Treatment of botulism in humans. How does botulism manifest itself and what should be done? What is considered reliable diagnostic criteria

The first signs of botulism were noted in the 18th century in Germany, when six people died during a mass poisoning with black pudding.

Since then, the concept of "botulus" has entered the medical terminology - translated from Latin, sausage.

After 60 years, van Ermengem proved that the cause of intoxication was a bacterial toxin released by many foods.

Causes of botulism

The main cause of botulism is a toxin produced by Clostridium. Botulinum toxin is one of the strongest organic poisons that has no taste, color or smell. Clostridia surround us everywhere: the smallest spores are found in the ground, rotting plants, dead animals, but they themselves are not the cause of the disease.

Microorganisms stay in unfavorable conditions for decades, waiting for "their high point". From the soil, clostridia get on food, and when suitable conditions arise, they begin to become more active.

Microorganism resistance to external factors:

1. Clostridial spores can withstand boiling for more than 4 hours.
2. Microorganisms do not die under the influence of an acidic environment.
3. The causative agent of botulism poses no danger of freezing at low temperatures and exposure to ultraviolet rays.

Botulinum toxin is released only if optimal conditions for growth and reproduction are created for Clostridia.

Conditions of a favorable environment for the release of toxin:

• Complete absence of oxygen.
• High ambient temperature: 26 to 35 degrees Celsius.
• A certain acidity of the external environment.

Only when all these requirements are met, clostridia begin to produce a dangerous poison.

Causes of botulism:

1. The first place among the causes of poisoning is the consumption of pickled mushrooms. () The absence of vinegar in the jar, insufficient heat treatment of forest products causes the active vital activity of microorganisms that produce botulinum toxin.
2. Clostridia are also found on fruits and vegetables that grow close to the ground. In a jar of cucumbers and tomatoes, the spores get a favorable environment for reproduction in the form of lack of oxygen and low acidity.
3. Signs of botulism appear when eating fish and meat smoked in artisanal conditions.
4. The cause of the disease can be flower honey. The spores of microorganisms penetrate into the pollen of plants, which are collected by bees.
5. Contact with a fresh wound of dirty earth often causes botulism.

The most common form of the disease is foodborne botulism. Toxins enter the body along with spoiled food products: canned food, sausage, fish, homemade preparations in jars.

Botulism poisoning - symptoms

The incubation period of the disease depends on the amount of botulinum toxin that has entered the body. On average, a person feels the first signs of malaise 5-10 hours after eating a poor-quality product.

The onset of the disease in each case is individual: sometimes the symptoms are mild, and in other cases, the signs of botulism are acute.

Signs of severity of botulism:

• The mild form of the disease is characterized by a slight deterioration in vision, muscle lethargy, lowered upper eyelids. Signs of mild severity of the disease disappear on their own in 3-4 days.
• The average severity of botulism is manifested by a change in the timbre of the voice, difficulty swallowing. The duration of the disease does not exceed two weeks.
• A severe form of botulism is extremely dangerous for human health. There is a violation of the respiratory function, which can lead to death.

The following signs should arouse suspicion:

1. Dryness of the oral mucosa.
2. The division of objects.
3. The appearance of a veil before the eyes.

With mild severity, this symptomatology goes away on its own and the person recovers completely. However, in some cases, the signs of botulism worsen, and the victim urgently needs medical attention.

💡 Clinical signs of botulism:

In addition to the neurological signs of botulism, there is also a gastroenteritis syndrome.

Signs of infectious intoxication:

1. Severe pain in the abdominal cavity.
2. Vomiting no more than twice a day.
3. Loose stools do not exceed five times in one day.
4. In rare cases, the body temperature rises.

In the midst of the disease, the victim of botulism does not look the best: the eyelids are lowered, shortness of breath appears, the face resembles a motionless mask, speech is slurred. Self-medication with such signs often provokes serious complications, up to death.

Diagnosis and treatment of botulism

It is impossible to independently determine the signs of botulism, the diagnosis is made only on the basis of laboratory tests.

Diagnostic methods:

• Disease history.
• Laboratory study of feces, urine, vomit of the patient.
• Blood chemistry.

To determine the presence of botulinum toxin in the blood of the victim, white mice are injected with a small dose of the patient's blood and anti-botulinum serum.

If the rodent remains alive, then the serum has neutralized a certain type of toxic substance. However, in severe forms of the disease, doctors do not always wait for the results of the study and administer anti-botulinum serum to the victim.

Infection treatment

When the first signs of botulism appear, the patient should be hospitalized. Home treatment of intoxication by doctors is not provided. Medicinal serum is effective only in the first three days from the onset of the disease, so every minute counts for the patient.

Complex therapy for signs of botulism:

1. Gastric lavage. To free the stomach from food debris with botulinum toxin, a large amount of boiled water is injected through a special probe into the patient.
2. The main step in the treatment of signs of botulism is the introduction of medicinal serum. With mild and moderate severity, the drug is administered twice a day, with a severe course of the disease - every 8 hours. Before starting treatment with toxoid, the patient is tested for a possible allergic reaction to the drug. If the test is positive, the serum is administered together with antihistamines.
3. Symptomatic treatment: restoration of water and electrolyte balance, normalization of intestinal microflora, vitamin therapy, therapeutic diet.

The choice of method for treating botulism directly depends on the characteristic clinical signs of the disease.

What can be done before the doctor arrives

At the first signs of poisoning in adults and children, emergency assistance should be called. Prior to her arrival, the victim must be given first aid.

First aid steps:

• Rinse the patient's stomach. To do this, a person must drink a large amount of liquid and forcefully induce vomiting.
• Make a cleansing enema.
• Take any sorbent: activated carbon (at the rate of one tablet per 10 kg of weight), Smecta or Eterosgel.

Irritation, a feeling of sand in the eyes, redness are only minor inconveniences with impaired vision. Scientists have proven that vision loss in 92% of cases ends in blindness.

Crystal Eyes is the best remedy for restoring vision at any age.

The sooner the first aid is provided to the patient, the less toxins will enter the bloodstream.

Prevention and consequences

Prevention of signs of botulism consists in strict observance of the rules and safety standards when using canned products and semi-finished products from meat and fish.

