Botulism

Botulism (from lat. botulus - sausage; SYN. allantois; from the Greek. alias, allantos - sausage) is a severe disease caused by food contaminated with the bacilli of the genus Clostridium botulinum and their toxins. Botulism occurs in all parts of the world, often in countries where the population uses a large number of different canned homemade products. Mortality in botulism is currently in England 76,5, in the USA 65, in Denmark 40,6, in Japan 31,9, in the USSR to 24.5%.
Etiology. The following types of the germ that causes botulism, belonging to the genus Clostridium: Cl. botulinum And (E. van Ermengen, 1896), Cl. botulinum (Leuchs, 1910), Cl. botulinum C (Bengston, 1922), Cl. botulinum C3 (Seddon, 1922), Cl. botulinum D (Theiler, 1920; 1927), Cl. botulinum E (E. D. Kushnir, 1934), Cl. botulinum F (Moller, J. Scheibel, 1960). All types of the germ that causes botulism are just sticks with size 3 - 9X0,6 - 0,8 MK with rounded ends (Fig. 1-4), form an oval terminal disputes, giving the sticks look tennis rackets (Fig. 5-6). The causative agent of botulism mobile, has from 3 to 20 flagella, located all over the body surface cells (Peetri); capsules does not form; it is well painted aniline dyes; in young crops all gram-positive cells in the old part of gram-negative. Bacillus botulism - strict anaerobes; when growing them in anaerostat (see) on the surface of dense nutrient media (blood or liver agar) need a complete vacuum. On the surface of the agar, colonies Cl. botulinum first small, shiny, round, in the form of dew drops, then increases, becomes grayish with smooth or jagged edges (Fig. 7-10); blood agar, colonies have an area of hemolysis; agar column pathogens botulism form two types of colonies: disc-shaped ("lentil") and in the form of lumps of cotton (the"fluff"). Optimum temperature for growth and coccinobaphi bacilli types a, b, C, D are equal 34-35°, for types E and F 25-28 degrees; pH=7,4 - 7,6. Microbes types a and b have a strong proteolytic properties: with the growth by liquid media is melted pieces of meat, liver; less pronounced proteolytic properties of types C, D, E, F, Bacillus botulism fermented some carbohydrates with production of acid and gas.
Pathogens B. in food products, canned food, feed, in humans and animals, as well as on artificial nutrient media produce specific toxins, with a strong toxic effect on humans and animals at various ways of introduction (through the mouth, under the skin, intravenously, through the respiratory tract). Its effect on the body toxins B. surpass all other bacterial toxins (see). Liquid nutrient mediums you can get a native toxins of types a, b, C, D containing 1 ml of 0.5 - 2 million DLM, type F - 150 thousand DLM for white mice. Crystal toxin type And contains 32 billion DLM 1, pathogens Toxins botulinum highly resistant to temperature radiant energy and other environmental factors; when heated up to temperature of 58° destroyed after 3 hours, up to 80 degrees through 20-30 minutes, up to 100 degrees - in 3-5 minutes Stability toxins to high temperature depends on the type of the product in which it is located. The presence of fat and sucrose increases resistance to the toxins to heat. In the acid medium (pH 3,5 - 6,8) sustainability higher than in neutral; in alkaline medium (pH=a 7.6 - 8) are inactivated toxins faster. In canned products they long remain. Proteolytic enzymes (pepsin, Pancreatin, trypsin) do not destroy the toxin type a, b, C, D.E and F and increase in 10-500 time activity protoxin type E, which is under their influence becomes active toxin. Disputes CL. botulinum type a and b are saved by boiling in 3-5 p.m., when temperature 105° they are destroyed in 1-2 hours, at 120 degrees - in 20-30 minutes; resistant to low temperatures. In the dried state spores can remain viable for decades; in products and environments can germinate in vegetative forms that produce powerful toxins. Disputes die when exposed to 10% hydrochloric acid in 1 hour, 20% of formalin solution - 24 hours, ethanol - 2 months. Disputes Cl. botulinum able to germinate in gastric and pancreatic juice, which indicates the possibility of multiplication of bacilli of botulism in the digestive tract of humans and animals.
Epidemiology. The causative agents of botulism are widely distributed in nature; the permanent residence of them is the soil where they fall into the water, food in the intestines of humans and animals, with faeces which are scattered along the earth's surface.
