- Reasons Botulism
- Symptoms Botulism
- Treatment Botulism
Botulism is an acute, progressive state which is caused by botulinum toxin, the peculiar natural poison produced by spore-forming bacteria of Clostridium bothulinum. The main reason for a disease is a consumption of the contaminated food stuffs though, botulism can be caused in children of chest age by special types of clostridiums which get from the soil or an inhalation way. Growth of bacteria happens bacteria in the child's intestines. Botulinum toxin is a neurotoxin which blocks activity a neurotransmitter acetylcholine necessary for transfer of nervous impulses to muscles. Sluggish paralysis is caused by influence of botulinum toxin. At botulism breath also suffers that happens because of failure of muscles which control respiratory tracts.
In the modern world botulism meets extremely seldom, but its high lethality causes attention to this disease both in the general public, and in medical society. Clinical descriptions of botulism meet since times of ancient Rome and Greece. Nevertheless, interrelation between the contaminated food and botulism it was not defined until the end of the 1700th years. In 1793 the German doctor, the Yustiny Centre punch (1786-1862), drew a conclusion that substance in the spoiled sausage which he called "wurstgift" ("sausage poison"), causes botulism. An origin of toxin and its role in a disease remained uncertain while Emil van Ermengem (1851-1932), the Belgian professor, isolated Clostridium bothulinum in 1895 and defined it as a source of food poisoning. Three types of botulism were defined: food, wound and children's botulism. The main distinction between types depends on a way of influence of toxin. Food botulism meets in 25% of all cases of botulism, and, as a rule, develops after consumption of the infected home-made canned food. Children's botulism is diagnosed in 72% of all cases. About 98% of children completely recover at adequate therapy.
Botulism is not transmitted from one person to another. It develop at influence of deadly toxin of botulism, the natural poison produced by some bacteria of Clostridium which can be found in canned food, other food stuffs, and sometimes and in intestines of babies. Botulinic disputes can cause spread of a disease if get to the environment.
The toxins produced by Clostridium bothulinum bacteria are the main etiological agent of botulism. Other representatives of the sort Clostridium can also produce botulism toxin, namely C. argentinense, C. butyricum and S. baratii, but these sources are not so considerable. To grow, these bacteria demand low acidity, the oxygen-free environment. In the absence of these conditions of a bacterium turn into disputes which, as seeds of plants, can remain at rest for many years. Clostridiums and their disputes exist around the world, especially in the soil and water. They do not threaten health of the person or animals until dispute gets on Wednesday which favors to growth. At germination disputes deadly botulinum toxin is produced.
Scientists found out that the clostridium can make at least seven types of toxin of botulism which are defined as A, B, C, D, E, F and G. People, as a rule, suffer from A, B, E, and very seldom F-types; babies are more subject to influence of toxins of type A and B. Domestic animals, such as dogs, cattle, and also minks suffer from botulism like C which also influences birds and causes a mass case of domestic and wild waterfowl. Botulism of D can be observed at cattle and horses.
Botulinum toxin tropine to specific proteins in nerve terminations it is also irreversible destroys them. These proteins control release of acetylcholine, the neurotransmitter which stimulates muscle cells. At toxin influence nerve fibrils cannot stimulate muscles. However this effect of botulinum toxin gave it a useful niche in world medicine. Some nervous breakdowns are characterized by involuntary and uncontrollable muscular contractions. Medical researchers found out that injections of strictly controlled doses of botulinum toxin in the affected muscles are suppressed by their excessive reduction. As a result of it muscles will partially be paralyzed and the normal movement remains.
The botulism of the person caused by toxins of botulism A, B and E can be connected with the infected food stuffs contaminated by wounds or intestinal botulism toxins (at babies).
Food botulism. The food with the violated conditions and a period of storage may contain botulinum toxin. Long ago it is known that preserved foods of food can cause botulism. Symptoms of food botulism usually appear during 18 till 36 o'clock after the use of the infected food, however this period can vary from 4 hours to 8 days. Initial symptoms include an illegibility of sight or doubling in eyes, the complicated swallowing and the speech. Possible gastrointestinal signs include locks, nausea and vomiting. When progressing botulism, the patient tests weakness or paralysis, since head muscles, progressing down a body. Breath becomes complicated. Without medical care, death from respiratory insufficiency is quite probable.