Prevention measures:

• When picking mushrooms, cut off the stem as high as possible from the ground.
• When growing berries and vegetables on a personal plot, put a special film under low-stemming fruits.
• Do not pick fruits from fruit trees from the ground.
• Vegetables and fruits should be washed several times before canning.
• Vinegar is added directly to the jar before the lid is rolled up.
• Spoiled vegetables should not be preserved.
• Jars and lids must be sterilized before canning.
• The optimum storage temperature for preservation is 5-8 degrees Celsius.
• Jars with swollen lids are not recyclable and should be thrown away.
• Vegetables that do not have natural acidity (cucumbers, peas) require artificial addition of vinegar essence during canning.
• You can not buy homemade blanks in spontaneous markets and bazaars.

Effects

Untimely treatment of signs of botulism can cause serious complications for the body.

Types of complications:

1. From the respiratory tract: pneumonia, bronchitis.
2. Cardiac pathologies occur due to an insufficient amount of oxygen supplied with dysfunction of the respiratory system.
3. The addition of an additional bacterial infection greatly complicates the treatment of signs of botulism.

The most characteristic signs of botulism are a violation of the functioning of the organs of vision, the respiratory system, and motor function. A correct diagnosis and timely treatment will help a person to completely recover from the disease.

To avoid a dangerous disease will help the implementation of simple precautions when buying and eating canned foods, as well as smoked meat and fish.

Video: what are the first symptoms of botulism

Signs of botulism in humans indicate the presence of a dangerous disease. It is insidious in that contaminated products most often look quite benign, but at the same time they can become a source of severe pathology. Botulism without treatment is fatal. The initial symptoms of this disease resemble food poisoning. Often, patients begin to be treated with home remedies and seek medical help only when the pathology has already affected the nervous system.

The causative agent of the disease

Botulism is caused by Clostridia. This microorganism belongs to rod-shaped bacteria. Its body is equipped with special flagella, with the help of which Clostridia move.

These bacteria live inside the body of waterfowl, fish, and warm-blooded mammals. Animals are often asymptomatic carriers and are passed out with faeces. Once on the soil, bacteria turn into spores. In this state, microorganisms can persist for quite a long time.

Bacteria get into food from the soil. In the absence of oxygen, botulinum toxin is released. It is these conditions that are created in canned food, this product most often becomes a source of infection. Clostridia are anaerobic bacteria. This means that an oxygen-free environment at a temperature of +35 degrees is the most favorable for their life.

Botulinum toxin is one of the most powerful natural poisons. Even in the smallest doses, it is deadly to humans. This poison cannot be destroyed by the use of salt and spices in canning. Clostridia in the form of rod-shaped bacteria die during boiling for 5 minutes. However, it is very difficult to destroy this microorganism in the form of spores; this is possible only with autoclaving.

Ways of infection

There are several ways of infection with toxin and spores:

1. Fecal-oral. The pathogen enters the body by eating contaminated canned food.
2. Raneva. Spores penetrate from infected surfaces into the body through damaged skin.
3. Respiratory. Infection occurs by inhalation of spores.

With fecal-oral infection, botulinum toxin enters the body, and with wound and respiratory infection - spores. In the vast majority of cases, infection occurs through the use of canned food. Wound infection is quite rare. It is possible when soil with clostridia spores enters the bloodstream.

Very rare cases of infection through the respiratory system. You can become infected only by inhaling a large number of spores.

In this case, the patient does not pose a danger to others. It does not shed or spread Clostridium. This disease proceeds as intoxication with botulinum poison, which cannot be transmitted from person to person.

Botulism does not confer lasting immunity. A person can become infected with this disease again. To form an immune response, a toxin dose close to lethal is required. If such an amount of botulinum poison enters the body, then most often a fatal outcome occurs. For this reason, an effective vaccine against this disease has not yet been developed.

Disease pathogenesis

Botulinum toxin is a protein compound. It is the strongest nerve poison. Once in the body, it is not destroyed in the digestive tract under the action of hydrochloric acid and enzymes. In addition, a person can swallow with contaminated canned food not only the toxin itself, but also live clostridia, which will produce new portions of the poison in the body.

Botulinum toxin blocks the transmission of impulses from the central nervous system to the muscles. As a result, the muscles do not receive a signal to contract and relax. There is a sharp decrease in muscle tone, up to the complete cessation of their function. Pseudo-paralysis occurs. This condition should be distinguished from true paralysis, when anatomical changes occur in the central nervous system. Botulinum toxin causes only functional disorders, after treatment, muscle function is restored.

First of all, the muscles of the eyes, larynx and pharynx are affected. It becomes difficult for the patient to swallow, his vision is impaired, his voice becomes hoarse. Then the muscles of the ribs and diaphragm are involved in the pathological process, which leads to a violation of the breathing process. There is a severe oxygen deficiency in the body. Respiratory failure is one of the main causes of death in botulism.

In addition, the action of botulinum toxin adversely affects the state and function of blood cells - leukocytes and erythrocytes. Because of this, a person's resistance to infections is sharply reduced and the level of hemoglobin drops.

Signs of product contamination

In most cases, it is impossible to determine. This is the insidiousness of the disease. Infected canned food may look normal. It is impossible to detect the presence of clostridia by the appearance of the product. Infected preservation does not change color, taste and does not have an unpleasant odor.

However, there are signs of botulism in the can that may indicate contamination of the product. These include:

1. Bloating and other deformations of the lid (bombing). This does not always indicate the presence of Clostridium. Other anaerobic bacteria may also be the cause of the bombing. But such canned food should never be eaten. The likelihood of them being infected with botulinum toxin is very high. Sometimes people believe that boiling swollen canned food will help kill the infection. But this is an erroneous opinion. Heat treatment does not affect botulinum toxin.
2. Spontaneous opening of the jar due to the departure of the lid. This indicates increased gas formation and the presence of anaerobic bacteria.
3. Mold on the product. This is an indirect sign of botulism in conservation. Mold is formed due to the growth of fungal bacteria. In such a bank, favorable conditions are created for the life of Clostridia.
4. Expiration date. Eating expired canned food carries a high risk of infection with Clostridium.

It is important to remember that the absence of the above defects does not mean that there is no botulism in canned food. A contaminated product may appear benign. The toxin has no taste or smell.

