In this article we will talk about : Botulism causes, symptoms and treatment.
The botulism is a neurological disease caused by a bacterium called Clostridium botulinum. This bacteria produces the botulinum neurotoxin which, in humans who ingested or inhaled it (through the respiratory tract), can be responsible for paralysis by blocking neuromuscular transmission (between nerves and muscles).
Four kinds of botulism
There are four kinds of botulism depending on the mode of contamination:
- food botulism;
- Botulism by injury or inoculation is often encountered in drug addicts who use intravenous drugs or sniff;
- infant botulism mainly concerns infants under 6 months of age;
Botulism is a rare but potentially fatal diseasethat’s why we must manage it as quickly as possible.
Bacterium, Clostridium and botulinum cause the botulism. This bacteria produces the botulinum neurotoxin.
Different botulinum toxins exist. In humans, toxins of type A, B or E are generally involved.
The bacterium is present mainly in the soil, marine sediments and the digestive tract of many animal species. It survives in the form of very resistant spores.
Depending on the form of botulism, the causes are different:
- the consumption of food containing spores of bacteria causes food botulism. We are talking about food poisoning. It generally occurs after the ingestion of products that we put in glass jars without great care (during the manufacture of artisanal preserves or even in restaurants or industries that do not respect the production and conservation chains);
- botulism by injury or inoculation is caused by contamination of a wound with spores of C. botulinum;
- infant botulismis due to the consumption of spores of bacteria (sometimes present in sugary products like honey or corn syrup) which will then develop in the intestines and produce the toxin;
- the botulinum toxin causes bioterrorism which is one of the biological agents which can be used during malicious and terrorist acts.
Whatever the mode of contamination, botulism manifests itself after a relatively short incubation period (period between contamination and the first signs). This duration depends on the type and amount of toxin ingested. It is generally between 12 and 72 hours, but can range from 2 hours to 10 days.
This diseasecan start in two forms:
- a brutal form: digestive disorders (nausea, vomiting, abdominal pain and diarrhea);
- a progressive form marked by visual disturbances.
Neurological symptoms of botulism
Then settle the neurological manifestations:
- ocular: mydriasis (dilation of the pupils) bilateral with paralysis of accommodation (modification of the curvature of the lens allowing a clear image on the retina) and double view (diplopia);
- motor: in the form of bilateral and symmetrical paralysis progressively reaching the muscles of the face, limbs, breathing. The risk is the occurrence of sudden respiratory failure which can lead to death;
- in connection with a drying up of secretions: dryness of the mouth and eyes (xerophthalmia), sluggishness (lack of tone) of the esophagus from where difficulties in swallowing food (dysphagia), severe constipation or even occlusion, difficulties in urinating (dysuria) which may go as far as retaining urine;
- orthostatic arterial hypotension (drop in blood pressure occurring when standing up), heart rhythm disturbances.
In no case is there fever or damage to the central nervous system (brain).
From the first symptoms, a rapid hospitalization is imperative because of the three major risks:
- respiratory failure;
- heart rhythm disorders;
- and those of swallowing.
The prevention of botulism is mainly based on food hygiene, and in particular on the parameters of food preservation. It is important to be vigilant when consuming products that we store in jars and not to eat food without knowing the place and conditions of manufacture.
Respect for the cold chain is also an important point (refrigeration slows the development of the clostridium botulinum bacteria ).
It is necessary to disinfect wounds well and treat them as best as possible until they heal.
Specialist do not recommend the introduction of sweet products containing honey or corn syrup into your baby’s bottles (toddlers).
There is an anti-botulinum vaccine, but only exposed people can sue it (laboratory workers, for example).
In order to confirm the diagnosis of botulism , after the precise questioning of the patient (about diet, possible injuries, symptoms experienced, etc.) and the clinical examination, the doctor may have recourse to various additional examinations:
- a electromyogram;
- tests allowing the detection of the toxin or the bacteria itself in the blood, vomiting, stool and / or contaminating food.
The management of botulism is necessarily hospital.
The treatment of botulism is especially symptomatic, that is to say, it aims to eliminate the manifestations of the disease. It combines:
- maintaining hydration because of dry syndrome (drying up of body secretions) thanks to aerosols, foggers, artificial tears;
- parenteral (by intravenous infusion) or enteral (using a gastric tube that goes from the mouth to the stomach) nutrition, in case of dysphagia (difficulty in feeding);
- artificial ventilation in the event of respiratory damage;
- sometimes, the installation of a urinary catheter (in case of retention of urine) and digestive enemas (in case of constipation).
Etiological treatment of botulism
Specialist have disscussed the subject of the etiological treatment (that is to say to attack the cause of the disease, therefore the bacteria): serotherapy (injection of antibodies) is possibly only effective in severe forms if it is put in place in the first 24 hours.
In case of infant botulism, we can use antibiotics.
The vast majority of patients with adequate care recover without sequelae, but the duration of treatment and recovery can be long.
For information, We use botulinum toxin frequently and widely to treat certain motor dysfunctions (focal dystonia, spasticity, etc.). It also has applications in cosmetology.
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