What is Botulism?

It is mainly transmitted through food and is more common in cured meats. Nervous food poisoning, bacon, pork, and poorly made canned foods. Some areas have been affected by eating tempeh, watercress, stinky tofu and stale fish, pork, and pork liver. ^[1]

Introduction to botulism

Botox is a toxic disease caused by botulinum exotoxin. The disease is divided into four types: food poisoning, infantile botulism, traumatic botulism, and adult infantile botulinum poisoning. The botulinum toxin produced by botulinum is a kind of exotoxin with neurological and cytotoxic properties. It can be divided into A, B, C, D, E, F, G7 types according to its antigen structure. Each strain can only produce a single type of toxin, of which the three types A, B and E are the main toxins that cause human disease, which is extremely toxic, and can be lethal by 0.01 mg orally. In addition to being absorbed from the gut, botulinum toxin can also be invaded through the respiratory tract, eye conjunctiva, and damaged skin. The route of transmission of infant botulinum toxin is unclear. It is reported that honey may be a transmission medium. Food poisoning type botulism is mainly caused by meat and canned food. There are also reports of illness caused by eating fermented steamed buns, noodle sauce or home-made stinky bean curd. , Followed by type A, if not treated in time, the mortality rate is higher (60% -70% for type A, 10% -30% for type B, and 30% -50% for type E)

Mechanism of botulism

Sources of infection: domestic animals, poultry and fish are the source of infection; transmission routes: mainly through food, more common in bacon, bacon, pork and poorly made canned foods. Fresh fish, pork, pig liver, and disease; Susceptibility: Generally susceptible, does not cause human-to-human transmission ^[1] .

Clinical manifestations of botulism

1. Dizziness and weakness throughout the body;

2. Blurred vision, diplopia, strabismus, poor radiated eyes, impaired eye movements, dilated pupils, disappeared light reflexes, drooping eyelids and other symptoms of eye muscles;

3. Difficulty in chewing, difficulty swallowing, difficulty in pronunciation, difficulty in raising head, difficulty in breathing, and paralysis of the limbs are progressive, symmetrical and descending.

Types of botulism food

1. Fermented soybean products: including stinky tofu, bean paste, stinky tofu, moldy tofu, tofu residue, pea paste, broad bean paste, red bean paste, mold bean, etc.

2. Fermented noodle products: including corn flour sauce, wheat bran sauce, sweet noodle sauce, rice souffle, soy sauce.

3 Animal food. Including bacon, stinky lamb, cooked mutton, bad pork, dead donkey, mutton, pork, rotten eggs, stinky fish, salted fish, bacon, dried beef, dried horse meat, roast beef.

4 other. Pickled river beans, rotten potatoes, mold corn, etc.

Its technological processes are as follows: (1) The food raw materials are still local products, and all of them have the possibility of being contaminated by Clostridium botulinum spores (especially virus-producing strains). (2) It is basically in an anaerobic fermentation state. (3) Place the fermented food at an ambient temperature between 25 and 35 ° C (placed next to the fire wall or on a bun) (4) After the bean paste is made, a small amount of salt, seasoning, etc. cannot change the properties of the bean paste ^{[1 ]} .

Preventive care for botulism

Strict management and inspection of food. Pay particular attention to the preparation and preservation of canned food, ham, and pickled food. If there is bulging at the two ends of a canned food or the content of the flavor changes, it should be prohibited from selling and consuming, even if it is boiled. Not suitable for consumption. Cereals and legumes may also be contaminated with botulinum. Therefore, it is prohibited to eat fermented or spoiled food. In case of botulinum poisoning in the same food, the rest of the staff should immediately give a multivalent refined botulinum antitoxic serum. For prevention, 1000 ~ 2000u subcutaneous injection, once a week, a total of 3 times, those who can eat canned food regularly may consider botulinum toxoid injection ^[1] .

Diagnosis and identification of botulism

Diagnose based on

1. Suspicious food (especially canned food) and the collective history of the same food eaters, the incubation period is the shortest 2 hours, the longest 14 days, and most of the 12-16 hours.

2. The clinical manifestations are mainly the symptoms of craniocerebral and spinal cord motor palsy, the gastrointestinal symptoms are not obvious, the consciousness is always clear, and the feeling is not affected.

3. Botox exotoxin can be detected in the sera and stools of patients during the onset period.

4. The botulinum bacteria of type A, B or E can be isolated from the stool of patients during the onset of disease.

Features of botulism

The extent of botulism is determined by the spread of food containing botulinum toxin. There are two types of botulism in our country: collective outbreaks, often in a canteen, where most employees and their family members share the same toxic food, resulting in poisoning by dozens or more. For example, in Qingdao City in 1960, 450 people ate together to eat steamed canned meat, which caused 75 people to be poisoned by botulism. This is also a rare case of botulism in China for thirty years. Family-on-a-house chain disease: Often a housewife makes fermented soy products or fermented noodles. Since fermented soy products are mostly a small amount of table food, the onset is sporadic, and the onset at different times is not as short as other food poisoning. Many people have the same type of clinical manifestations over time. Some housewives inadvertently gave away poisoned fermented soybean products to their neighbors, causing poisoning in their neighbors. Therefore, due to the spread of poisoned food, the spread of the incidence range accordingly. This onset feature is still the most common and common feature of botulism in China ^[1] .

Treatment of botulism

Principles of botulism treatment

1. Reduce toxin absorption.

2. Antibiotic treatment.

3. Promote the recovery of neuromuscular function.

4. Intravenous infusion, symptomatic supportive treatment.

The principle of botulism

1. The drug treatment for light cases is mainly based on the "A".

2. Nasal feeding and intensive supportive treatment should be given to patients who can not eat, which can include medication limits "A" and "C".

3. For those with pneumonia, it is advisable to choose effective antibiotics and highly effective new antibiotics according to the results of bacterial drug sensitivity tests.

4. Critical and complicated cases of heart failure and respiratory failure should be given reasonable and effective symptomatic medication and treatment, if necessary, artificial respirators can be used to assist breathing.