The botulism is a neurological disease caused by bacterial toxins Clostridium botulinum.
Despite the fact that the bacterium is distributed worldwide, the disease occurs in sporadic outbreaks. Although it is not such a common disease, it is estimated that there are at least a thousand cases a year in the world.
The Botulism is a disease characterized by very rapid unaprogresión, worsening its course with each passing day, so it should be treated in time.
However, there are patients who present an acute stage and later, their symptoms stabilize over time. The severe presentation of botulism is due to neurological symptoms, since the bacterial toxin affects all the nerves of the body.
Symptoms such as blurred vision and double vision (diplopia) due to involvement of the nerves of the extra-ocular muscles that control the movements necessary to fix the gaze. On the other hand, symptoms such as drooping of the eyelids (called palpebral ptosis), dry mouth in conjunction with a sore throat, dilation of the pupils, altered reflexes and cranial nerve involvement are common.
The neurological symptoms are the most severe in botulism, since there may be paralysis of the cranial nerves and of the nerves that go to all the muscles causing a flaccid descending muscle paralysis, even affecting the respiratory muscles, which leads to the patient present respiratory failure and in some cases, it may be life-threatening.
Including nausea, vomiting and abdominal pain, due to retention of food from the stomach that does not empty properly. Some patients complain of difficulty swallowing, which is known by the medical term dysphagia. Due to the paralysis of some autonomic nerves, intestinal obstruction can occur due to the lack of motility of the intestine; In addition, you can see distension of the bladder causing urinary retention and with it, urinary infections.
Such as malaise, dizziness secondary to low blood pressure, headache and general weakness.
It is important to mention that 9 out of 10 patients present gastrointestinal symptoms (nausea and vomiting) together with double vision and dry mouth. Therefore, a patient with these symptoms should be ruled out botulism in the first hours of consultation in the emergency area, without waiting for the other symptoms to develop.
Causes of botulism
The disease is caused by contact with toxins from the bacterium Clostridium botulinum.
The Clostridium botulinum is a gram - positive bacillus that produces spores and toxins that can cause illness in humans. The bacteria are generally found in contaminated soil and water and reproduce rapidly in spoiled food. When the toxin comes into contact with the body, it enters the circulation and travels towards the neuromuscular junction, causing nerve paralysis.
At present, six ways of contagion of botulism are known (Centers for Disease Control and Prevention):
1. Botulism food: caused by the consumption of food and beverages contaminated by bacteria. They have been described in foods such as fruits, garlic, peppers, potatoes and red meat, among others.
2. Botulism wound or botulism deep: caused by the penetration of bacteria into the body through a wound. In fact, cases have been described in patients using intravenous drugs and after performing cesarean sections.
3. Infant botulism: when the child ingests the spores (and not the preformed toxin) of the bacteria and they reproduce in their intestines. This presentation is common in young infants (less than 1 year old) and the main food related to this entity is honey, although it is believed that other foods can also harbor spores. When this happens in adults it is known as adult intestinal toxemia.
4. Botulism unnoticed: effect that occurs as botulinum toxin adversodel use used as therapeutic treatment.
5. Inhaled botulism: described in cases of bioterrorism.
6. Indeterminate botulism: the mechanism of transmission of the bacteria is not specified.
Of all these, infant and food botulism are the most frequent forms.
How is botulism treated?
Treatment should be started as soon as possible in order to avoid the rapid progression of the disease. Heptavalent botulinum antitoxin, which comes from horse plasma, has been approved to treat cases of botulism in patients older than 1 year of age.
Other schemes approve the use of immunoglobulins for its treatment and thus avoid neurological progression.
The use of antibiotics such as penicillin, chloramphenicol and clindamycin is also indicated in the case of deep or wound botulism. In addition, the associated complications should be treated. If there is paralysis of the respiratory muscles, mechanical ventilation and tracheostomy may be indicated, in addition to physical therapy and muscle rehabilitation.
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