- food - a person ate food, water that contained a toxin,
- wound - the soil got into the wound, where the process of botulinum toxin germination took place,
- children - children are infected with spores of toxins up to the age of half a year,
- botulism of unknown origin - doctors can not establish the connection of the disease with food.
Botulism - its forms are the course and the main symptoms:
- 1 easy - paralysis of the eye muscles responsible for motor function occurs,
- 2 medium - except for damage to the eye muscles, the laryngeal and pharyngeal muscles are damaged,
- 3 severe - begins respiratory failure and bulbar syndrome (cranial nerves are damaged).
The first signs of botulism:
- first of all, nausea, vomiting, indigestion, which after a while gives way to constipation, bloating and colic,
- visual impairment (the patient sees everything as “in the fog”, the veil creeps before his eyes, the clarity of vision is lost, the pictures become blurred, sometimes everything is seen through the cell,
- pains begin in all muscles
- a person becomes pale, lethargic,
- pay special attention to salivation (dry mouth, perhaps one of the most prominent symptoms of botulism, with which ordinary poisoning can be separated from the disease),
- fever, blood pressure, chills,
- the voice or its timbre changes,
- impaired respiratory function.
Useful products for botulism
Under normal health, with botulism, you must adhere to diet table number 10.
If a patient has botulism in severe form, then it must be fed through a tube or prescribed parenteral nutrition. It should be borne in mind that food mixtures should contain a large amount of protein (1.5 grams per kg of weight is required).
Also, the patient must drink plenty of water, since botulism loses a large amount of fluid from the body.
If you follow the diet number 10, we recommend the following products and dishes:
- 1 animal origin: meatballs, meatballs made from low-fat fish and meat, 1 egg per day, cottage cheese, dairy products, butter,
- 2 vegetable origin: more vegetables and fruits (only not coarse fiber), various jellies, mousses, jam from them,
- 3 porridges,
- 4 vegetarian soups,
- 5 drinks: compotes, juices, green tea, broths of rose hips, lingonberries, hawthorn.
All dishes must be steamed or boiled, stewed (but only after boiling).
Traditional medicine for botulism
With this disease, self-medication is contraindicated. At the first signs of botulism, you need to call an ambulance and while it gets you need to do a gastric lavage with a solution of baking soda, put an enema and give a laxative.
If the patient starts having problems with breathing - make an artificial one.
There is such a popular recipe for botulism: you need to take one teaspoon of cinnamon (chopped), stir it in 200 milliliters of cold purified water. Put on the stove and boil for 3 minutes. This liquid must be constantly stirred. You should get a thick brown mass, like a thick jelly. This broth should be drunk warm. If a child is sick, then add a small amount of sugar to taste.
In order to prevent botulism, it is necessary, when canning, to keep all technological prescriptions, not to use preservation with swollen lids, preserved fruits, vegetables, mushrooms, wash thoroughly, remove spoiled products.
Dangerous and harmful products with botulism
- homemade canned meat and fish,
- dried, dried, smoked fish and meat,
- canned mushrooms,
- pastry containing cream.
All these products in most cases are the source of botulism bacteria in case of non-observance of the technology of preparation and storage. These products are especially dangerous in the summer. They should be stored at a temperature of no more than +10 degrees Celsius.
Diagnostic Methods Edit
General clinical diagnostic methods, such as urine and feces, do not have any features characteristic of botulism. Given the pronounced metabolic disorders, the control of the acid-base state in dynamics is shown. In the differential diagnosis with neuroinfections, research on the cerebrospinal fluid is not important when the clinical picture is not clear and the results of the unconvincing results of the pH of the toxin are inconclusive (it is not changed in botulism).
Material for bacteriological examination feces and emetic masses of the patient, washings of the stomach and intestines, the contents of wounds (in case of wound botulism), suspected food. Since it is difficult to diagnose botulism in an adult patient right away, toxin is detected in the test material.
The study is carried out on white mice. They are intraperitoneally injected with a liquid obtained after centrifuging the patient’s serum mixed with anti-tululin serum types A, B, E.
