Botulism is the sharp food toksikoinfektion developing as a result of hit in a human body of a botulotoksin. Infection occurs in the alimentary way, is the most frequent at consumption of the canned food containing disputes of botulism. Botulism is characterized by defeat of nervous system as a result of blocking botulotoksiny atsetilkholinovy receptors of nervous fibers, shown in the form of muscular paralyzes and paresis. The main danger of botulism consists in development of such complications as sharp respiratory insufficiency and violations of a warm rhythm. Diagnosis of botulism is based generally on data of the anamnesis of a disease and results of neurologic survey.
Botulism is the sharp food toksikoinfektion developing as a result of hit in a human body of a botulotoksin. Botulism is characterized by defeat of nervous system as a result of blocking botulotoksiny atsetilkholinovy receptors of nervous fibers, shown in the form of muscular paralyzes and paresis.
Characteristic of the activator
Botulotoksin develops Clostridium botulinum bacterium – a grampolozhitelny sporoobrazuyushchy stick, an obligate anaerobe bacteria. Adverse environmental conditions are endured in a look by a dispute. Disputes of klostridiya can remain in the dried-up state many years and decades, developing in vegetative forms at hit in optimum conditions for activity: temperature 35 C, lack of access of oxygen. Boiling kills vegetative forms of the activator in five minutes, temperature in 80 C bacteria is maintained within half an hour. Disputes can keep viability in the boiling water more than half an hour and are inactivated only in the autoclave. Botulotoksin easily collapses during boiling, but is capable to remain well in the brines, canned food and foodstuff rich with various spices. At the same time existence of a botulotoksin does not change taste of products. Botulotoksin treats the strongest toxic biological agents.
The tank and source of klostridiya of botulism is the soil, and also wild and some house (pigs, horses) animals, birds (mainly natatorial), rodents. Animals carriers of a klostridiya are usually not harmed, allocation of the activator happens to a stake, bacteria get to the soil and water, a forage of animals. Obsemeneniye of environment objects klostridiya also perhaps at decomposition of corpses of animals sick with botulism and birds.
The disease is transmitted on fecal oral mechanism in the food way. Most often the use preserved in house conditions of the products polluted by disputes of the activator becomes the reason of botulism: vegetables, mushrooms, meat products and salty fish. An indispensable condition for reproduction of klostridiya in products and accumulation of a botulotoksin is lack of access of air (densely closed canned food). Infection with disputes of wounds and abscesses is in certain cases probable that promotes development of wound botulism. Botulotoksin can be soaked up in blood, both from a gastrointestinal tract, and from mucous membranes respiratory ways, eyes.
At people the high susceptibility to botulism is noted, even small doses of toxin promote expansion of a clinical picture, however most often its concentration is insufficient for formation of anti-toxic immune reaction. At poisoning botulotoksiny of preserved foods cases of family defeat are frequent. Now cases become more frequent in view of distribution of house conservation. Most often with botulism persons from age group of 20-25 years get sick.
The incubatory period of botulism seldom exceeds days, most often, making several hours (4-6). However can sometimes drag on about one week and 10 days. Therefore observation of all people eating one food with the patient continues up to 10 days. In an initial stage of a disease the nonspecific prodromalny symptomatology can be noted. Depending on a primary syndrome distinguish gastroenterologichesky, eye options, and also - a clinical form in the form of sharp respiratory insufficiency.
The Gastroenterologichesky option meets most often and proceeds as a food toksikoinfektion, with pain in an epigastriya, nausea and vomiting, diarrhea. The expressiveness of enteralny symptomatology moderated, however, is noted dryness of skin inappropriate to the general loss of liquid, and also quite often patients complain of frustration of a proglatyvaniye of food ("a lump in a throat").
The initial stage of botulism proceeding by eye option is characterized by disorders of sight: zatumanivaniye, messing around of "front sights", loss of clearness and decrease in visual acuity. Sometimes there is sharp far-sightedness. The most dangerous option of an initial stage of botulism on a current is the sharp respiratory insufficiency (which is suddenly developing and the progressing short wind, the extending cyanosis, violations of a warm rhythm). She develops extremely quickly and threatens with a lethal outcome 3-4 hours later.
