The Botulism is a crippling disease that begins in the cranial nerves and extends posteriorly to reach the lower and upper limbs. It is produced by Clostridium Botulinum, by protein neurotoxin manufactured by this microorganism.
Causes of botulism
Clostridium Botulinum is a Gram + anaerobic bacillus found in the soil and marine environment around the world, producing the most potent bacterial toxin known.
The disease is produced by the effects of neurotoxin, which penetrates the vascular system and is transported to cholinergic peripheral nerve endings and has a non-paralyzing lethal activity.
The disease can be produced by several mechanisms:
1st. Ingestion of preformed toxin in food contaminated by Clostridium Botulinum . Food-borne botulism has been observed in home canning, especially vegetables (green beans, peppers, asparagus, etc.); fruits, condiments, meat and fish. Commercial products cause epidemic outbreaks. In epidemics originating in restaurants, schools, etc., different types of food have been implicated (beef stews, packaged cakes, baked potatoes, etc.).
Food poisoning is the most common mechanism of infection. In Spain there are 3-10 episodes a year, with 10-50 affected.
Food botulism occurs in several ways:
- A food has become contaminated with spores.
- Preservation does not inactivate spores, but kills other spore bacteria that can inhibit the production of Clostridium Botulinum and also provide the ideal environment for germination and production of the toxin.
- By not heating food to a temperature that destroys the toxin before ingesting it.
- It is necessary that several days have elapsed from the manufacture of the food to its consumption (at least eight days), and that the food has not been heated prior to ingestion, since the toxin is destroyed at 80ºC.
2nd. By toxin produced in wounds contaminated by Clostridium: wound botulism .
3rd. By ingestion of spores and toxin production in the infant’s intestine: infant botulism .
4th. By ingestion of spores and toxin production in the adult intestine: infantile botulism of the adult .
5th. By indeterminate mechanism .
After the ingestion of food contaminated with the toxin, the disease starts from a mild form that does not need medical attention, to a severe condition that can be fatal within 24 hours.
The incubation period is 18-36 hours, depending on the amount of toxin ingested. Symmetric descending paralysis begins , which can lead to respiratory failure and death.
- They begin with cranial nerve palsy with diplopia, dysarthria with or without dysphagia, motor weakness from the head affecting the neck, thorax, arms, and legs.
- It is accompanied by nausea, vomiting, abdominal pain , before or after paralysis; there may be fainting, blurred vision, dry mouth , and dry throat.
- The patient remains conscious and oriented, and may be drowsy, agitated or anxious.
- There is no fever .
- Eyelid ptosis appears , and diminished pupillary reflexes , with fixed and dilated pupils.
- It is common paralytic ileus , constipation intense and urinary retention.
It appears in wounds contaminated by spores of Clostridium Botulinum. The spores can germinate and give vegetative forms of the microorganism that produces the toxin. It is seen in traumatic wounds contaminated with soil, in chronic parenteral drug addicts , and after cesarean delivery. When there is fever, there is usually a simultaneous infection by bacteria.
It’s the most frequent form. The toxin is made and absorbed in the intestine after germination of ingested spores. The intensity varies from mild forms to fulminants with paralysis and respiratory failure.
Contaminated honey and corn syrup are a source of spores, so these foods are not recommended for children under twelve months.
The most frequent cases appear in children under six months.
Susceptibility decreases as normal intestinal flora develops . The picture is highly variable, from constipation to the “sudden death” syndrome.
The most common is the so-called “floppy infant” syndrome with decreased sucking, weak crying, lethargy, and loss of ability to maintain head posture. There may be respiratory symptoms and generalized muscle weakness.
Infantile adult botulism
The toxin is produced in the intestine in people colonized by the germ. Toxins and microorganisms can be found in the stool for long periods of time; spores may be found in the suspect food, but not the toxin.
The previous pathology of the digestive system or previous surgeries at that level, can predispose to the disorder.
How is it diagnosed?
It should be suspected in patients without fever and in good mental state who present symmetric descending paralysis, without sensory manifestations.
The identification of the toxin in the serum by bioassay in mice is conclusive; but this test can be negative in infant botulism and in wound botulism; it is only performed in specialized laboratories. The demonstration of the toxin or microorganism in vomiting, gastric secretion, or stool is highly suspicious, as is the finding of the microorganism in wound cultures.
Nerve conduction velocity is normal, but action potentials are decreased in the electromyogram, and facilitation is observed after repetitive stimuli.
It is necessary to make a differential diagnosis with other diseases such as Guillén-Barré Syndrome (ascending paralysis plus sensory alterations and increased proteins in the cerebrospinal fluid), poliomyelitis , tick paralysis, acute abdomen, pharyngitis , ACVA, mushroom poisoning, medications or chemical products.
In food-borne cases, horse antitoxin is given as soon as possible; laboratory confirmation is not necessary; purgatives and enemas should be given to remove the toxin from the intestine; vomiting and gastric lavage are only useful if ingestion was recent (hours before).
In infant botulism only maintenance treatment is carried out.
In botulism of wounds, horse antitoxin and antibiotics, such as penicillin, are administered; the wound is also checked and debrided.
How can I avoid it?
To prevent the onset of the disease, it is important to attend to the risk factors; for this it is recommended:
- Washing of vegetables and fruits before their ingestion
- Caution with home preserves, heating the preserves at 110ºC for 35 minutes, in a pressure cooker; prevent toxin production by salting, acidifying, or adding sodium nitrite
- Special attention to canning jars (dents, opening, expiration date …).
- Gentle cleaning of wounds and other dermal erosions
- Avoid the intake of honey in children under one year
A primary care physician should be consulted when there is suspicion of consumption of canned food in poor condition, or when there are wounds with a contaminated appearance along with the appearance of any of the aforementioned symptoms (nausea, vomiting or the onset of paralysis).
Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.