The study takes 4 days. During this time, mice that are not protected by the type of antitoxin that caused the disease in a patient die. Mice that were injected with serum corresponding to the type of toxin circulating in the patient's blood remain alive.
Serological studies are not carried out, since the disease is not accompanied by the production of pronounced antibody titers, which is associated with a small dose of toxin that caused the damage.
Diagnosis Criteria Edit
In the early days of the disease to determine the diagnosis is very difficult. The diagnosis helps the presence of the following factors:
Despite the well-defined clinical picture, a sufficiently large number of errors are allowed, due to the fact that the disease is relatively rare, and doctors are not familiar with it.
The initial symptoms of the disease (gastroenteritis, gastritis, enteritis, symptoms of general intoxication) are very similar to the initial stage of salmonellosis and food-grade gastroenteritis of staphylococcal etiology. But, unlike botulism, salmonellosis is characterized by a pronounced febrile reaction, watery, offensive feces with an admixture of greenish mucus.
Food toxicoinfection of staphylococcal etiology is most often associated with the consumption of poor-quality confectionery products and is characterized by a short incubation period, the predominance of gastritis symptoms in the absence of severity of enteric manifestations. Severe botulism is characterized by the clinical picture of acute respiratory failure, while the severity of food toxicoinfections is caused by both water and salt losses, and general intoxication syndrome.
A differential diagnosis between botulism and encephalitis is also carried out. Unlike botulism, encephalitis begins with prodromal symptoms in the form of malaise and headache, fever is observed. The oculomotor disorders are caused by the damage most often to the nuclei of the third pair of cranial nerves and are usually partial.
The clinical picture of botulism is sometimes characterized by a combination of symptoms similar to polyencephalitis. Pathognomonic sign of polyencephalitis is considered the initial drowsiness, passing into soporous state. Often there is eye paralysis, cerebellar ataxia, dysarthria, intentional trembling, and conduction disorders. Retrobulbar neuritis is considered an early symptom. Stem phenomena can be combined with cranial nerve polyneuritis — lesions of pairs V, VII, VIII and IX, especially in encephalopathy.
Patient Treatment Algorithm Edit
The algorithm of intensive care of patients with botulism includes:
- gastric lavage to remove toxin residues from the stomach,
- intestinal dialysis (5% soda solution),
- anti-toxic serum (type A, C, E to 10 000 ME, type B 5 000 ME),
- parenteral administration of infusion media for the purpose of detoxification, correction of water-electrolyte and protein disorders,
- antibiotic therapy
- hyperbaric oxygenation as a means of eliminating hypoxia,
- treatment of complications.
General treatment Edit
Treatment of botulism consists of two directions. The first is to prevent the realization of the hypothetical possibility of the formation of a toxin. in vivo, removal of poison from the body to neutralize toxin circulating in the blood. The second is the elimination of pathological changes caused by botulinum toxin, including secondary ones.
All patients and persons with suspected botulism are subject to mandatory hospitalization. Regardless of its timing, treatment begins with washing the stomach and intestines with 2% sodium bicarbonate solution (soda) and siphon enemas with 5% sodium bicarbonate solution of up to 10 liters to remove toxin that has not yet been absorbed. Gastric lavage should be carried out in the first 1-2 days of illness, when there may still be contaminated food in the stomach. Carry out washing with a probe to avoid possible aspiration of wash water, in small portions of the liquid, especially in the presence of respiratory failure, so as not to cause a reflex stop breathing.
Glucocorticoids are used as a pulse therapy to prevent allergic reactions to the administration of heterogeneous antitoxic serums. Also, glucocorticoids are used in the treatment of serum sickness.