Certain types of foods carry an increased risk of botulism. These include the following preserves:

1. home preservation. If the processing rules are violated, clostridia can get into the product. At home, the correct canning technology is not always observed. Spores get into the product when vegetables and fruits are not washed enough, as well as when jars are poorly sterilized. Infection can enter homemade preparations through hands contaminated with soil particles.
2. Canned mushrooms made at home. You can become infected with the use of any preservation: vegetable, fruit, berry. However, fungi are the most common cause of botulism. They grow in soil that may contain spores. It is sometimes difficult to qualitatively clean mushrooms from soil particles. As a result, clostridia enter the jar. Even heat treatment of the product before canning does not always destroy the spores. The use of vinegar also does not destroy the toxin. Therefore, the product should be processed in special autoclaves before harvesting. Frozen mushrooms are not dangerous, as the toxin is released only at high temperatures.
3. Homemade meat and fish canned food. Such a product requires professional processing. Homemade stew and canned fish are very common causes of botulism. The product is usually cooked in an oven and then rolled into a jar. Such heat treatment is not enough to destroy the spores. In the manufacture of canned meat and fish at home, it is necessary to use autoclaving.

It should be remembered that the release of botulinum toxin occurs only in hermetically sealed jars. Under such conditions, there is no oxygen, and the anaerobic environment is favorable for clostridia. If plastic and metal screw caps are used, botulism is unlikely to develop. In this case, the jar is not hermetically sealed, and anaerobic conditions are not created.

The first symptoms of the disease

The incubation period usually lasts from 2 to 12 hours after bacteria or spores enter the body. After that, there are signs of botulism in humans. More on this later. However, the duration of the latent period may be longer. It depends on the amount of botulinum toxin that has entered the body. Symptoms of the disease may appear after 2 - 3 days, and in isolated cases - after 9 - 12 days. With the wound method of infection, the incubation period is from 4 to 14 days. The sooner signs of botulism poisoning occur, the more severe the disease will be. A short incubation period indicates that a large amount of toxin has entered the body.

The first signs of botulism are similar to those of a gastrointestinal illness or food poisoning. They are associated with the effect of the toxin on the gastrointestinal mucosa. The following symptoms are noted:

• acute pain in the abdominal cavity, localized in the center of the abdomen;
• diarrhea (up to 3 - 10 times a day);
• repeated vomiting.

In addition, there may be: fever, malaise, headaches. The characteristic clinical signs of botulism have not yet been noted. In the initial period of the disease, only the gastrointestinal tract is affected. This goes on for about 24 hours. By the end of the first day of illness, the patient's temperature decreases. Diarrhea passes, severe constipation sets in due to intestinal atony. This indicates that botulinum toxin has already begun to affect the nervous system.

Typical signs of infection

The most characteristic clinical signs of botulism appear a day after the first gastrointestinal manifestations. First, the toxin affects the cranial innervation of the eye muscles. The following disorders of visual function develop:

• haze or feeling of a grid before the eyes;
• double vision;
• pupil dilation;
• deterioration in visual acuity;
• drooping of the upper eyelid (ptosis);
• strabismus;
• violations of the movements of the eyeballs (up to immobility).

At the same time, the toxin disrupts the innervation of the throat. There are characteristic signs of botulism from the oropharynx and larynx:

1. It becomes difficult for a person to swallow solid food first, and then liquid. When you try to drink water can pour out through the nasal passages.
2. There is discomfort and the constant presence of a lump in the throat.
3. The patient's voice changes timbre, nasality appears. Then there is hoarseness. In severe cases, the voice is completely lost.

If a person has such symptoms after eating canned food, then you should immediately call an ambulance. Before the arrival of the doctor, the patient needs to wash the stomach with a solution of soda and give an enterosorbent. Otherwise, the disease will progress and without treatment can lead to death.

In the future, the muscles of the ribs and abdominal muscles are involved in the pathological process. Because of this, respiratory function is impaired. The most characteristic signs of botulism at this stage of the disease are as follows:

• pain and tightness in the chest;
• difficulty breathing;
• feeling of lack of oxygen;
• frequent and shallow breathing movements.

Then the weakness of all skeletal muscles increases in a person. The patient has difficulty holding his head due to a violation of the transmission of impulses to the cervical muscles. The patient becomes inactive, his face looks masklike and pale. In addition, there is severe constipation with bloating, as well as urinary retention due to a decrease in smooth muscle tone.

Botulism in infants

The signs of botulism in adults and children older than 1 year were listed above. However, this pathology is also observed in infants. There is a term "baby botulism", this disease occurs only in infants up to 6 months. In this case, it is not the toxin that enters the body, but Clostridial spores.

A child can become infected through dirty hands. Also, various objects that the baby pulls into the mouth can become a source of infection. Spores enter the body and along with dust. There are known cases of infection through honey, which is used in the preparation of infant formula for artificial nutrition. Therefore, doctors do not recommend giving this product to babies under 1 year old.

In infants, the gastrointestinal period of the disease is absent. The following neurological signs of botulism occur in infants:

• loss of appetite;
• weak sucking of the mother's breast;
• difficulty swallowing;
• strong hoarse crying;
• persistent constipation;
• inability to hold the head due to weakness of the neck muscles.

If such symptoms are found in babies under 6 months old, you should immediately call a doctor. Botulism is extremely dangerous for babies and can lead to the death of a child.

Diagnosis and treatment

If clinical signs of botulism occur, the patient is admitted to the hospital. This disease cannot be cured at home. A blood test is taken from the patient to detect botulinum toxin. This must be done before starting treatment. Also carry out sowing of feces and vomit. In addition, canned food that the patient has eaten is also examined for the presence of botulinum poison.

If the patient has clear signs of botulism, then treatment is started without waiting for the results of the tests. The following therapies are used:

• the introduction of anti-botulinum serum along with corticosteroid hormones (effective in the first 3 days of illness);
• infusion therapy with detoxification solutions;
• antibiotic prophylaxis to prevent secondary infection;
• gastric lavage (in the early stages);
• resuscitation measures to support breathing.

Clostridial toxin poisoning is manifested by extremely severe symptoms. But in the process of treatment, all signs of botulism gradually disappear. After a course of therapy, the motor function of the muscles is restored completely. However, this takes quite a long time.

The patient is treated in the hospital for at least 3-4 weeks. Then the patient is under outpatient medical supervision for 14 days. The rehabilitation period after an illness takes from 3 to 6 months.

Complications and prognosis of the disease

With proper treatment, all body functions are restored. Botulism does not lead to subsequent disability. However, in the acute period of the disease, the following complications may occur:

• respiratory failure;
• pneumonia;
• purulent tracheitis and bronchitis;
• muscle inflammation (most often calf);
• inflammation of the parotid glands (very rare).

