Botulism have very rare cases, but the disease is relatively severe and extremely urgent, as evidenced by the high number of deaths caused by this disease, about 50-70% Botulism is an intoxication, as well as tetanus. It is caused by the Botulinum Clostridium. Paralysis is a serious disease caused by the poison (toxin) which attacks the nerves that are produced by bacteria Clostridium Botulinum.
Clostridium botulinum multiply by forming spores and toxin production. The toxin can be destroyed by high temperatures because it was botulism is very rarely found in the environment or people who have a habit to cook or boil until it cooked. There are three main types of botulism
- Foodborne botulism. Caused by foods that contain the botulism toxin.
- Wound Botulism. Caused by toxins from wounds infected by Clostridium Botulinum.
- Infant Botulism. Caused by the spores of the botulinum bacteria who develops in the intestines and release toxin.
All forms of botulism can be fatal and is a state of emergency. Foodborne botulism is a type of botulism that may be the most dangerous disease because many people can be infected by eating contaminated food. Early diagnosis and preventive measures are needed to avoid botulism infection, lack of knowledge of botulism will lead to the increasing incidence of this disease. Treatment and intensive care are needed for patients with botulism in order to survive. The following botulism symptoms in order to diagnose early:
Symptoms of botulism for early detection
Symptoms of batulism in early stages is very important to know. In USA, reported about 110 cases of Botulism occured each year. And about 25% of its foodborne botulism, 72% of infant botulism, and the rest are wound botulism.
Foodborne botulism is usually due to eating canned food. Wound botulism increased due to the use of heroin, especially in California. There are three main symptoms of all botulism as follows:
- Disorders of muscle in the morning
Abnormalities ranging from eyelid muscles, the muscles of mastication parese soft palate / arch faringeus / uvula / muscles of the pharynx and tongue (early stage). In advanced stages of the neck muscles can be affected so that the head should be enforced by hand. Then followed the limb and intercostal muscles.
Typical symptoms are morning the patient feels there is no interference, the disorder during the start of the half-closed eyelids (ptosis) and the body feels weak. Talk began hoarsely, difficulty swallowing, a complaint when it is old.
- The emergence anamnesis
Before paralysis arises are the typical anamnesis ie upper respiratory tract infection. Between the time of infection until the onset of paralysis is symptoms of the disease-free period ranges from a few days up to 3- 4 weeks. Paralysis occurs in all four limbs, generally starts in the distal part of the leg and then spread to proximal to the arms, neck and face . In the early stages of micturition and defecation disorders can be a hallmark of the disease. This paralysis is flaccid and bilaterally symmetrical. When infected dorsal root there paraesthesia in the area of the lesion, often in the hands and feet (gloves and stockings).
- The occurrence of dissociation cytoalbuminigue
Examination of cerebrospinal fluid contained high levels of the protein is 1000mg/100ml (normal 15-45mg/ml), while the number of cells (lymphocytes and mononuclear cells) are usually in a state of normal 0-3/mm³ and does not exceed 5/mm³. This situation is known as dissociation cytoalbuminigue that are characteristic of the syndrome. Respiratory acidosis occurs when the respiratory muscles are affected. An emergency that can lead to coma and even lead to death.
Symptoms of Botulism by its type
In addition to three main symptoms above, each type of botulism have different signs, the following signs is as follows:
Symptoms of Foodborne Botulism
Foodborne Botulism is caused by the foods that contain the Botulism toxin. Symptoms begin to appear a few hours to a few days (2-8 days) after ingestion of contaminated food. Generally, it is occur within 12-72 hours after eating, the first sign is sometimes gastrointestinal symptoms such as nausea, vomiting, diarrhea and abdominal cramping. Foodborne botulism following symptoms:
- People who attacked by foodborne botulism, initially showed gastrointestinal symptoms such as nausea, vomiting, abdominal cramps, dry mouth and diarrhea.