Children's botulism. Children's botulism was for the first time described in 1976. Children swallow of the disputes which are contained in food, dust or dirt. Disputes burgeon in a large intestine and colonize it. Toxin is developed and soaked up in a body of the baby from all digestive tract. The first symptoms include a lock, slackness, small appetite. When progressing children's botulism, the act of suction and swallowing becomes more difficult. The child suffers from the general weakness and cannot control the movements of the head. Sluggish paralysis of muscles develops. Breath is broken, and very real danger is represented by respiratory insufficiency.
Wound botulism. The confirmed cases of wound botulism were connected with an injury, such as severe injuries of extremities, surgical wounds, and injection wounds at the use of drugs. Wound botulism arises when clostridiums colonize contaminated wounds and produce in them botulism toxin. Symptoms are usually shown for 4-18 days after an injury, manifestations are similar to food botulism though gastrointestinal symptoms can be absent.
Symptoms of children's botulism can be imperceptible for parents because its manifestations of a malovyrazhena. Parents have to call the doctor or bring or the child to hospital as soon as the child shows such symptoms as weakness or slackness, drowsiness, irritability and bad food on a row with reduction of defecation or a lock. The sick child can be so weak that will not be able to control the movements of muscles, especially the movements of a neck and the head. If parents know about possible botulism toxin sources, the directing symptoms should not be ignored.
Differential diagnosis of botulism can be difficult because symptoms are similar to symptoms of other diseases, in particular the diseases which are characterized by muscular weakness. Botulism needs to be differentiated from such diseases as:
- syndrome to Giyena-Barra;
- system poisoning or sepsis;
- reaction to medicines;
- infections of a nervous system;
- poisoning with carbon monoxide or atropinic intoxication;
- heavy allergic reactions to a sting of a bee, mollusks and other allergens.
Sepsis is the most widespread primary diagnosis at botulism at babies. The encephalomeningitis can also be the diagnosis if there is an irritability and slackness. Children's botulism was connected in due time from 5 - 15% of cases of the syndrome of sudden children's death (SSCD) because disputes of botulism are in 4 - 15% of cases.
Laboratory tests are used to make the final diagnosis, but if the diagnosis of botulism explicit, treatment begins at once, without waiting for results of researches which can take up to 2 days. Diagnostic testings are directed to identification of the microorganism causing a disease. Carry out crops of culture from the contaminated materials, the emetic mass and gastric contents of the patient, washouts from a nose or a throat. At children's botulism the patient's chair can be cultivated. Growth of Clostridium in crops confirms the diagnosis.
Children of advanced age and adults with botulism as treatment accept the specific antitoxin received from horse serum. Antitoxin (it is effective against toxins of types A, B and E), inactivates only botulinum toxin which is tied to nerve terminations. Early administration of antitoxin, ideally within 24 hours after emergence of symptoms, can keep nerve terminations, prevent progressing of a disease and reduce mortality.
Unfortunately, antitoxin use is not shown to children. To children appoint antibotulinic immunoglobulin (BIG) which is a treatment procedure of choice. BIG neutralizes toxin like A, B, C, D, E before they can contact nerves.
Along with purpose of antitoxin, for treatment of botulism appoint other types of therapy. Antibiotics are not effective for prevention or treatment of botulism because clostridiums are not sensitive to them. Antibiotics can be used for treatment of secondary respiratory tracts and other infections.
Respiratory support. Children with heavy respiratory disturbances are in intensive care unit, getting intensive support of respiratory system and probe food. The respirator often is required from children of advanced age and adults to help breath; the tracheostomy can be in certain cases necessary.
Also surgical intervention can be sometimes necessary: for the purpose of sanitation of contaminated wounds and removal of a source of the bacteria producing toxins.
If food became the reason of botulism, to children of advanced age and adults carry out a gastric lavage. Often use purgatives or enemas. It is important to avoid products which contain magnesium as magnesium strengthens effect of toxin.
Food security is the most reliable way of prevention of botulism. Botulinum toxin cannot be found on a smell or taste therefore the best council is the refusal of any food which seems spoiled, to avoid the food packed into a container with dents, a rust or convex sides; to avoid freezing of meat, not to eat products which were stored at the room temperature or above more, than several hours. It is not recommended to feed with honey of children aged up to 12 months as honey is one known source a botulism dispute. It is necessary to adhere to the same precautionary measures when the child begins to eat firm food.