Also in the treatment of botulism using antibiotic therapy. It is prescribed for the prevention and treatment of inflammatory processes caused by botulism pathogen that has entered the intestines, as well as to prevent frequent complications (pneumonia, cystitis). If swallowing is not impaired, then chloramphenicol is prescribed at 0.5 grams 4 times a day for 5 days or ampicillin 0.75–1 grams per day. The course of treatment is about a week, but if the need for antibiotic therapy arises again, then you should not take those antibiotics that the patient received in the first days of the disease. It should be noted that the appointment of antibiotics can lead to intestinal dysbiosis with all its complications. The therapeutic role of antibiotics in wound botulism is not clear. According to M. Merson (1973), local, oral and intramuscular administration of antibiotics did not prevent the disease in any of the 9 cases described by the author.
Antitoxic Serum Edit
Antitoxic serums are obtained by immunizing horses with increasing doses of toxoids. Calcium chloride, potassium alum, Freund-type adjuvants and tapioca are widely used in the production of anti-toxic serums. Antitoxic sera are released with a specific content of antitoxins, measured in international units (IU), adopted by WHO. For 1 IU, that is the minimum amount of serum that is able to neutralize a certain dose of toxin. The action of the sera is reduced to the neutralization of toxins produced by the pathogen. Titration of antitoxic serums can be carried out by three methods - Ehrlich, Remer, Ramon. The therapeutic effect of serum is the formation of a non-toxic toxin-antibody complex with direct contact between botulinum toxin freely circulating in the patient’s blood and serum antibodies.
Antitoxic Serum Treatment Edit
For the prevention and treatment of botulism, anti-botulinum treatment-and-prophylactic anti-toxic serums are used, produced as a set of monovalent or polyvalent sera. Serum is used after the mandatory determination of the patient's sensitivity to equine protein using an intracutaneous test. In the event of a positive reaction, the serum is administered according to absolute indications under the supervision of a physician with special precautions. Sick and all persons who consumed the product that caused the poisoning, prescribe anti-toxic polyvalent serum.
Active immunization is carried out with purified sorbed pentaanatoxin, which provides protection against botulinum toxins of types A, B, C, D, E, and sextanathoxin. The drugs are intended for immunization of a limited contingent of the population. One treatment dose for type A, C, E antitoxins is 10,000 IU, type B is 5,000 IU each.
In the mild form - on the first day - two doses, the next day one dose, each of the three types of serum A, B, C. In total, the course of treatment is 2-3 doses. Serum is administered intravenously or intramuscularly after prior desensitization (the method Often). With the introduction of serum intravenously, it is necessary to mix it with 250 ml of saline, warmed to 37 ° C.
In case of moderate form, on the first day, 4 doses of each type of serum are administered intramuscularly with an interval of 12 hours, later according to indications. The course of treatment is 10 doses.
In severe form - on the first day, 6 doses, on the second - 4-5 doses. The course of treatment is 12-15 doses. Enter intramuscularly with an interval of 6-8 hours.
Be sure to test for sensitivity to a foreign protein, since the antitoxic serum is heterogeneous. If the test is positive, then a preliminary desensitization is carried out (in the presence of a doctor), then the necessary dose of serum is administered under the cover of corticosteroids. Serum complications can occur, the most dangerous of which is anaphylactic shock. A serum sickness may develop in the second week of the disease. There is an alternative to antitoxic serum - native homologous plasma (injected 250 ml 1-2 times a day).
Prevention of food botulism is hampered by the widespread distribution of botulinum in nature and its resistance to adverse environmental conditions. The main preventive measures against infection is the creation of conditions that prevent the growth and reproduction of bacterial spores and prevent the ingress of the pathogen in food. The latter include measures to maintain cleanliness in places where food products are prepared, constituting a favorable place for the development of the causative agent of the disease.
Home canning products in hermetically sealed containers are the most dangerous to humans, since at home to achieve complete destruction Clostr>.
Prevention of wound botulism is reduced to the primary surgical treatment of wounds.
With the early introduction of antibotulinic serum, the prognosis is favorable. Without the use of modern methods of treatment mortality can be 30-60%. Death usually occurs from paralysis of the respiratory muscles and subsequent hypoxia (respiratory failure). Timely treatment of the disease reduces the percentage of mortality of the outcome to 10%, and in specialized centers - up to 3-4%. In the absence of the ability to perform artificial respiration, 65% of the patients die. The recovery period lasts for several months and ends in complete recovery.