The prognosis of the disease depends on how timely the patient sought medical help. If a large amount of toxin has entered the body, and treatment was prescribed too late, then death occurs in 30-60% of cases. It is important to remember that it helps only in the first 3 days of illness. Therefore, it is necessary to consult a doctor at the initial signs of botulism. If the serum was administered on time, and the necessary treatment was carried out, then the lethality is reduced to 3-4%.

Prevention

The main measure of prevention is compliance with the rules of canning products. When preparing homemade preparations, it is necessary to rinse vegetables, fruits and berries well. It is also important to carefully sterilize the jars. Before canning, you need to wash your hands so that no soil particles remain on the skin.

At home, you should not make canned mushrooms with hermetically rolled lids. An oxygen-free environment is favorable for clostridia. It is better to cook salted mushrooms in a jar with a plastic lid, such preservation is not dangerous, or use an autoclave.

Very often, infection occurs when eating homemade canned meat and fish. In the manufacture of such a product, pre-autoclaving is necessary. No other heat treatment will help destroy clostridia.

You should also avoid eating canned food with obvious signs of poor quality. Swollen cans should be thrown away immediately. It is also unacceptable to eat preservation that has expired. Compliance with these rules will help prevent a serious and dangerous disease.

At the initial stage of development, it is easy to confuse it with gastroenteritis - inflammation of the mucous membrane of the small intestine and stomach. With untimely therapy, a high concentration of poison that has entered the body and, in especially severe cases, leads to death.

What it is?

Botulism is an infectious disease that develops as a result of the ingestion of the waste product of the bacterium Clostridium botulinum, botulinum toxin, into the human body. The disease is quite rare today, about 1000 cases per year are recorded worldwide. The disease continues to be deadly. Its main source is food, although others stand out.

Classification

There are four types of botulism:

1. Food (in case of infection by eating food containing botulinum toxin);
2. Wound (when open wounds are contaminated with contaminated soil);
3. Botulism of childhood (in children under 6 months due to the ingestion of Clostridium spores into the gastrointestinal tract; the source is most often contaminated soil, house dust, less often honey);
4. Botulism of unknown etiology.

How can you get infected?

The causative agent, Clostridium botulism, is widely distributed in nature with a permanent habitat in the soil. It forms spores that are extremely resistant to physical and chemical factors.

• Spores withstand boiling for 5 hours and only at a temperature of 120 degrees. Celsius perish after 30 minutes. In an environment with a low amount of oxygen, they multiply and form a toxin. The toxin is partially destroyed when heated to 70-80 degrees. Celsius, when boiled for 5-15 minutes, is completely destroyed. Botulinum toxin is one of the strongest poisons known in nature, its lethal dose for humans is about 0.3 micrograms.
• The reservoir of causative agents of botulism in nature are warm-blooded, less often cold-blooded, animals, in the intestines of which there are clostridia, excreted with feces into the external environment. The pathogen itself does not cause human disease, only the toxin is dangerous. For the occurrence of poisoning, it is necessary to multiply the pathogen with the accumulation of botulinum toxin in an environment with a small amount of oxygen (ham, sausages, canned food, salted fish), as well as in canned vegetables, fruits, mushrooms.

In recent years, the role of canned mushrooms in the occurrence of botulism has increased. The accumulation of toxins occurs especially intensively at a temperature of 22-37C. A person becomes ill by eating foods containing botulinum toxin. The patient is dangerous to others.

Incubation period

On average, the incubation period of the disease can last from several hours to one day. Its duration is determined by the amount of infection in the body.

The period from poisoning to the appearance of the first signs of botulism can be up to 2-3 days and even up to 10 days, but such cases are quite rare. Cases were recorded when the duration of the incubation period increased due to the use of alcohol by the patient.

The manifestations of the disease are most often sudden, strongly reminiscent of the symptoms of food poisoning. Toxin with contaminated products is rapidly absorbed into the intestines, enters the bloodstream and instantly spreads throughout the body. In this case, vital organs become the objects of damage.

The earlier botulism makes itself felt, the more severe the course of the disease is.

First signs

The first symptoms of botulism include the following:

1. Sharp pains in the abdomen, having a cramping character.
2. Nausea, indomitable vomiting.
3. Diarrhea, the stool becomes frequent and liquid, there are no foreign impurities in it.

These are early signs of botulism, many associate them with ordinary food poisoning and do not go to the doctor, relying on their own strength, thereby only worsening their condition and prognosis.

Symptoms of botulism

The above symptoms of botulism last for about a day, then there is bloating, a feeling of "bursting" in the stomach, diarrhea is replaced by constipation. Such manifestations are due to the development of intestinal paresis. Motor neurons responsible for intestinal peristalsis are affected. Accordingly, this leads to the fact that peristalsis disappears, there is no passage through the intestines, gases and feces accumulate in it.

Neurological symptoms appear after the gastrointestinal ones. Among them:

1. The face becomes like a mask, facial expressions are absent, the patient cannot stick out his tongue.
2. Separately, it is worth noting muscle weakness, it manifests itself in almost all muscle groups.
3. Among the first, the motor neurons innervating the occipital muscles are affected, which causes their paralysis, the head hangs down and to keep it in its normal position, the patient has to hold it with his hands.
4. Among the neurological symptoms are also drooping of one or two upper eyelids, dilated pupils, sluggish pupillary response to light or its absence, strabismus, nystagmus, weak convergence.
5. The patient is lethargic, he is disturbed by headaches of a diffuse nature, dizziness, weakness, as a rule, there is no fever.
6. Weakness of the intercostal muscles causes respiratory failure, breathing becomes superficial. Gradually, weakness appears in the limbs.
7. Double vision, a feeling of fog before the eyes, the inability to see small details, reading is difficult, this is due to accommodation paralysis.

Also, there is a violation of the cardiovascular system, with auscultation of the heart, muffled tones are detected. Due to respiratory disorders, hypoxia develops (lack of oxygen in the blood). The onset of respiratory failure is a poor prognostic sign, as it is the leading cause of death in people with botulism.

There are also other symptoms of poisoning, botulism is manifested by dry mouth, the mucous membrane of the oral cavity is dry, bright red. In the supraglottic space, there is an accumulation of transparent mucus, which eventually becomes whitish in color. The voice changes, becomes muffled, the patient is disturbed by the sensation of a "coma" in the throat.

Complications

The most common side effects of botulism are:

Diagnostics

The diagnosis is usually made on the basis of a medical history (indicating the use of poorly processed food), clinical examination and bacteriological examination of feces, vomit, gastric and intestinal washings, wound contents, suspected food.