The clinical picture of botulism at the height of a disease is rather specific and is characterized by development of paresis and paralyzes of various groups of muscles. At patients the symmetric oftalmoplegiya is noted (the pupil is steadily expanded, the squint which is usually meeting vertical , omission of a century takes place). The dysphagy (disorder of swallowing) is connected with the progressing paresis of muscles of a throat. If originally patients feel discomfort and difficulties of swallowing of firm food, then with development of a disease becomes impossible and proglatyvany liquids.
Violations of the speech develops, passing consistently four stages. At first the voice timbre changes, the osiplost results from insufficient humidity mucous vocal chords. Further in view of paresis of muscles of language there is a dizartriya ("mushmouth"), the voice becomes nasal (paresis of muscles of a palatal curtain) and disappears completely after development of paresis of vocal chords. As a result of frustration of an innervation of muscles of a throat the push is lost kashlevy. Patients can choke at hit in airways of slime and liquid.
Botulotoksin promotes paralyzes and paresis of mimic muscles, causing asymmetry of the person, a dismimiya. In general the general weakness, instability of gait is noted. In view of paresis of intestinal muscles locks develop. Fever is not characteristic of botulism, is in rare instances possible subfebrilitt. The condition of warm activity is characterized by increase of pulse, some increase in peripheral arterial pressure. Disorders of sensitivity, loss of consciousness are not characteristic.
The most dangerous complication of botulism – development of sharp respiratory insufficiency, respiratory standstill owing to paralysis of respiratory muscles or asphyxia of airways. Such complications can lead to a lethal outcome. In view of development of developments of stagnation in lungs, botulism can provoke secondary pneumonia. Now there are data on probability of a complication of an infection myocarditis.
Diagnosis of botulism
Due to the development of neurologic symptomatology of the patient by a butulizm needs survey of the neurologist. Specific laboratory diagnosis of botulism on early terms of development of an infection is not developed. The clinical picture and data of the epidemiological anamnesis forms the basis for diagnosis. Toxin is emitted and identified by means of biological test on laboratory animals. At the height of a disease it is possible to define presence of toxin at blood by HGUF with an antitelny diagnostikum.
Anti-genes of activators come to light by means of the immunofluorescent analysis (IFA), and also - RIA and PTsR. Allocation of the activator by crops of kalovy masses does not bear significant diagnostic information as development from a dispute of a vegetative form of klostridiya in intestines of the healthy person can take place.
Treatment of botulism
At suspicion of botulism obligatory hospitalization in office with a possibility of connection of the device IVL, for the purpose of the prevention and the timely help in a case of development of life-threatening complications is made. The foremost medical action made in the first days of a disease is washing of a stomach by means of the thick probe.
Botulotoksin circulating in blood of patients neutralize by means of single introduction of polyvalent protivobotulinichesky serums by Bezredki's method (after implementation of desensitization of an organism). In case single introduction of serum was not rather effective and 12-24 hours later at the patient progressing of neurological symptomatology is noted, introduction of serum is repeated.
Introduction of protivobotulinichesky human plasma is quite effective, however this medicine is quite rare in view of a small period of storage (no more than 4-6 months). Now in treatment of botulism protivobotulinichesky immunoglobulin finds application. The complex of actions of etiotropny therapy joins the antibiotics appointed for the purpose of suppression of probable development of vegetative forms of the activator, and also and ATP. The positive effect is rendered by hyperbaric oxygenation.
For the rest treatment is appointed proceeding from weight of a current and symptomatology. In case of formation of sharp respiratory insufficiency of patients transfer to artificial ventilation of lungs. Feeding of patients in case of formation of a resistant dysphagy is made liquid food via the thin probe, or transferred to parenteral food. During recovery in respect of the fastest restoration of functions of muscular system the physical therapy has good effect.
The forecast at botulism
The forecast at a high dose of the received toxin and lack of timely medical care can be extremely adverse, the lethality of such cases reaches 30-60%. Application of etiotropny treatment and methods of intensive therapy at development of terrible complications considerably reduce risk of a lethal outcome (to 3-4%). In case of timely treatment the disease comes to an end with recovery with a complete recovery of functions in several months.
Prevention of botulism
Preventive measures against botulism mean strict following to sanitary and hygienic norms at production of canned food, sterilizations of ware for preparation of products of long storage. Fish and meat products have to be preserved only in the fresh and carefully cleared of soil particles look. Preservation of overripe fruits is inadmissible. Conservation in house conditions has to be carried out in strict accordance with a compounding at sufficient concentration of salt and acid in ware, open for oxygen access.