What are the complications of botulism?
Botulism is a severe infectious disease that occurs with damage to the nervous system, oculomotor system and general intoxication.
Symptoms of the disease are very diverse and are due to dysfunction of the spinal and medulla. As recovery progresses, all signs of infection disappear without a trace, while the developed complications of botulism force doctors to take emergency measures for the subsequent treatment of the patient.
Complications of botulism can be divided into groups according to the pathogenetic principle - complications from the poisoning itself and those resulting from the addition of a secondary infection.
It is an inflammation of the pulmonary tissue caused by a sudden ingress of a large amount of saliva or vomit into the lungs through the bronchi of a foreign body. In botulism, the mechanism of its development is determined by the paralysis of the motor muscles (intercostal muscles, diaphragm, auxiliary muscles of the shoulder girdle) and the violation of the act of swallowing. This type of pneumonia is extremely dangerous, since the effect of the pathological agent on the lungs goes in three directions:
- mechanical obturation;
- chemical exposure (for example, hydrochloric acid);
- and bacterial contamination.
Aspiration pneumonia may begin acutely due to vomiting or eating (choking) and is characterized by the following symptoms:
- acute onset, dry barking cough;
- shortness of breath, forced position of the patient;
- palpitations and fear, anxiety, increased pressure;
- cyanosis (blue coloring of the skin occurs when the large bronchus obturation).
1-3 days after the acute phase of aspiration, bacterial inflammation of the lung begins. The body temperature, purulent sputum, severe wet cough, chest pain, sometimes, the appearance of pink frothy sputum or hemoptysis increases. In the next 24 hours, purulent bronchitis and atelectasis can join (a decrease in the area of lung tissue).
Aspiration pneumonia is treated with broad-spectrum antibiotics, bronchodilators and expectorant, vascular drugs and antihistamines. In severe cases, resorted to washing the bronchial tree, the constant aspiration of sputum and artificial ventilation of the lungs (if indicated).
Acute Purulent Mumps
A common symptom of botulism is hypo-salivation (reduction of salivation). Permanent dry mouth, lack of moistening of the oral mucosa leads to the growth of pathogenic microorganisms - staphylococci and streptococci, which, in turn, cause ascending infection of the parotid gland. 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, sharp pain when pressed. Two days later, thick pus is secreted from the salivary gland canal.
In any purulent process in the parotid salivary gland, surgical treatment is indicated: opening, drainage, washing, sanitization of the oral cavity. Intramuscularly prescribed antibiotics.
Bladder and kidney infections
Such a complication does not develop as often and is associated primarily with the atony of the bladder during botulism, urinary retention. As a result, an ascending infection develops, signs of cystitis appear: pain in the lower abdomen, soreness and discomfort during urination, fever, clouding of urine.
Diagnosis helps the analysis of urine, sometimes ultrasound of the bladder.
Therapeutic measures consist of a course of antibacterial and anti-inflammatory therapy.
Complications caused by the introduction of anti-tumoral serum
Antitoxic antibotulinic serum consists of horse protein. Before its use, a test of the body's reaction to foreign protein is carried out, since serum can cause a number of complications.
The most dangerous complication from the introduction of antibotulinic serum is anaphylactic shock, or anaphylaxis - an acute allergic reaction of the body, which in 10% -20% of cases ends in death.
A sharp decrease in blood pressure and tachycardia can be signs of anaphylactic shock and require emergency anti-shock therapy. The development of a severe allergic reaction - anaphylaxis, requires the introduction of hormones, plasma, cardiotonic and other means.
This is an allergic reaction resulting from the introduction of an alien protein - an antigen. In this case, immunoglobulins of horse blood plasma - serum components against botulism act as antigens. A similar reaction develops in almost one third of patients. The resulting immune complexes damage the vascular endothelium and determine the clinical picture.
Signs of General Serum Disease
- rash, erythema (urticaria), itching;
- headache and pain in the lumbar region;
- the appearance of protein in the urine and edema;
- joint damage (arthritis);
- laryngeal edema and bronchospasm.
Local serum sickness: redness, itching and burning, swelling, tissue necrosis at the site of serum injection.
The symptoms of serum sickness go away on their own and do not require special treatment. Sometimes antihistamines and heart medications are used to alleviate the condition.
Acute ventilation failure and myocarditis
It is a sharp decrease or inhibition of bronchial-pulmonary respiration with the development of hypoxic lesions of organs and tissues. The reason is paralysis of the respiratory muscles due to botulism poisoning. Botulinum toxin damages spinal cord motoneurons and leads to movement disorders in all muscle groups. Particularly affected diaphragm and intercostal muscles.
Signs of ventilation failure may develop gradually or appear acutely with an attack of shortness of breath (up to 40 breaths per minute), tachycardia, asphyxiation, cyanosis. Patients take forced posture in bed, gasp their mouths, intercostal spaces are drawn in, anxiety and fear are observed. At this stage, without waiting for the deterioration, it is necessary to transfer the patient to artificial ventilation (ventilator) in reanimation.
Acute ventilation failure is the most common cause of death in botulism. Myocarditis and sudden cardiac arrest may also be the cause of death, but such complications develop extremely rarely, mainly in severe botulism with severe intoxication or in an advanced form.
How to prevent the emergence of botulism
Measures to prevent the entry of botulinum toxin into the body consist of several points:
- thorough heat treatment of products;
- compliance with the storage conditions of canned food, fish and meat (cold stores);
- 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, since the toxin and its spores are stable in the environment. Nevertheless, following the above rules will allow several times to reduce the likelihood of infection with botulism.