On the territory of the USSR, the USA, France, East Germany and West Germany detected in the soil Cl. botulinum type A. b, C, D, E; in England, Sweden, Norway, Denmark, Yugoslavia types a, b, C, Africa - types C and D, in Japan - the type that is All agricultural and industrial products, contaminated soil and faeces of humans and animals can be infected with pathogens of botulism. Especially dangerous is the use for conservation of domestic and industrial methods of infected fruit and vegetables: anaerobic conditions, created in cans of food, promote germination of spores pathogens of botulism and totsinoumstum. Contamination of meat slaughterhouses and meat processing plants can occur at non-observance sanitary rules of the slaughter and butchering. The disease may be caused by the consumption of red and ordinary fish, which sometimes contains intestinal pathogens of botulism.
In humans, the disease can be caused by all types of germs of botulism, but mostly the types a, b and E. the Causative agents of botulism can grow on necrotic wound tissue. Experimentally proved the possibility of wound B. the person that was observed later in hospital.
Pathogenesis and pathological anatomy. The body is affected by the toxin contained in the food product, and also formed in the digestive tract and necrotic tissues. Toxicoinfections nature of pathogenesis B. installed Soviet researchers. People very sensitive to toxins all types of pathogens B.: the fatal dose of toxin type In poisoning by mouth to 3500 DLM for mice (Meyer, Eddi, 1951). Botulinum toxin is rapidly absorbed in the stomach, intestines, simultaneously affecting the smooth muscles bowel. Proven the presence of toxins in the blood of patients with botulism. Damage to the capillary endothelium and precapillaries leads to violation of their integrity and increased permeability, resulting toxin penetrates into the tissue stem part of the brain, affecting mainly ganglion cells. In botulism affects also the end of the motor nerves muscles I diaphragm, and therefore sharply weakened muscle tone, they become a pasty. Multiple daily effect on the body-lethal doses of the toxin of botulism 1/10, 1/50 DLM causes hypersensitivity to him, and the animals die from B. when you get 1/2-1/5 DLM (K. I. Matveev). This phenomenon is observed in humans at the use of their food product, containing a small amount of botulinum toxin.
At the opening of dead people and animals that died from botulism, find a sharp hyperemia of all internal organs with multiple small and large hemorrhages, flushing of the membranes of the brain, thrombosis and degenerative-necrotic lesion of epithelial vessels. The most significant defeat noted in the ganglion cells of the nervous system: change of their form, loss of shoots, vacuolization of cytoplasm, nucleus disintegration.
The immune system. Acute disease of the immune system leaves. Long-term or chronic intoxication, caused by eating food contaminated with spores of botulism can cause some resistance to the toxin and the accumulation of agglutinins in the serum. In this regard, in animals (pigs, cows, dogs, cats), often eating infected food, there is resistance to botulinum toxins. Toxins produced by the agents of the Baltic different types, different antigenic properties and neutralized only homologous antivenom (see), in connection with which the treatment applied polyvalent whey. Against botulism possible active immunization polyvalent toxoid. In the USSR developed a method of immunization of people concentrated adsorbed anaerobic Polianytsia, including seven antigens: tetanus, Cl. perfringens, Cl. oedematiens and four botulinum toxoid types a, b, C and E.
The clinical picture and over. The incubation period for the Baltic ranges from 2 hours. up to 10 days, usually 18-24 hours. The disease usually begins with a General weakness, malaise, headache, and characterized by rapid emergence and development of neurological symptoms. In typical cases, the temperature remains normal or low grade, frequent constipation and flatulence. The clinical picture of botulism is composed of the following symptoms: visual disturbances, diplopia, ptosis, eye, anisocoria, miosis, mydriasis, and others; upset the secretion of saliva and mucus, dry mouth and throat, difficulty swallowing, dysphagia or aphagia; the defeat of the vocal apparatus is hoarse, weak, silent voice; respiratory disorders - pressure and compression in the chest, shortness of breath, respiratory rhythm disturbance; bradycardia, lability of heart rate, cyanosis mucous membranes, pale skin; relaxation of the muscles of the limbs, abdomen, back, in severe cases, causes a total adinamii. Toxins bacilli botulism different types cause identical clinical picture of the disease. Depending on the severity of these symptoms and speed their development, there are three forms of flow B.: effaced, light and heavy. Death in botulism usually comes from paralysis of the respiratory system, with complete consciousness. B. it should be differentiated from other food-related disease, toxic diphtheria (see), encephalitis (see), polio (see), as well as from poisoning belladonna, atropine, methyl alcohol, or mushrooms (see Poisoning).


