Botulism

Botulism is a poisoning due to Clostridium botulinum toxin, which affects the peripheral nerves. Botulism may occur without infection when toxin is ingested, injected or inhaled. The symptoms are symmetrical cranial nerve palsies accompanied by a symmetric descending weakness and flaccid paralysis without sensory deficits. The diagnosis is made clinically and by detecting the toxin. Treatment is supportive and with antitoxin.

C. botulinum is one of several types of clostridia that cause human disease. Botulism is a rare, life-threatening condition that occurs when Botullinumtoxine spread via the bloodstream and affect the release of acetylcholine at peripheral nerve endings. Botulism is a medical emergency, and sometimes an emergency public health.

Botulism is a poisoning due to Clostridium botulinum toxin, which affects the peripheral nerves. Botulism may occur without infection when toxin is ingested, injected or inhaled. The symptoms are symmetrical cranial nerve palsies accompanied by a symmetric descending weakness and flaccid paralysis without sensory deficits. The diagnosis is made clinically and by detecting the toxin. Treatment is supportive and with antitoxin. C. botulinum is one of several types of clostridia that cause human disease. Botulism is a rare, life-threatening condition that occurs when Botullinumtoxine spread via the bloodstream and affect the release of acetylcholine at peripheral nerve endings. Botulism is a medical emergency, and sometimes an emergency public health. C. botulinum forms 8 types antigenically distinct neurotoxins (types A to H). Five of the toxins (types A, B, E and rarely F and H) are transmitted to humans. The types A and B are highly toxic proteins that resist destruction by gastrointestinal enzymes. About 50% of food-borne outbreaks in the United States are caused by type A toxin, followed by the types B and E. Type A toxin is mainly west of the Mississippi, type B in the eastern states and type E in Alaska and the the great lakes region before (type e is commonly associated with the consumption of fish) type H is the most powerful known toxin. Botulism can occur if a neurotoxin in vivo by C. botulinum elaborated or if it is acquired. (Rare) wound botulism infant botulism (the common form) adult enteric botulism in wound botulism is neurotoxin spread in infected tissue: In-vivo propagation causes the following forms. In infant botulism and enteric botulism in adults, spores are added, and neurotoxin is elaborated in the GI tract. Adult enteric botulism occurs usually only in adults with reduced resistance. Acquisition of preformed neurotoxin causes the following forms: Food-related botulism iatrogenic botulism botulism through inhalation In foodborne botulism is neurotoxin that is produced in contaminated food eaten. In iatrogenic botulism type A toxin is used therapeutically injected to reduce strong muscle activity; rare botulism has occurred even after the cosmetic injections. Botulism toxins are by inhalation either randomly or – if they are used as a biological weapon – intentionally aerosolized; aerosolized toxins do not occur in nature. C. botulinum spores are highly heat-resistant and can survive several hours of cooking at 100 ° C. Exposure to moist heat at 120 ° C for 30 minutes, kills the spores, however. The toxins formed are in contrast, easily destroyed by heat, and cooking food at 80 ° C for 30 minutes provides effective protection is against botulism. A toxin production (especially type E) can occur even at temperatures as low as 3 ° C (eg. example, within a refrigerator) and requires no strict anaerobic conditions. Tips and risks C. botulinum can produce toxins at temperatures as low as 3 ° C, so that when foods are contaminated, storing them in the refrigerator does not protect. Toxin Sources The most common sources of ingested toxins are homemade preserves, particularly foods with a low acidity (z. B. pH> 4.5), commercially prepared food but the outbreaks were associated with about 10%. The most common carriers are vegetables (but usually no tomatoes), fish, fruits and spices, but also beef, dairy products, pork, poultry and other food were involved. The outbreaks caused by seafood, type E was involved in about 50% of cases, types A and B in the remaining 50%. In recent years, non-preserved foods (such. As cooked baked potatoes, chopped garlic in oil, sandwiches) were identified as the cause of outbreaks associated restaurant. Sometimes the toxin is absorbed through the eyes or an opening in the skin and can cause a serious disease in such cases. C. botulinum spores are ubiquitous in the environment; most cases of infant botulism caused by ingesting spores. Spores can penetrate into the body when drugs are injected with unsterilised needles; can cause wound botulism. Injections of contaminated heroin in a muscle or under the skin ( “skin popping”) is most risky; they can cause gas gangrene. When botulinum toxin enters the bloodstream, botulism results, regardless of how the toxins. Symptoms and complaints General botulism symptoms and complaints include dry mouth blurred or double vision drooping eyelids Slurred speech dysphagia The pupil light reflex is diminished or completely lost. Dysphagia can lead to aspiration pneumonia. These neurological symptoms are characteristically bilateral and symmetrical, starting with the cranial nerves, followed by a descending weakness or paralysis. Sensory deficits do not occur, and the sensorium usually remains clear. The respiratory muscles, the muscles of the limbs and trunk are progressively weakened in a descending pattern of involvement. Fever is absent and the pulse remains normal or slow, while in the meantime do not develop infections. After the appearance of neurological impairment often leads to constipation. Among the important complications include respiratory failure due to diaphragmatic paralysis lung and other nosocomial infections Foodborne botulism food-related botulism begins abruptly, usually 18 to 36 hours after toxin