Killer sausage: what is botulism and why is it so dangerous

Infectious disease specialist

Sinitsyn

Olga Valentinovna

33 years of experience

Highest qualification category of infectious disease doctor

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The vast majority of Russians know that consuming low-quality canned or smoked products can lead to a serious illness - botulism. This is an acute disease of infectious-toxic origin, caused by the pathogen Clostridium botulinum and the toxic product of its vital activity, which is a powerful poison of biological origin. It is botulinum toxin that makes the disease extremely severe and often fatal.

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Botulism

“Botulism” comes from the Latin botulus, meaning sausage, as poorly cooked sausages and sausages were previously associated with food poisoning. Botulism is a rare, potentially fatal disease resulting from exposure to botulinum neurotoxin ( BoNT ), produced primarily by the bacterium Clostridium botulinum. BoNT is one of the most powerful organic poisons. 1–3 ng/kg of poison can be fatal. Botulinum toxin causes disruption of neuromuscular signal transmission, which leads to paralysis [1].

Read more about natural neurotoxins in the articles “Tetrodotoxin - the story of a legendary killer” and “Poisons are precision weapons: a computer study of natural neurotoxins.” - Ed.

Botulism poisoning symptoms and signs

Typical signs of botulism

1. Visual disorders

• Decreased visual acuity , patients have difficulty distinguishing nearby objects, at first they cannot read ordinary text, and then large text
• Complain of fog or blurred vision
• Double vision
• Drooping of the upper eyelids (ptosis)
• Limitation of eyeball movement
• Strabismus
• Rapid involuntary movements of the eyeballs
• Possible complete immobility of the eyeballs

1. Swallowing and speech problems

• Dry mouth
• Changes in pitch and timbre of voice, nasality
• As the disease progresses, the voice becomes hoarse, hoarse, and complete loss of voice is possible.
• Sensation of a foreign body in the throat
• Swallowing is impaired. First when swallowing solid food, and then liquid food. In severe cases, when trying to swallow water, it begins to pour through the nose.

1. Respiratory disorders

• Lack of air
• Chest tightness and pain
• Shallow and rapid breathing

1. Movement disorders

• Muscle weakness, patients are inactive
• Muscle weakness increases as the disease progresses
• First, the back muscles of the neck that support the head weaken. As the symptom increases, the patient supports his head with his hands so that it does not fall towards the chest.

• Shallow and rapid breathing

What does a patient look like at the height of the disease?

The patient is lethargic and inactive. The face is mask-like, pale. Bilateral drooping of the upper eyelids, dilated pupils, strabismus and other visual impairments listed above. The patient has difficulty sticking out his tongue. Speech is impaired. The mucous membrane of the mouth and pharynx is dry and bright red. The abdomen is moderately distended. Breathing is shallow.

Mortality

Although BoNT is a powerful poison, the preconception that every or almost every case of botulism will be fatal is incorrect. Statistically, the mortality rate from botulism is very low, as are cases of infection in general. About fifty years ago, for every 100 people with botulism, there were about 50 deaths. However, thanks to the advent of toxoid and proper patient care, today the mortality rate from botulism has decreased to 5 (or less) cases per 100 cases [1].

First aid

Timely seeking medical help prevents the disease from developing and leading to irreparable complications. However, before the ambulance team arrives, it is necessary to provide a number of measures that can alleviate the patient’s condition.

Such actions are advisable only when the arrival of specialists is delayed.

First aid that can be provided at home is to drink plenty of warm drinks and take activated carbon .

Traditional therapy

After the diagnosis of botulism has been confirmed, and the symptoms and acute stage of the disease have been neutralized, it is time to apply therapeutic treatment. At this stage, the use of traditional medicine is allowed, but only in combination with a prescribed course of medications.

The most common folk remedy that helps to quickly cope with botulism is cinnamon.

Method of preparation: 1 tsp. crushed cinnamon, pour 1 glass of water, put on fire. After boiling, cook for 2-4 minutes, then remove from heat and cool slightly. It is recommended to drink this decoction warm; a small amount of sugar can be added.

Among the herbal decoctions and infusions are:

Story

The first mention of cases of botulism refers to a decree banning the consumption of blood sausage due to its danger to life, signed by the ruler of Byzantium, Leo VI (866–912). Nine centuries later, the “Killer Sausage” has again attracted public attention. In 1789, after a case of poisoning in Württemberg, 13 people, 6 of whom died, scientists began to look for the cause of sausage poisoning. It was never found, and for a long time it was believed that during storage, “cadaveric acid” was formed in the sausage, leading to intoxication of the body.