- Symptoms of nerve. Early neurological symptoms usually, attacking the nerves of the head such as blurred vision, eyelid fall, photophobia, and neurological dysfunctions such as joint stiffness, impaired speech and unable to swallow food.
- The symptoms of muscle weakness. Muscle weakness starting from the muscles that move the head, upper arm muscles, respiratory muscles and the muscles of the lower limbs latter. This weakness usually lasts symmetrically. Death usually results from respiratory failure. Clinical symptoms arising from inhalation of toxins through the respiratory tract (usually occurs in the laboratory) cause similar clinical symptoms in foodborne botulism.
- Botulismus paralysis can last for a long time. Mechanical ventilation may be needed for 2 to 8 weeks, and paralysis can last for 7 months. Body temperature is usually normal.
- Symptoms of foodborne botulism in animals. Botulismus clinical symptoms differ only slightly between that occurs in humans and animals. In cattle and horse will looks depressed, lazy to move and no appetite, can not swallow and feed falls from the mouth, and then seen their bloating, and vomiting. The disease does not show symptoms of fever, but there is flaccid paralysis, starting with weakness, muscle tremors and hard standing. How the animals lie also not normal. The weakness of the hind legs spread to the front legs, head and neck. The eyes can be seen close, dilated pupils.
Meanwhile, if foodborne botulism occurs in cattle, the signs are as follows:
- Once the toxins are eaten by cattle, clinical signs of the disease can occur within 24 hours to 7 days.
- The major signs in cattle is a muscle – the muscle becomes weak and wobbly. This weakness is caused by the toxin disruption of nerve impulses to the muscles. Usually weakness in hindlimbs comes first and continues to move toward the head.
- The animals infected with these bacteria will lie down with his head in the pelvis, similar to the symptoms of disease “milk fever”. His expression was different, namely the eyelids down, saliva and its ability to take the food to their mouths reduced. the tongue may hang out of the mouth due to a lack of muscle.
- aloe farm animals may be sticking out of the mouth because of weak muscles. the intestine is usually covered without activity rumen, bloat and hard, dry manure. The intestine is usually close without rumen activity, experiencing bloat and dry dirt. The range of signs varies greatly from case to case with acute death from 24 hours to moderate, general weakness that can last for weeks.
- The range of signs vary greatly from case to case with acute death within 24 hours, and can persist for several weeks.
Symptoms of Wound Botulism
Wound botulism often occurs as a result of injecting drugs. Most of those affected by drug injecting several times. In some cases, the area around the infected wounds become inflamed (red and swollen). The initial symptoms that would cause other symptoms of neurological symptoms such as:
- Vision problems; blurred vision, double vision and eyelid sagging
- Difficulty swallowing (dysphagia) and dry mouth
- Difficulty speaking (dysarthria), such as slurred
- Facial weakness, followed by paralysis gradually spread to the body, arms, chest and legs
- Difficulty in breathing and cause respiratory failure and even death
- Fever
Symptoms of Infant Botulism
Symptoms caused the Infant Botulism is caused by toxins that affect the nervous system, but a little different with foodborne and wound botulism. Symptoms of Infant botulism is constipated, but there are some other symptoms associated with neurological, such as:
- Voice weak
- Inability to suck, hard to eat
- Fatigue
- Easy to anger
- The eyelids droop
- The head, neck and limbs were not stiff
In about 90% of babies with infant botulism, constipation is the initial symptoms. Then muscles become paralyzed, starting on the face and head and rushed to the arms, legs and muscles associated with breathing. Drooping eyelids, weak cry, the baby can not suck, and they lose face expression. The range of issues to be weak and slow meal to lose muscle tone in large quantities and have difficulty breathing. When the baby loses muscle tone, they can feel lame, were abnormal.
Infant Botulism From the research, honey often as sources of contaminants, and therefore should not be given to infants under one year. In addition, when giving formula, note ordinances baby treatment before consumption. Among boil the milk bottle, closed immediately wrap the remaining milk and store it in a safe place and clean.