ingestion, but the incubation period can vary from 4 hours to 8 days. Often go to neurological symptoms as nausea, vomiting, abdominal cramps and diarrhea voraus.Wundbotulismus Neurological symptoms similar to food-induced botulism, but there will be no gastrointestinal symptoms or signs that would indicate a contribution of food. The tentative diagnosis can (especially if caused due to an injection of illegal drugs) through case history on a place in the previous two weeks traumatic injury or a deep puncture wound near fall. It should be carefully looked for skin injuries and skin abscesses caused by self-injection of illegal drugs. Diagnosis toxin assays Sometimes electromyography Botulism may be confused with Guillain-Barre syndrome, poliomyelitis, stroke, myasthenia gravis, tick-induced paralysis and poisoning by curare or belladonna alkaloids. In electromyography characteristic enhanced responses to rapid repetitive stimulation are visible in most cases. In food-induced botulism, the pattern of neuromuscular disorders and the ingestion of a likely serving as a source of food are important diagnostic clues. The simultaneous presentation of at least two patients who have eaten the same food, simplifies the clinical diagnosis, through the detection of C. botulinum toxin is confirmed from the chair or stool in the serum or by the cultural isolation of the pathogen. The detection of C. botulinum in suspect food samples identified the source. In botulism the diagnosis by the detection of toxin is confirmed in serum or the cultural isolation of C. botulinum in anaerobic cultures of wound swabs. Toxin assays are carried out by certain laboratories that may belong to the local health authorities, or the “Centers for Disease Control and Prevention (CDC).” Therapy Supportive treatment heptavalent antitoxin from Horse Any person known or suspected has an exposure to contaminated food, must be carefully observed. The administration of activated charcoal can be helpful. Patients with significant symptoms often have impaired airway reflexes – if charcoal is used, this should be given by gavage, and the respiratory tract should be protected through a tracheal tube with inflated cuff. The greatest threat to life is respiratory insufficiency and the resulting complications, patients should be hospitalized and closely monitored by serial measurements of vital capacity. By a progressive paralysis symptoms of respiratory failure can be obscured due to falling vital capacity. A respiratory failure requiring intensive care due to a possibly required intubation and mechanical ventilation. Through these improvements in supportive care the mortality rate could be reduced to <10%. Nasogastric intubation is the preferred method of nutrition because they Simplifies management of calories and fluids stimulates peristalsis (the C. botulinum from the gut eliminated) Allows the use of human milk in infants Avoids the potential infectious and vascular complications iv a Alimentation are connected. Patients with wound botulism wound cleansing and administration of parenteral antibiotics such as penicillin or metronidazole are required. Antitoxin A new heptavalent antitoxin horses (A to G) is now available in the US, it replaces the older trivalent antitoxin. Antitoxin not inactivated already at neuromuscular junctions bound toxin; Therefore, pre-existing neurological impairment can not be reversed quickly. (The final recovery depends on the regeneration of nerve endings from, can last for weeks or months.) Nevertheless, further progress can be slowed or stopped by antitoxin. Patients with wound botulism antitoxin can reduce complications and mortality. The administration of antitoxin should be done as quickly as possible and are not delayed pending receipt of culture results after the commencement of clinical diagnosis. The probability of a positive effect of an antitoxin administration decreases when it is given to> 72 hours after onset of symptoms. A 20 – or 50-ml vial of heptavalent antitoxin, diluted 1:10, administered as a slow infusion adults; Dose and infusion rate are adjusted for infants and children. All patients who need the antitoxin, the state health authority must be notified, which then requests the antitoxin from CDC. This is the only way. Users can not receive directly from the CDC antitoxin. Since the antitoxin is derived from horse, there is a risk for anaphylactic reactions or serum sickness. (For precautions, drug hypersensitivity; for treatment, anaphylaxis: therapy) prevention As can even cause tiny amounts of C. botulinum toxin to a serious illness, any potentially toxin-containing material requires special handling precautions. Toxoids are available for active immunization for people who work with C. botulinum or its toxins. Details on the to be observed during sample collection and handling measures can be obtained from the competent “State Health Department” or the CDC, in Germany the Robert Koch and the Paul Ehrlich Institute. Importantly, homemade preserves are properly potted and heated before serving. Having preserved the signs of spoilage, and canning with distended cover (camber) or leaking containers should be discarded. Conclusion botulism can by recording lebensmittelübertragbarem toxin by toxin release of a – caused by absorption and enteric colonization of C. botulinum spores – in infants. Botulism can be caused by human-induced botulism toxin which is injected for therapeutic or cosmetic reasons or inhaled (in an aerosolized form). Botulinum toxins block the release of acetylcholine at peripheral nerve endings and leading to bilateral, symmetrical descending weakness, starting with the cranial nerves. Feeling and consciousness are not affected. Cooking destroys the botulinum toxin, but not the spores. To diagnose toxin assays should be used. From the horse-derived antitoxin, which are available from the CDC about the “state Department of Health,” should be given.

Health Life Media Team

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