The toxin is also detected in the studied materials by the biological method (on white mice).

How to treat botulism?

The algorithm for intensive treatment of patients with botulism includes:

• gastric lavage to remove residual toxin from the stomach;
• intestinal dialysis (5% soda solution);
• antitoxic serum (type A, C, E 10,000 IU each, type B 5,000 IU);
• parenteral administration of infusion media for the purpose of detoxification, correction of water-electrolyte and protein disorders;
• antibacterial therapy;
• hyperbaric oxygenation as a means of eliminating hypoxia;
• treatment of complications.

The treatment of botulism consists of two directions. The first is to prevent the realization of the hypothetical possibility of toxin formation in vivo, the elimination of poison from the body, and the neutralization of the toxin circulating in the blood. The second is the elimination of pathological changes caused by botulinum toxin, including secondary ones.

1. All patients and persons with suspected botulism are subject to mandatory hospitalization. Regardless of its timing, treatment begins with washing the stomach and intestines with a 2% solution of sodium bicarbonate (soda) and siphon enemas with a 5% solution of sodium bicarbonate with a volume of up to 10 liters to remove the not yet absorbed toxin. Gastric lavage is advisable to carry out in the first 1-2 days of illness, when contaminated food can still remain in the stomach. Washing is carried out with a probe to avoid possible aspiration of washing water, with small portions of liquid, especially in the presence of respiratory failure, so as not to cause reflex respiratory arrest.
2. Antibiotic therapy is used in the treatment of botulism. It is prescribed for the prevention and treatment of inflammatory processes caused by the causative agent of botulism that has entered the intestines, as well as to prevent frequent complications (pneumonia, cystitis). If swallowing is not disturbed, then chloramphenicol is prescribed at 0.5 grams 4 times a day for 5 days or ampicillin at 0.75-1 grams per day.
3. Glucocorticoids are used as pulse therapy to prevent allergic reactions to the administration of heterogeneous antitoxic sera. Glucocorticoids are also used in the treatment of serum sickness.

Enterosorbents are also prescribed (polyphepan, enterodez, microcrystalline cellulose, etc.). 400 ml of lactasol, diuretics (furosemide, lasix 20-40 mg) are administered intravenously daily. It is necessary to monitor compliance with the water-electrolyte balance, energy supply. Means of metabolic support are prescribed, such as glucose-potassium-magnesium mixtures, riboxin, ATP, vitamins (mainly group B).

Rehabilitation

A person who has had botulism should be under the supervision of a local therapist for 2 weeks after discharge. If he has residual effects, it is also necessary to observe a cardiologist (with myocarditis), a neuropathologist, an ophthalmologist (with consequences associated with the organs of vision). If there are indications during the recovery period, the attending physician may prescribe medication to the patient - drugs against atrophy of the optic nerves, vitamins, nootropics, cardiovascular agents.

• For 3 or more (according to indications) months, the patient should avoid excessive physical activity. Under the ban are specialized sports training, hard physical labor, work that implies strong stress on the visual analyzer.
• A patient who has had botulism should pay special attention to his diet, its calorie content and composition. It is recommended to eat 4 times a day, doing it at set time intervals. It is not allowed to include fatty and spicy dishes in the menu, it is necessary to limit the intake of salts. It is advisable to abandon animal fats in favor of vegetable fats, to provide a sufficient amount of protein. The lack of vitamins can be replenished by taking special complexes - complivit, vitrum, alphabet, and so on.

Also, a person who has had botulism can be prescribed physiotherapy procedures. This includes water manipulations (therapeutic showers, baths), hardening, oxygen inhalations, electrosleep. This is necessary to get rid of the residual effects of hypoxia if the disease was acute. Wellness procedures of a general nature will also bring benefits, including therapeutic exercises, massage, swimming in the pool. All this together will accelerate the process of restoring the normal functions of the muscular system.

Prevention of botulism

The main preventive measures against infection are the creation of conditions that prevent the growth and reproduction of spores of bacteria and the prevention of the pathogen entering food. The latter include measures to maintain cleanliness in places where food is prepared, which is a favorable place for the development of the pathogen.

Home canning products in hermetically sealed containers are the most dangerous for humans, since it is impossible to achieve complete destruction of Clostridium botulinum at home. Most of all, this applies to mushrooms, because it is very difficult to wash them from soil particles that contain botulinum spores.

Before using canned food, it is necessary to warm opened cans at 100 ° C for 30 minutes (in boiling water) to destroy the toxin. Food products that are not subject to heat treatment, but are a favorable place for the toxin (salted and smoked fish, lard, sausages) should be stored at a temperature not exceeding 10 ° C.

Which doctor to contact

If you suspect botulism (nausea, vomiting, fever, diarrhea that occurred after eating home-made canned food), you must call an ambulance, which will take the patient to the infectious diseases hospital. In addition to an infectious disease doctor, a neurologist can participate in the treatment of a patient, in severe cases, an anesthesiologist-resuscitator.

Botulism is a rather severe disease of a toxic-infectious nature, the course of which leads to damage to the nervous system, spinal cord and medulla oblongata. Botulism, the symptoms of which are manifested when botulinum toxin-containing products, aerosols and water enter the body, as a result of a complex of processes, also leads to the development of acute and progressive respiratory failure. As a result of the lack of proper treatment of botulism, the onset of death is not ruled out.

general description

To define this disease, the Latin word botulus is used, which means sausage in translation. The fact is that for the first time the causative agent of the disease in question was found precisely in sausage, and later in the bodies of people who died after eating it. To this day, the main causes of botulism are the consumption of ham, smoked fish and salted fish.

In addition to the ingestion of toxins with food, other ways of contracting botulism are possible, which determines such types of this disease as, for example, neonatal botulism or wound botulism. Due to good absorbability, blood toxin saturation occurs already during the first day from the moment it enters the body, however, those doses that did not come into contact with the nervous tissue are excreted from the body with urine already on the third or fourth day. As for the pathogenetic mechanisms that contribute to the development of intoxication, at the moment they are not completely clear.

Causes of botulism. Transfer Methods

If the carrier of the causative agent of this disease is an animal, then there is no visible harm to it under the influence of the infection. As for directly sick people, for those who surround them, they are not epidemiologically dangerous.

