What are the complications of botulism?
Botulism is a serious infectious disease that occurs with the defeat of the nervous system, the oculomotor system and general intoxication.
Symptoms of the disease are very diverse and are caused by dysfunction of the spinal and medulla oblongata. As recovery, all signs of infection pass without a trace, but the developed complications of botulism force doctors to take emergency measures for the subsequent treatment of the patient.
The complications of botulism can be divided into groups according to the pathogenetic principle - complications from the poisoning itself and resulting from the attachment of a secondary infection.
It is an inflammation of a pulmonary tissue site caused by a sudden ingress of a large amount of saliva or vomit into the lungs through the bronchi of a foreign body. With botulism, the mechanism of its development is determined by paralysis of the motor muscles (intercostal muscles, diaphragm, accessory muscles of the shoulder girdle) and violation of the swallowing act. This type of pneumonia is extremely dangerous, since the pathological agent's influence on the lungs goes in three directions:
- mechanical obturation;
- chemical exposure (eg, hydrochloric acid);
- and bacterial contamination.
Aspiration pneumonia can start acutely due to vomiting or eating (poppers) and is characterized by the following symptoms:
- acute beginning, dry barking cough;
- shortness of breath, forced position of the patient;
- palpitation and a sense of fear, motor anxiety, increased pressure;
- cyanosis (blue coloration of the skin occurs when obturatsii large bronchus).
After 1-3 days after the acute phase of aspiration, bacterial inflammation of the lung begins. Increases body temperature, purulent sputum, a strong moist cough, pain in the chest, sometimes, perhaps, the appearance of pink frothy sputum or hemoptysis. In the next 24 hours, purulent bronchitis and atelectasis (a decrease in the area of the lung tissue) may join.
Treatment of aspiration pneumonia is carried out with antibiotics of a wide spectrum of action, bronchodilators and expectorants, vascular drugs and antihistamines. In severe cases resort to washing the bronchial tree, constant aspiration of sputum and artificial ventilation of the lungs (according to indications).
Acute purulent mumps
A common symptom in botulism is hyposalivation (decrease in saliva secretion). The constant dryness in the mouth, the lack of moistening of the oral mucosa leads to the growth of pathogenic microorganisms - staphylococci and streptococci, which, in turn, cause an ascending parotid infection. Acute parotitis is one of the frequent complications of botulism.
There is a fever, pain when chewing and swallowing, swelling and redness of the skin over the gland, a sharp pain when pressed. Two days later, a thick pus emerges from the canal of the salivary gland.
In any purulent process in the parotid salivary gland is shown surgical treatment: opening, draining, washing, sanitation of the oral cavity. Intramuscular antibiotics are prescribed.
Infections of the bladder and kidneys
This complication does not develop so often and is primarily due to atony of the bladder in botulism, a delay in urination. As a consequence, an upward infection develops, signs of cystitis appear: pain in the lower abdomen, resists and discomfort with urination, fever, and urine turbidity.
Diagnosis is helped by a study of urinalysis, sometimes ultrasound of the bladder.
Therapeutic measures consist of a course of antibacterial and anti-inflammatory therapy.
Complications caused by the introduction of anti-botulinum serum
Antitoxic anti-botulinum serum consists of horse protein. Before its application, a test of the body's reaction to a foreign protein is performed, since serum can cause a number of complications.
The most dangerous complication from the administration of anti-botulinum serum is anaphylactic shock, or anaphylaxis is an acute allergic reaction of the body, which in 10% -20% of cases ends lethal.
A sharp drop in blood pressure and tachycardia can be signs of anaphylactic shock and require urgent anti-shock therapy. The development of severe allergic reaction - anaphylaxis, requires the introduction of hormones, plasma, cardiotonic and other means.
This is an allergic reaction, which appeared as a result of the introduction into the body of a foreign protein - antigen. In this case, immunoglobulins of horse blood plasma are the antigen - serum components against botulism. A similar reaction develops in almost one third of patients. Emerging immune complexes damage the endothelium of blood vessels and determine the clinical picture.
Symptoms of total serum sickness
- rash, erythema (urticaria), itching;
- edema of Quincke;
- headache and pain in the lumbar region;
- the appearance of protein in the urine and edema;
- joint damage (arthritis);
- edema of the larynx and bronchospasm.
Local serum sickness: redness, itching and burning, edema, necrosis of tissues at the site of serum administration.
Symptoms of serum sickness pass independently and do not require special treatment. Sometimes, to ease the condition, antihistamines and cardiac drugs are used.
Acute ventilation failure and myocarditis
It is a sharp decrease or suppression of bronchial-pulmonary respiration with the development of hypoxic lesions of organs and tissues. The reason is the paralysis of the respiratory muscles due to poisoning by botulism. The Botulinum toxin damages the motor neurons of the spinal cord and leads to movement disorders in all muscle groups. Especially affects the diaphragm and intercostal muscles.
Signs of ventilation deficiency can develop gradually or appear acutely from an attack of shortness of breath (up to 40 breaths per minute), tachycardia, suffocation, cyanosis. Patients take a forced posture in bed, grasping the air with their mouths, intercostal spaces are drawn, anxiety and fear are observed. At this stage, without waiting for deterioration, you need to transfer the patient to artificial ventilation (ventilator) in intensive care.
Acute ventilation failure is the most common cause of death in botulism. Also, the cause of death may be myocarditis and sudden cardiac arrest, but such complications develop extremely rarely, mainly with severe current of botulism with severe intoxication or in neglected form.
How to prevent the emergence of botulism
Measures to prevent the ingestion of botulinum toxin into the body are made up of several points:
- careful heat treatment of products;
- compliance with the conditions of storage of canned food, fish and meat (cold rooms);
- control of the shelf life of the product;
- sanitary and hygienic cleanliness of the room in which food is prepared.
Prevention of botulism is a very difficult task, as the toxin and its spores are stable in the external environment. Nevertheless, following the above rules will reduce the probability of infection with botulism several times.