sodium chloride and 5% solution of glucose. When cyanosis of the skin and shortness of breath is the inhalation of oxygen.
Prevention. Strict sanitary supervision at cooking, especially for the manufacture of canned food. The great importance of strict compliance with domestic production of vegetable, mushroom and fruit canned food (see Canned).