The isolation of bacteria from an infected organism in any case occurs by the fecal or oral route with their subsequent entry into water, soil, etc. The external environment, in terms of its individual elements, can be polluted through the decomposition of birds and rodents that died from the disease in question (that is, directly through their corpses) . The actual mechanism of transmission of the disease is fecal-oral.

As for the causes of botulism, they consist in the use of such foods as home canning (especially vegetables and mushrooms), ham, fish (salted, smoked), sausages. Almost all those products that have been contaminated by soil or contaminated by the contents of the intestines of animals, fish and birds contain spores of the causative agent of the disease we are considering.

Botulism in newborns, as well as wound botulism, are much less common. In the first case, the disease occurs against the background of clostridia entering the intestines with their subsequent production of a toxin in it, in the second case, due to the lack of access to oxygen in wounds of a necrotic and crushed type, conditions close to anaerobic are created, as a result of which spores begin to germinate in them during subsequent accumulation botulinum toxin.

It is noteworthy that good absorption of the toxin is noted not only when considering this process within the gastrointestinal mucosa, but also when such a process is relevant for the ocular and upper respiratory mucosa. This, in turn, determines the corresponding danger of the toxin in its possible use as a weapon of a biological type.

If we talk about the susceptibility to botulism of people, then, as you can see, it is quite high. Given the fact that the activity of the toxin occurs within the framework of minimal doses, this, in turn, excludes the possibility of the appearance of appropriate immune reactions on the part of the body, respectively, immunity to such exposure is simply not developed.

Botulism: symptoms

Duration incubation period This disease in the vast majority of cases is quite short and is on the order of several hours. Meanwhile, in some cases, it is possible to lengthen it up to a period of 7-10 days, which, accordingly, determines the need for constant monitoring during this time of what will be the state of health of each of the persons who used the product, which acted as the main reason for the first reported case of the disease.

Concerning initial period, then here the symptomatology of the disease may be characterized by its own vagueness, as well as blurring, that is, similarity with a number of other types of diseases, as a result of which early diagnosis becomes difficult. Based on the nature of the clinic of this period, the following conditional variations with their characteristic symptoms can be distinguished:

• Gastroenteric. There are pronounced pain sensations of a cramping type in the epigastric region, vomiting may also appear (single or double) with the release of food eaten. The course of the disease may resemble the symptoms of food poisoning. At the same time, it is important to take into account the fact that botulism is not characterized by a pronounced increase in temperature, while its course is characterized by the development of significant dryness, noted in the mucous membranes of the oral cavity, and a small, in fact, loss of fluid in this case, such a manifestation is not explains. Also, under the frequent symptoms of this period, there is difficulty in passing food along the esophagus, which is described by patients as a sensation of a “lump in the throat”.
• "Ocular". It is characterized by the appearance of disorders associated with visual function. In particular, such disorders can be "flies" or fog before the eyes, a feeling of a grid and a loss of clarity in considering the contours of surrounding objects. Possible drooping of the eyelids (or ptosis), strabismus, unevenness in the state of the pupils or their expansion, double vision. It also happens that during this period the so-called acute farsightedness develops, which can be corrected using plus lenses for this. Severe cases of the course of the disease may also be accompanied by immobility of the eyeballs.
• Respiratory failure. This variant of the course of botulism is the most dangerous of those listed, at least due to the lightning speed of its own development. Manifestations of respiratory failure are the appearance of shortness of breath and tachycardia, cyanosis (that is, cyanosis of the mucous membranes and skin). Breathing according to its type in any of the options is defined as pathological. Actually, the danger of this period lies in the fact that, in addition to the severity of the listed manifestations, the onset of a fatal outcome becomes possible in it, and it can occur within the next 3-4 hours.

Now let's take a closer look at the step height of botulism. The clinic of manifestations of this disease is quite characteristic, it is distinguished by a combination of some syndromes. So, there are disturbances in the movement of the eyeballs, swallowing is disturbed, which initially concerns only hard foods, and then liquid ones. In the latter case, even an attempt to drink ordinary water leads to its pouring out through the nose, which occurs as a result of paresis of the swallowing muscles (that is, their characteristic weakness due to "disconnection" from the nervous system).

In addition, within this period of the course of the disease, phonation disturbances are noted, which are characterized by a sequence of the course in the form of four main stages. So, initially there is hoarseness of the voice or a decrease in timbre, which occurs as a result of dryness noted in the mucous ligaments.

Then dysarthria begins to develop, which is described by the sensation of "porridge in the mouth", after which there may be a change in voice in favor of nasality. In the end, the changes reach the stage of the appearance of complete aphonia, that is, the absence of a voice in its sonorous form during the transition to a whisper, which is explained by paresis of the vocal cords. Due to the absence of a cough shock, the patient experiences asthma attacks, which occurs as a result of liquid or mucus entering the larynx.

In some cases (although not on a permanent basis), innervation disorders may be observed, manifested in the form of a distortion of the face, as well as the impossibility of teeth grin, etc.

Also, at the height of botulism, patients may complain of severe muscle weakness, instability of gait (which can be compared with the gait of a drunk person). The first hours of the disease can occur in combination with dryness of the mucous membranes of the oral cavity, constipation.

As for the temperature, it often has normal indicators, only occasionally rising to subfebrile levels. Tachycardia (increased heart rate) also appears, arterial hypertension (i.e., increased pressure), shortness of breath, shallow breathing, dilated pupils are possible. Tachycardia can also alternate with bradycardia (a condition in which, on the contrary, the heart rate decreases).

Urodynamic disturbances are possible, manifested in the form of involuntary urination or, conversely, in the form of an acute urinary retention. Actual muscle weakness is most pronounced in the region of the occipital muscles, which, in turn, leads to drooping of the head and to attempts by patients to hold it. The preservation of this state can reach about six months. Auditory functions and consciousness remain normal, there are also no disturbances in the sensitive sphere.

Wound botulism, infant botulism: main features

As we have already noted, these forms of botulism are not so common. Meanwhile, there are certain characteristic features for them:

• infection occurs by spore-forming rather than vegetative forms;
• the duration of the incubation period is noted;
• there is no gastroenteric period during the course of the disease;
• the symptoms of botulism in newborns are manifested in the weakness of sucking or even in the refusal of it, in lethargy and retention of stools, in the weakening of the sucking or swallowing reflexes, the ophthalmological (above - “eye”) symptoms of the disease are also relevant, crying is hoarse;
• complications in children (for example, in the form of pneumonia) are observed much more often, in addition, deaths are also more common among them.

