Frequent questions He asks the doctor Beginning   
BOTULISM
EFFECTS YOU CAUSE CLINICAL DECLARATIONS DIAGNOSIS EVOLUTION AND PROGNOSIS TO CONSULT

EFFECTS

The botulism is a serious illness caused by a neurotoxina produced by the bacillus Clostridium botulinum.

The toxin is extremely powerful, even mortal in negligible quantities. Called acetilcolina blocks the liberation of a substance in the nervous completions, with what it paralyzes the muscles and can lead to the death for respiratory stop. The intensive cares have obtained disminuír the mortality from 60 to 20 %.

CAUSES OF THE BOTULISM

  • Ingestion of home-made conserves of vegetables, fruits, sausages and seafood (clams, mussels), in most of the cases. The canisters packed commercially rarely are implied.
  • Ingestion of large fresh vegetables in soils contaminated with the ubiquitous spores of the C. botulinum.

CLINICAL DECLARATIONS

The symptoms can appear in 6 hours, or can be late up to 6 days. The period of more common incubation is 18 to 36 hours. As soon as possible the symptoms begin, more seriously it is usually the poisoning.

The affected person is awake and without fever. The most frequent neurological symptoms are a dry mouth, double vision, make difficult in the nearby vision, make difficult to swallow and to pronounce the words. There are usually previous abdominal symptoms or accompanying to the neurological ones, like morning sickness, vomiting, twistings and diarrhea.

The clinical signs include:

  • Weakness or palsy of the extremities, bilateral in 80 % of the cases.
  • Immobile thorax, with difficulties to ventilate.
  • Constipation.
  • Ocular signs: Pupils that do not react to the light, fallen eyelids, nistagmo (automatic rapid movements of the eyes).
  • Ataxia (instability to the gait).

DIAGNOSIS

The electromiografía shows abnormal finds, although not botulism specifics.

The test of the chloride of edrofonio is positive in most of the patients: A substance is administered that the destruction of the acetilcolina prevents, and the rapid one produces, although fleeting, improvement of the symptoms to herself.

The detection of the neurotoxina in the whey or the dregs confirms the diagnosis. Also there will be investigated the meals suspicious of detecting the neurotoxina. Since this one is extremely powerful, the samples manage in his original packings and with supreme care.

The distinguishing diagnosis of the botulism includes processes as the neuropathy of Guillain-Barré (that happens after some viriasis), the syndrome of Eaton-Lambert (associate to some lung cancers), chemical poisonings or trichinosis.

EVOLUTION AND PROGNOSIS

The evolution depends on several factors:

  • Age: The affectation is major major all that is the patient.
  • Type of neurotoxina: C. botulinum it produces 7 types of different toxins. Her To and the most powerful and most frequent are the B. Her To produce illness more serious than the B.
  • Rapidity in the medical attention and in the establishment of mechanical ventilation.
  • Infections opportunists (like complication of the stay in UVI).

There exists a trivalent antitoxin (To, B, E) available, that can modify the course of the illness.

Without treatment, the mortality of the botulism is very high (60 %) for the respiratory insufficiency derived from the palsy of the diaphragm and the intercostal muscles, and for the infections. The intensive cares there is disminuído the mortality to 10-20 %.

WHAT DOCTOR CAN TREAT ME?

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Writing: Medical equipment   Update: June, 2009
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