Botulism suffer from many species of animals and birds. Under natural conditions, botulism outbreaks among animals of certain species are caused by certain types of toxins. In horses, botulism is most often caused by group B toxin, less commonly A and C toxins. Cattle botulism is caused by types D and C toxins. Sheep, like fur animals (mink), are also susceptible to type C toxin.
What foods cause botulism?
Mushrooms, fish, cucumbers - these familiar products for every person, used in any family, seem to be completely harmless. However, in the fermented, salted, pickled form, they are the ones that can become a source of a dangerous disease that can be fatal - botulism. Anyone who is not able to give up appetizing homemade preparations, you need to learn the rules for their safe preparation and use.
Botulism in canned food
Fans of homemade canned food is best to review their food addictions. Only in an industrial environment can you cope with botulism disputes. This is achieved by autoclaving at 125 ° C. Ordinary boiling allows you to fight only with the vegetative form of infection.
Fish, vegetables, meat, mushroom canned food - a potential threat to health:
Spores of botulism can originate in canned meat if it takes a long time between the slaughter and processing. Poor washing of meat and improper smoking also pose a threat.
70% of cases of botulism account for fungi. This is due to the complexity of the full cleaning of the product from the particles of the earth, long-term storage after collection.
Smoked and dried fish cause whole family outbreaks of infection. The reason can be a variety of factors: violation of storage conditions, preparation of spoiled, non-cooled product.
Beets, carrots, cucumbers and other vegetables, poorly cleared from the soil, are also able to become a source of infection.
Botulism in mushrooms
Rarely there are people who negatively relate to such a universal and tasty product as mushrooms. They serve as the basis for salads and soups, fried with potatoes, dried, pickled, salted. Unfortunately, not only poisonous mushrooms are dangerous to humans. Avid mushroom pickers are at risk, botulism threatens them first.
Compliance with simple rules will help reduce the risk.
Collecting mushrooms, you should avoid the old and overgrown, because this product belongs to the category of perishable.
It is forbidden to keep mushrooms for a long time, especially not to keep them warm.
The soil in which the mushrooms grow is one of the main factors of botulism infection. In order not to allow them to become carriers, one should not pull up the product with the mycelium, but carefully cut it off. The most polluted area will remain in the ground.
Thorough cleaning is another effective prophylactic. Before cooking the mushrooms, regardless of the method, you should carefully clean them from the blades of grass, sticky leaves, dirt, rinse repeatedly.
Botulism in pickled mushrooms
Fried and boiled mushrooms are not as dangerous to human health as pickled. Many doctors advise people to completely give up this source of botulism. Reducing the risk helps the correct technology blanks.
Regardless of whether mushrooms are pickled, boiled or salted, it is strictly forbidden to roll up cans. The right decision - plastic caps that provide the flow of oxygen into the tank. Bacillus botulism is distributed in hermetically sealed vessels, the absence of air is the ideal environment for them.
There is a mistaken belief that botulism disputes are destroyed by sterilizing cans. However, for the death of bacilli, the temperature must rise above 125 ° C. To achieve a similar result in the absence of a professional autoclave is difficult.
The fact that you can not buy pickled mushrooms from strangers in the markets, remember almost everything. But cases when a person fell ill with botulism, having tried them on a visit to friends or relatives, are quite frequent. Only self-cooking can reduce the risk.
It is not recommended to self-dry, to smoke fish at home, in the intestine may contain botulinum spores.
Botulism in cucumbers
Among the vegetables, cucumbers gained fame as one of the most frequent sources of botulism. First of all, it concerns homemade cucumber blanks that can lead a person to a hospital bed.
To prevent this from happening, you must either discard them or adhere to the basic rules of preparation:
It is necessary to carefully study the cucumbers intended for canning. It is recommended to get rid of products on which there are signs of rot and spoilage immediately.