Diagnosis of Botulism
In order to resolve the problem as soon as possible and allegations of botulism, then enforcement early diagnosis is the best way to get the best treatment.
- Diagnosis of Foodborne botulism. In foodborne botulism, diagnosis is made based on the pattern that is typical of nerve and muscle disorders. The symptoms are often confused with other it, such as stroke. If botulism occurs in two or more people who eat the same food and at the same place, it will be easier to diagnose. To confirm the diagnosis, the blood test for the presence of toxins or stool sample cultures to grow the bacteria causing the infection. The toxin can also be identified in the suspect food.
- Diagnosis would Early diagnosis of wound botulism is based on patients with wounds infected by a new or a history of drug use. Sometimes the lesion is unclear. Diagnosis requires laboratory tests to detect BoNTs in serum and wound. Detection of injuries generally satisfactory for laboratory diagnosis. Analysis of feces and food may be useful. The differential diagnosis includes myasthenia gravis, Guillain-Barre syndrome, Lambert-Eaton syndrome, and foodborne.
- Diagnosis of infant botulism. To establish infant botulism, the doctor will perform a physical examination. This may indicate decreased muscle, missing or decreased gag reflex, missing or decreased deep tendon reflexes, and drooping eyelids. Fecal samples from babies may be inspected to check for botulinum toxin or bacteria. Then to complete the beliefs, your doctor may take Electromyography (EMG) to help differentiate between muscle and neurological problems.
Treatment of Botulism
Generally, Botulism should be hospitalized in a long time. To cope with botulism, the doctor will give primary treatment to prescribe an antibiotic, an antitoxin (a chemical antidote for poison), and with the support of the machine with the required ventilator to assist breathing. If antitoxin is given early in the disease course, it will prevent the ill effects of toxins, but has no effect on the symptoms that have been run. In addition to providing medical treatment, patients generally require physical therapy to overcome muscle strength recovery.
The following are the available treatment options that can be given to infants with infant botulism:
- The first treatment will include restoring the baby’s respiratory function. At this stage, the baby’s breathing should be monitored.
- Your doctor may give a drug known as ‘botulism immune globulin’. Children can also get an extra dose of antibiotics if other complications such as pneumonia.
- If necessary, the doctor will give botulinum antitoxin.
- As part of the precautions, the doctor may recommend avoiding honey and cornstarch in baby food intake.
Prevention of Botulism
- To foodborne botulism is usually caused by clostridium botulinum. Clostridium botulinum bacteria that causes botulism as highly resistant to heat. Even so, the poison quickly destroyed by the heat. Following ways can help prevent foodborne botulism: Before buying canned goods, note the shape of the container. Forms contaminated prominently bloated, relatively far different from the normal. Follow the procedures for treatment before eating preserved foods, especially canned or boiled until boiling for 10 minutes, calculated from the time when the boil. It would be much better if it is boiled in a pressure cooker. Likewise for other types of food preservation sealed.
- Preventing Botulism Sore. How to prevent botulism would do to avoid the wound from dirt, especially on the ground. Immediately provide antiseptic fluid. Did not close the wound tightly (airtight).
- Prevent Infant Botulism. From the research, honey often as sources of contaminants, and therefore should not be given to infants under one year. In addition, when giving formula, note ordinances baby treatment before consumption. Among boil the milk bottle, closed immediately wrap the remaining milk and store it in a safe place and clean.
The botulism patients can experience difficulty in breathing (advanced stage) because it requires breathing assistance apparatus or a ventilator for weeks (usually 4 weeks) or until the effects of toxins discharged, plus intensive care and treatment. After several weeks, the paralysis gradually emerged and became clear. If the diagnosis can be enforced early, foodborne and wound botulism can be treated with anti-toxin that can block the action of toxins in the bloodstream.
This can help make the patient’s condition did not get worse, but recovery still takes time for weeks. Enema or fishing may be required that the patient vomit removes foods that contain toxins that still exist in the gut. Wounds should be treated, usually with surgery, to remove the source of the botulism toxin production.