The diagnosis. Microbiological diagnosis is based on detection of toxins or germs of botulism in the patient's body or bodies of the corpse. If you suspect B. the patient take of the blood, the first flush water stomach or vomit (if vomiting), and faeces. From a corpse take on the investigation of the piece of liver, the contents of the stomach and small intestine. Examine also the presence of pathogens botulism and their toxins products (meat, vegetables, fruit), causing poisoning, as well as water, soil.
Solid materials pound in a sterile mortar add double the amount of saline and salt products - distilled water and allowed to stand at room temperature for one hour, after which the extract is filtered through cotton-gauze filter or centrifuged. Two-thirds of the volume of the extract is used for the detection of toxin; one third - for planting on the environment and the allocation of a microbe. To detect the toxin used neutralization reaction with botulinum diagnostic antitoxic serum. First, put a reaction with polyvalent whey a, b, C, E or two white mice injected or intraperitoneally 0,5-0,8 ml of the studied extract; another pair of MYShEI impose a mixture of 0,5-0,8 ml of the extract from 0.2 ml polyvalent whey (0.05 ml monovalent sera types a, b, C, E). Before the introduction of the mixture was incubated for 30 minutes at room temperature. In the presence of toxin die mouse, which introduced the extract without serum. After that, to determine the type of toxin put an expanded response neutralization with typespecific diagnostic sera And, In, With, that is, For the detection of pathogens botulism produce a crop in a liquid nutrient medium. Each study material sow in two bottles with a capacity of 100 ml; one bottle is heated on a water bath for 20 minutes at temperature of 80 degrees. After 48 hours. incubation crops are examined for the presence of agents of botulism by microscopy and setting the neutralization. If the result is negative, the analysis of cultures repeat for 6-10 days of growth. When the sowing of microbes, morphologically similar to Cl. botulinum, and the presence of toxin give a positive conclusion. If the crops discovered typical microbes, but the toxin, you need to activate cultural liquid with Pancreatin or trypsin to identify protoxin Cl. botulinum type that is Pure cultures of pathogens of botulism allocate by planting on the surface of dense environments or at high temperatures agar and isolate the colonies with further identification of cultures with the neutralization.
Treatment. Specific therapeutic agent - protivopodagricescoe antitoxic serum. If you suspect botulism to establish the type of pathogen apply polyvalent antitoxic serum And, In, With, that is, After the establishment of the type of the agent that caused the disease and treatment are only relevant monovalent serum.
The serum is injected intramuscularly as early as possible; in the first day - 50 000 - 100 000 AE each type, just 200 000 - 400 000 AE. In more severe cases a part of the serum is injected.
Also recommend early gastric lavage warm 5% solution of baking soda and purpose enemas, as well as olive or sunflower oil and animal coal for the absorption of the toxin. In testimony appoint heart funds and means of stimulating the activity of the respiratory centre, as well as glucose (intravenously), vitamins and other
Prevention. Compliance San.-the gig. rules for handling, transportation and storage of food raw materials, food for people and feed for animals. On fisheries and plants necessary to watch, that the fish was not exposed to contamination of soil, heated by the sun, storage without ice, transport and store fish only in the packaging. For preparation of balyk selected fish freshly caught without surface damage. Canned should prepare fresh benign raw materials, observing all rules of technology preservation (cleaning and processing of raw materials, sterilization and other) and storage of finished products. It is necessary to ban the sale of products home canning. To prevent botulism in farm animals is necessary to monitor the quality of silage, chaff and other fodder that can be heavily polluted land, bird droppings, the dead rodents. Prevention of botulism, in addition, use highly efficient toxoids for active immunization of human and animals, and the outbreak b. among people possible previously used protivopodagricescoe serum: intramuscularly in a dose of 5000-8000 AE serum types a, b, C, E, only 20 000 - 24 000 AE polyvalent whey.
Cm. also of Foodborne disease.