Washing cucumbers should be repeated, cleaned vegetables in running water. Boiling does not help to completely protect yourself against infection, but will reduce the risk. It is necessary to boil not only vegetables, but also the dishes used for blanks.
Hermetically sealed containers created at home are the shortest way to botulism. For the preparation of pickles is best to give preference to plastic caps.
The right places for storing pickles - cellars, refrigerators. Keep your homework warm.
Before use, banks should be carefully inspected. The slightest sign of bloating is a reason for rejection.
Open cucumber cans can not be kept in the refrigerator for a long time. If the product is not eaten within a few days, it is best to discard it. Normal color, smell and taste do not prove the safety of pickles.
Botulism in fish
In Russia, botulism has gained fame thanks to fish. In pre-revolutionary times, this disease was blamed mostly on red salted fish, eaten after cold-smoked or raw. Also the source of infection was salmon, herring, smoked and salted bream, nelma.
Modern studies have confirmed that sturgeon is the most dangerous in relation to botulism, representatives of this species are distinguished by a lack of sensitivity to toxin. Particle fish - bulls, bream, herring, omul can also be a carrier. Fish continues to be dangerous these days, but the risk associated with the inclusion of fish dishes in the menu can be reduced.
Studies of cases of botulism, the source of which served as a fish, allowed to establish that the greatest danger is posed by products that have been stored for a long time without refrigeration before an ambassador.
High-quality cooling is necessary if the fish after smoking and preserving salt is placed on the table without prior heat treatment.
“Symptoms” of putrefaction of fish decomposition, even subtle, are considered by doctors to be the reason for throwing it out. Smoking and salting a stale product does not eliminate the likelihood of the presence of botulinum toxin.
When salting fish, the salt content in the solution should be at least 16%. In this solution, the product must remain at least a week. Recommended cooling temperature is up to 7 ° C.
Dried, salted, smoked fish should not be purchased from unknown persons, in unofficial places. Even if food created in artisanal conditions looks attractive, there is no guarantee that it is not contaminated.
The sad statistic says that the disease botulism in almost 60% of cases leads to the death of the victim. Therefore, despite the rarity of the infection, it is worth reconsidering your attitude towards your favorite household items.
Education: in 2008, received a diploma in “General Medicine” (Therapeutic and Prophylactic) ”in the Russian Research Medical University named after NI Pirogov. Immediately passed internship and received a diploma of therapist.
Brief about botulism
Botulism is an infectious disease that occurs when botulinum toxin, the strongest biological poison, enters the body.
Toxic substances are produced by Clostridium botulinum, microorganisms that are widely distributed in the environment.
Clostridia can be found in the soil, decaying plants and animals. Microorganisms form persistent spores, which until a certain point are not dangerous to humans. To produce a toxic substance by bacteria, the following conditions must be met.
Conditions for toxin release:
- Lack of air.
- Ambient temperature within 26-32 degrees.
- A certain level of acidity.
If one of the conditions is not met, the spores cannot go into a vegetative form and begin to produce dangerous poison. Botulism spores do not die when frozen, surface cleaning with cleaning agents, boiling for less than 4 hours, under the influence of ultraviolet rays. Despite the wide prevalence of Clostridium botulinum in nature, botulism is rarely diagnosed.
Products that cause botulism
Few people think, but the customary for our table canned food, homemade preparations, meat and fish can be dangerous to health. Improper preparation and storage of food provokes a strong food poisoning that can harm the body. To protect yourself and loved ones from intoxication, you need to know what products most often cause botulism.
Botulism in meat
Poorly roasted meat, black pudding and other home-cooked foods often cause intoxication of the body. Canned meat in the production packaging is safer for humans than homemade.
In the process of making meat stews, spores of microorganisms die because of the high temperatures that cannot be achieved at home. Open canned food should be stored in the refrigerator no more than a day.
Botulism in pickled cucumbers
In the second place after mushroom poisoning, there is intoxication with pickled cucumbers. In canned cucumbers an optimal environment is created for the vital activity of clostridia producing a dangerous poison.
Violation of canning technology can cause serious illness.