Complications of botulism

Complications of botulism can be of three types, each of which is characterized by its own manifestations:

• specific complications. This includes myositis with frequent damage to the calf, occipital and femoral muscles, which manifests itself in the form of swelling and difficulty in trying to make movements, as well as in soreness. In addition to myositis, the possibility of such a specific complication as damage to the nerve heart nodes is not excluded, which, in turn, leads to the formation of arrhythmias in patients.
• Bacterial (secondary) complications. This includes pneumonia and purulent form of tracheobronchitis, atelectasis and pyelonephritis, as well as sepsis.
• Post-treatment (or iatrogenic) complications. They appear in the form of intestinal atrophy, serum sickness, hyperphosphatemia, hyperglycemia.

Diagnosis

Diagnosis of botulism is based on the following data:

Epidemic data (for example, the use of home-preserved products by sick people);
- clinical data (concentration of lesions of the nervous system and its symmetry, the relevance of intoxication, febrile, meningeal and cerebral syndromes);
- data of laboratory diagnostics (in particular, it is focused on the identification of the pathogen in the patient's biomaterials and in products, the pH (that is, the neutralization reaction) in combination with ELISA (enzymatic immunoassay) is also applicable);
- data regarding the detection of the level of a specific type of enzymes, on the basis of which the degree of compensation relevant for the vessels and the heart is determined (in addition, in this case, an ECG is performed).

Botulism: treatment

The duration of the course of the disease can be about three weeks, which is important, provided that the required treatment is provided. Restoration of neurological symptoms is performed in the reverse order, focusing initially on breathing, and then on swallowing.

Other manifestations of botulism symptoms are cured without any particular sequence, and their persistence over a long time period (about 1.5 months or longer) is possible. In patients who have recovered from botulism, all symptoms disappear without a trace, respectively, and without any consequences. If treatment is not performed, then the possibility of death is not excluded. The treatment itself, in particular, consists of several stages:

• The use of anti-botulinum horse anti-toxic serum, which, in turn, can be monovalent or polyvalent (this option is relevant when the type of botulinum toxin acting is unknown). Human immunoglobin (anti-botulinum) can also be used.
• With the serum indicated above in any of its variants, prednisolone is also introduced, whose action is designed to exclude the possibility of developing anaphylactic shock. Also, to prevent the last manifestation, before the administration of serum, a test is performed using small doses, after which, if an allergic reaction does not occur, the dose of prednisolone is increased.
• As a result of the actual paresis for patients, the risk of blockage of their airways and the development of respiratory failure increases. These factors are a threat to life, and therefore it is necessary to provide patients with parenteral and tube nutrition while connecting them to a ventilator.
• In the case of the relevance of myocardial damage, cytoprotectors are prescribed.
• Bacterial complications require the use of broad-spectrum antibiotics.
• The early stages of the disease provide for the need to influence the pathogen also through the gastrointestinal tract, which is achieved through cleansing enemas, gastric lavage and the appointment of sorbents.

Additionally, a diet is prescribed (No. 10), dishes rich in extractive components, as well as fatty foods and spices, are excluded from the diet. Semi-bed/bed rest is also prescribed.

An important point that should be highlighted as a result of our article is the need to immediately call an ambulance for signs of food poisoning (nausea and vomiting, abdominal pain) in combination with severe muscle weakness, speech and visual disorders, as well as swallowing disorders . Otherwise, delay and exclusion of such assistance can lead to death!

First aid for botulism (poisoning with suspicion of this disease) consists, in addition to calling an ambulance, in giving the patient a large amount of liquid and providing him with access to fresh air. In case of respiratory arrest, it is necessary to proceed to the procedure of artificial respiration. It is also important to find, if possible, the remains of the food that was eaten by the patient before the onset of such a state - this is necessary for laboratory tests.

One of the most dangerous forms of poisoning is botulism. Although this is a rare and almost forgotten disease, it still affects people every year, regardless of gender, status, age and nationality, as well as living standards. Therefore, it is better to know in advance as much as possible about what botulism is and why it is dangerous, what factors lead to infection, how to treat it and methods of preventing it, so that you can warn yourself and your loved ones from potential danger.

Description of the disease

Clostridium botulinum is the bacterium that causes botulism, a disease that is deadly. Botulism is a disease of an infectious nature that causes acute damage to the body by toxins and poisons.

The bacterium botulism, also called coli, clostridium and botulinum. This is an anaerobic bacterium (using an environment without air for life), which forms many spores. The stick itself can be vegetative or spore.

Vegetative botulinum lives for years in a warm (20-37 degrees Celsius) environment devoid of oxygen. When boiled, it dies within half an hour. If the vegetative form of the bacterium is subjected to thermal heating, then sporulation can be provoked. This process is characterized by the "awakening" of inactive spores, which begin to actively multiply. These spores do not react either to the sun's rays or to any other temperature changes, like a bacterium, they feel great in an oxygen-free environment.

Botulinum spores are products that the bacterium produces in the course of its life. It can live for several decades. Neither freezing, nor drying, nor salt, nor acid, nor prolonged boiling kills it.

The only way to destroy it is to subject it to a half-hour heat treatment at temperatures above 120 degrees Celsius.

Types of disease

Depending on the method of infection, there are several forms of botulism - definitions of what it is, or rather, where it can enter the body. Each of them has its own specific features.

food

It is characterized by the fact that the bacterium and its waste products accumulate in food. Moreover, in order to become infected with food botulism, the bacterium needs to produce toxins even before the affected foods are eaten. At the same time, bacteria need an environment with a lack of oxygen to produce harmful spores. For example, such products can be home-made canned food prepared by light preservation. Industrial canned food can also contain active botulinum if the technology was violated during preservation.

Products in which botulinum toxin can develop: mushrooms, green beans, beets, spinach, sausages and ham sausages, smoked and salted fish products, canned fish.

The list of "dangerous" products varies from country to country and depends on the traditions of cooking and processing dishes.

wound

The botulinum bacterium lives everywhere, including in the environment. Under favorable conditions, it is activated. In itself, it is not harmful, but the danger is the disputes that arise in the process of its activity. If they fall into an open wound, then a person becomes infected with botulism through it, and not through food. This rarely happens and after infection it should take about two weeks before the first symptoms of infection appear. The risk group includes drug addicts who use injections to take drugs.

