botulism

Botulism: description

Botulism is a life-threatening poisoning. It is caused by the highly toxic botulinum toxin – a metabolite of the bacterium Clostridium botulinum. The bacteria multiply especially in a protein-rich environment under exclusion of air, for example in canned food. The name botulism derives from the Latin word for sausage, namely “botulus”. Colloquially botulism is also called meat poisoning.

Botulinum toxin is one of the strongest toxins found in nature and causes severe nerve disorders that can lead to death. However, most people are familiar with it under the name of Botox from the beauty industry, where its nerve crippling properties are used to smooth wrinkles.

Clostridium botulinum spores occur, inter alia, in land and seabeds, especially areas of the Baltic Sea are contaminated with the pathogens.

Main source: contaminated food

Most cases of botulism are due to the consumption of spoiled food. People become infected by inadequately sterilized and airtight packaged foods such as canned food, mason jars or airtight packaged smoked meat, sausages and fish-based foods.

Wound and infant botulism

Rarely, the bacteria multiply in wounds (wound botulism) or in the intestine of babies (infant botulism), whose intestinal flora has not been fully developed. In the latter case, the children usually take the bacteria with honey. Therefore children under the age of one should not receive any honey.

Chronic botulism

Chronic botulism is the name of an enigmatic, creeping disease that occurs primarily in cattle farming. The animals suffer from indigestion, paralysis and leanness. Many animals die too. The suspicion of many farmers and veterinarians: The animals had creeping poisoned with botulinum toxin. Origin could, for example, be fermentation residues from biogas plants that enter the animal feed. The germs could then settle in the colon of ruminants and multiply.

Even the farmers themselves, some fear, can fall ill. Dairy products of the diseased animals may also pose a risk. Officially recognized or scientifically proven the clinical picture and the underlying hypothesis are not yet.

Frequency of botulism

Botulism is relatively rare in Central Europe and the United States today. There are fewer than ten cases of botulism poisoning in Germany every year, experts estimate. Cause today are mainly self-canned food. The actual number may be higher – although botulism is notifiable, not all cases are recognized as such.

Botulism: symptoms

The symptoms of a botulism infection are very characteristic. The poisoning usually begins with nausea and vomiting, also abdominal cramps and diarrhea are possible. As the poison damages the function of the nerve cells, it gradually leads to paralysis of the body. First and foremost, the muscles in the head and neck (swallowing and speech disorders) are affected.

Later, the paralysis may spread to the whole body, including the respiratory muscles and extremities (flaccid paralysis of the arms and legs). In addition, the following phenomena occur in botulism:

• Seeing double pictures
• Ptosis (one or both upper eyelids hang down)
• wide pupils as well as no or attenuated pupil reflex
• dry mouth
• first diarrhea, then persistent constipation

Botulism: causes and risk factors

The cause of botulism is the toxin Botulismustoxin, which is produced by the bacterium Clostridium botulinum. The poison inhibits the signal transmission between nerves and muscles. The result is paralysis.

An infection in humans is almost always due to food poisoning. In meat or fish preserves that are produced under unhygienic conditions, the botulism clostridia thrive particularly well. But even in oil pickled vegetables, the bacteria can multiply. They are extremely resistant to heat, frost and dehydration.

The botulism toxin itself can be inactivated by cooking at 100 ° C for 15 minutes. Heat-resistant, however, are the spores of the bacteria, which multiply again after opening the preserve and can also form poison again at a later stage.

Infants can become infected with botulism by eating honey. The poison is absorbed by the intestine and passes through the blood into the nerve cells (infant botulism).

A botulism infection from person to person is not possible.

Botulism: examinations and diagnosis

The diagnosis of botulism relies on the typical symptoms as well as the details of the patient or his relatives. It is important to know whether canned, preserved products have been consumed and whether similar symptoms have occurred in the family or in the immediate vicinity.

If botulism is suspected, the doctor will examine possible leftovers, stool, blood and possibly stomach contents (vomit) for botulinum toxin (botulinum toxin). But until the result is there, one or two days pass. Therefore, if there is sufficient suspicion, the doctor immediately starts therapy – even before the test result is available. Because measures, such as the administration of an antidote, help only very limited time.

The transmission disturbance of nerve impulses triggered by the botulism poison can be determined by electrophysiological methods.

If there is a suspicion of wound botulism, the doctor cultivates the pathogens from wound cultures (sample material from the wound).

Botulism: treatment

Patients who are suspected of having botulism need immediate medical care. The therapy consists mainly of the administration of an antidote (antitoxin, botulism antiserum). It neutralizes circulating poison in the blood, but not that already bound to nerve structures.

Since most of the toxin is bound around 24 hours after receiving the botulinum toxin, the antitoxin must be administered as early as possible, otherwise it will be ineffective. In order to avoid severe allergic reactions to the antidote, the doctor first tests the effect by a small injection of antitoxin into the skin.

If the food poisoning is not long back, the doctor may try to remove the botulism poison from the gastrointestinal tract so that it is not absorbed by the body. This is possible through a gastric lavage, enemas and laxatives.

If the respiratory muscles are paralyzed by botulism, the patient must be artificially ventilated.

In wound botulism, the wound is surgically cleaned. Subsequently, the patient receives antibiotics to avoid additional wound infections. However, they are ineffective against botulism.

Botulism: prevention

Botulism is usually the result of eating spoiled, vacuum-packed food. Food botulism can therefore be prevented with the following measures:

• Do not open or eat any bulging cans.
• Note the expiration date.
• If you store vacuum-packed food below 8 ° C, then no germs can multiply in it.
• In case of doubt, heat food to 100 ° C for 15 minutes – heat destroys the botulinum poison.
• Do not give honey to children under the age of one. Honey may contain spores of the bacterium Clostridium botulinum and thus be the cause of botulism (infant botulism).

Botulism: disease course and prognosis

The incubation period in food botulism – ie the time between contagion on the appearance of the first symptoms – is usually after ingestion of the poison between 12 and 36 hours. The shorter the incubation period, the more serious the poisoning – and consequently the mortality rate is correspondingly higher. In some cases, the incubation period is extended to up to eight days.

In wound botulism, the incubation period is about ten days.

Infant botulism can also take days to experience the first signs of intoxication: constipation, muscle weakness, loss of appetite, vomiting, and apathy. Then paralysis of the cranial nerves (drooping eyelids, eye muscle paralysis, dysphagia, paralysis of the facial muscles) and a loss of reflexes are noticeable.

Botulism is a serious, life-threatening disease that can lead to death due to respiratory paralysis and cardiac arrest. Becomes botulism However, if treated in a timely manner, the prognosis is relatively good. Under intensive care therapy, the mortality rate for food botulism is less than ten percent – untreated up to 70 percent.