- Harvest vegetables for the winter, collected in their backyard.
- In the process of growing to cover the soil under the plants with a special coating.
- Do not roll in the banks of rotten and dirty cucumbers.
- Glass containers and lids must be sterilized.
- Ready preservation is stored in a cool place for no more than a year.
- Banks with raised lids and muddy brine should be disposed of.
The most frequent cause of spoilage of pickled cucumbers becomes poor quality raw materials.
What foods can still cause intoxication? Jam, vegetable salads, fruit jams, that is, everything that rolls into an airtight container without complying with the norms and rules of canning.
Ways to prevent botulism
It is quite possible to avoid botulinum toxin poisoning, it is enough to take precautions when canning vegetables and fruits at home.
- Carefully select products for home-made, the fruit of suspicion, it is better to throw away.
- Do not eat canned mushrooms and vegetables with a cloudy brine and a bloated lid.
- On the bank it is desirable to write the date of manufacture of the product.
- Before you start canning your hands and the working surface of the table must be thoroughly washed, sterilized jars.
- Do not buy in the markets home-made "hand".
- The cans with fish and meat canned food must contain the date of manufacture, information about the manufacturer and the composition of the product. (canned food poisoning)
Consequences of botulism
Late treatment of botulism can cause a number of complications.
- Botulinum toxin blocks the central nervous system impulses and causes paralysis.
- Dysfunction of the visual organs: a split in the eyes, the appearance of fog and flies before the eyes, squint.
- Violation of the motor system: the patient's body becomes sluggish, it is difficult for him to keep his head upright.
- The appearance of problems with respiratory and swallowing function: the victim can hardly swallow food, breathing becomes shallow and frequent.
- Gastroenteric syndrome: nausea, vomiting, diarrhea.
Time provided first aid and further treatment in the hospital under the supervision of doctors will help to avoid the serious consequences of intoxication.
To protect yourself and your family from botulism, you need to know what products cause botulinum toxin poisoning, how to properly preserve and store homemade preparations.
Botulism can be infected in several ways.
The most common cause of botulism are various canned food, and it does not matter whether they are vegetable or meat. Botulinum toxin can develop in absolutely all places where there is little or no air. True, not all canned food is dangerous. Microbe lives only in those banks that have been poorly thermally treated. It is also interesting that botulism from home canned food can be more often than industrial.
Botulism can be infected through an open wound on the body. The microbes inside the wound produce botulinum toxin, which enters the bloodstream and causes a toxic disease. That is why wounds are good to handle.
You can talk about botulism of small children, especially babies who eat mother's milk. The fact is that a botulism stick can enter the child’s body through milk. A woman could become infected through the food she eats. When a microbe along with milk enters the intestines of a baby, it begins to actively produce a toxin.
Botulism hides in many favorite foods.
In order to develop botuloxin, it takes time. Also necessary is a room without oxygen. That is why conservation is an ideal place for the development of this toxin. In order for botulinum to not develop, canned food cans should be processed at a temperature not lower than 120 ° C. Because of this, home canned food is most often subjected to "capture" by botuloxin.
It is also dangerous that botulism outwardly does not manifest itself. It does not give any smell, the color does not change, so you should be very careful and do not use suspicious products.
Most often botulism is found in canned mushrooms. It is very difficult to wash the mushrooms well, in order to clean them from all kinds of germs. And botuloxin, just, lives in the soil. Of course, this toxin is afraid of an acidic environment, but it is rare to find very sour pickles. But, if, after all, you want to eat mushrooms, then open cans should be boiled for about 30 minutes, then the botulinum toxin will collapse due to high temperatures.
Much has been said about botulism in fish. Especially the toxin is often found in poorly processed foods, and this can be smoked fish or lightly salted. And, of course, the fish that are stored in bad conditions under disturbed temperature conditions fall into the risk group.
Botulism can be infected even through jam, but there is salvation. Making it necessary to add as much sugar as possible and not to save on it. In high concentrations of sugar, botulinum toxin does not develop and you can safely eat your favorite jam.
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