Children's

From the name you can understand that this type of disease affects mainly only children, and usually only the smallest - newborns and under the age of six months. In children in this age group, the intestines have not learned how to defend themselves against most bacteria, its environment does not yet perform all the necessary protective functions, and immunity has not had time to form either.

Botulinum penetrates the intestines and distributes its poisons there. For babies whose intestines have got live botulinum, it is life-threatening, for other children and adults - no. Infection often occurs through honey. For this reason, it should not be given to such young children. Dust as well as soil can also be a hazard. The first symptoms do not appear immediately. The disease progresses to pneumonia and is fatal.

Respiratory

This type of disease is rare. It can only become infected through a deliberate biological attack, such as a terrorist attack, as well as as a result of the accidental release of a toxin from aerosols. The disease manifests itself 1-3 days after infection.

Uncertain

This type of disease is, in fact, a diagnosis when doctors could not establish the source of infection.

Water is a source through which the risk of infection through which is minimal, but still exists. Therefore, it is highly recommended to drink only purified and boiled water.

Reasons for the development of botulism

Eating unwashed vegetables and fruits, sausages of unknown origin and production, homemade sausages and sausages, fish, canned fungus is a risk of contracting botulism, despite rare cases of the disease.

To better understand what botulism is and why it is dangerous, what are the causes of the development of the disease, you need to know the mechanism of development of botulinum. First, it penetrates into the intestinal environment of wild animals, then it multiplies in the feces. Then, with a bowel movement, the masses of feces enter the soil, and with them clostridia, which can live in the soil for many years. Then they move into vegetables and mushrooms, which are then eaten by a person who has cooked them incorrectly. Accordingly, after taking such food, he becomes infected.

The cause of the development of the disease is the improper processing of food ingested. Insufficient washing, heat treatment and preservation, sterilization.

Interestingly, in terms of its toxicity, botulinum toxin is more dangerous than rattlesnake venom, and it’s not immediately possible to believe how many times - 370,000. This means that the faster a sick person goes to the hospital, the higher his chances of surviving, since such a powerful poison is quickly and irreversibly affects the vital functions of the body.

Also, various marine mollusks and fish, birds or soil at the place where the corpse of an infected animal lay was a source of infection.

The can where the botulinum has grown swells, but there is no specific smell or taste. This canned food should be thrown away!

Who can get sick

Despite the extremely rare foci of the disease on a national scale, cases of botulism are recorded annually. Certain categories of persons most susceptible to infection are statistically identified:

• Members from disadvantaged families with low social status, the poor. Such representatives of society tend to be careless about the rules of cooking and processing food. The low financial situation makes them eat canned food when it is clear that the jar with this product is swollen. They just hate to throw it away.
• Fans of buying dubious canned home-made products in the markets, from the hands of grandmothers selling on the streets, train stations, or through acquaintances. Such behavior of quite financially prosperous consumers is extremely careless. The idea of ​​eating homemade preparations is quite understandable and understandable, but no one knows what method of preparation was used and under what conditions the whole process took place. The same applies to smoked fish bought from the hands.

• Various holidays where representatives of several families bring food at once. It is not known how it was stored and prepared.
• People who do not disdain to eat the contents of a swollen jar, and especially if mold has already formed there. Many have a prejudice - if you remove a layer of mold, then you can eat it. Or, if the jar is swollen, but the smell and taste are normal, you can eat it. Such motives are dangerous to life, and behavior regarding one's health is ignorant.

First symptoms

Symptoms of botulism differ in the initial stages and depend on the type of disease.

The first signs are short-term and similar to acute intoxication or gastroenteritis:

• Acute pain in the epigastric region and in the middle of the abdominal cavity;
• Severe and sudden pain on the background of abdominal pain;
• Diarrhea, debilitating frequency of attacks - can be up to 10 times a day;
• Vomit;
• Loss of strength;
• Fever with a temperature reaching 40 degrees.

The complex of the listed first signs subsides by the end of the first day, but does not mean that the disease has passed. The first signs, even at the very beginning of their onset, should prompt the patient to call an ambulance.

There are also other symptoms, namely:

• Dry mouth for no apparent reason;
• The temperature is slightly elevated;
• "Lump" in the throat;
• Visual impairment (blurred contour of visible objects, "flies", double vision, sudden farsightedness);
• A sharp change in breathing (with a respiratory type of illness, not to be confused with an asthma attack);
• Blueness of the skin;
• Tachycardia;
• Dyspnea.

These were the first signs of the disease, which in varying degrees and combinations appear at an early stage.

The period of exacerbation

During the peak of the disease, other symptoms are observed:

• Difficulty swallowing food (diseases of the stomach and esophagus should be excluded);
• Immobility of the tongue located in the pharynx;
• Low mobility of the tongue;
• omission of the eyelids;
• Inability to fix the gaze for a long time, strabismus;
• Decrease in the functions of the vocal cords, as a result - the inability to speak;
• A nasal or hoarse voice;
• Distortion of her gait as she becomes less confident;
• muscle weakness;
• Inability to defecate normally, urination is also disturbed;
• pale skin;
• Inability to show a grin;
• Feeling of tension in the muscles of the face;
• Change in facial expression, distortion.

In the final period of the development of the disease, symptoms associated with breathing come to the fore. Pneumonia develops.

Muscle weakness is so pronounced that the patient is unable to independently raise his head or arms. After that, the body becomes paralyzed, breathing stops and death occurs.

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As a result, treatment is necessary and it should be started as early as possible. It is impossible to diagnose botulism on your own, as its symptoms are similar to manifestations of other diseases. They are easy to confuse and miss the opportunity to recover. If you feel alarming, then you need to call an ambulance - you should not wait until you can still endure pain in the abdomen.

Development of the disease and its treatment

The incubation period for each type of botulism is different, but on average it ranges from 1 to 10 days. Moreover, the faster the first symptoms occur, the more severe the course of the disease and treatment.

Treatment is carried out only under conditions of full hospitalization and round-the-clock monitoring. No self-healing options!

The hospital uses the following methods:

1. Gastric lavage;
2. Use of anti-botulinum serum;
3. Detoxification;
4. Taking antibiotics;
5. Artificial ventilation of the lungs;
6. Probe feeding;
7. Installation of a catheter;
8. Rehabilitation therapy;
9. Additional specific methods of therapy in emergency situations in conditions of increased danger to the life of the patient.

Prevention

In order not to get sick, you need to be hygienic, wash fresh food thoroughly, properly heat them and not eat questionable food. Unfamiliar canned food, even seemingly normal, should be used with caution.