It was only in 1895 that the Belgian bacteriologist Emil van Ermengem isolated the causative agent of the disease, a rod-shaped bacterium, from infected ham and the spleen of one of the victims. In Russia, S.V. studied botulism. Konstantinov. He named the pathogen that he managed to isolate from fish Bacillus ichtyismus, and the disease itself - “ichthyism” [2].

Prevention and recommendations

It is easier to prevent a deadly disease than to completely treat it.

Basic principles of botulism prevention:

• do not purchase canned food, seams, salted and dried home-made fish from strangers;
• When making your own preparations for the winter, take into account all the rules for safe canning: add vinegar or citric acid, treat jars and lids, store in a dark room at a temperature of 2-6 degrees;
• Do not roll foods such as meat, fish, herbs and mushrooms into jars at home;
• do not open or try canned goods with a swollen lid;
• When cooking, separate raw from cooked food and keep separate cutting boards for these foods.
• rules of personal hygiene: wash your hands after going outside, before eating;
• do wet cleaning in the house, especially if there is a small child in the family;
• If you have wounds or cuts on your hands, avoid direct contact with the ground.

Currently, there is a set of vaccinations against botulism, however, such preventive measures are recommended only for people who are in constant contact with harmful bacteria.

At the state level, botulism prevention is carried out through sanitary inspections of factories producing canned products. All warehouses and store shelves are also subject to control. Products that have not passed inspection according to production and storage standards are not allowed for sale.

Causative agents of botulism

Botulism is most often caused by the bacteria Clostridium botulinum. It is also caused by other clostridia: Clostridium butyricum and Clostridium baratii.

Clostridium botulinum is a gram-positive, rod-shaped bacterium (bacillus). Bacilli by their nature are capable of sporulation, which allows such bacteria to remain alive for a long time even in very unfavorable conditions. In spore form, Clostridium botulinum does not produce toxins and is absolutely safe for adults. When the spore germinates, the bacterium begins to actively multiply and secrete a toxin.

Favorable conditions:

• anaerobic (without O2);
• low acidity of the medium: pH 7.3-7.6 for growth and 6.0-7.2 for spore germination;
• low carbohydrates;
• low salinity;
• a certain temperature is about 4–45°C.

Due to the requirement for an oxygen-free environment for Clostridium botulinum to thrive, BoNT is most often found in canned foods.

Review

Foodborne botulism is a severe, potentially fatal, but relatively rare disease.
This is an intoxication usually caused by the consumption of highly potent neurotoxins, botulinum toxins, produced in contaminated foods. Botulism is not transmitted from person to person. The spores produced by Clostridium botulinum are resistant to high temperatures and are widely distributed in the environment. In the absence of oxygen, these spores germinate, develop and begin to release toxins. There are 7 different forms of botulinum toxin – types A – G. Four of them (types A, B, E and in rare cases F) cause human botulism. Types C, D and E cause disease in mammals, birds and fish.

Botulinum toxins enter the body through the consumption of unprocessed foods in which bacteria or spores survive and produce toxins. The main cause of human botulism is food intoxication, but it can be caused by intestinal infections in infants, wound infections, and by inhalation.

Where is botulism hiding, types of botulism

There are several types of botulism:

1. Food - This type of botulism can occur when eating foods containing botulinum toxins. BoNT can be found in:
   seaweed;
2. green beans;
3. spinach;
4. mushrooms;
5. beets;
6. fish;
7. meat products [3].
8. Infant botulism occurs when Clostridium botulinum spores enter the intestines of infants (usually before six months of age). In their unformed intestines, spores are able to enter a vegetative state and produce a toxin. A large number of cases of infant botulism are associated with the consumption of honey by children under 1 year of age.
9. Adult botulism is the “grown-up” version of the childhood type. The reason for its occurrence is still the same: spores of clostridium botulism in the intestines.
10. Wound botulism - infection with BoNT occurs through an open wound, from where the toxin spreads throughout the body along with the blood.
11. Iatrogenic is a rare type that is associated with “side” effects when using BoNT in medicine and cosmetology.

Treatment of other diseases starting with the letter - b

The information is for educational purposes only. Do not self-medicate; For all questions regarding the definition of the disease and methods of its treatment, consult your doctor. EUROLAB is not responsible for the consequences caused by the use of information posted on the portal.

BoNT

BoNT is a protein (150 kDa), has light and heavy chains. Each chain performs its function during intoxication of the body [1].

There are seven different BoNT neurotoxins, A through H. Each is associated with some form of botulism. Botulinum toxins A, B, E and sometimes F are dangerous to humans [2].

Toxin exposure, synaptic transmission, molecular mechanisms

heavy chain searches for specific receptors on the surface of target neurons and facilitates the penetration of the toxin into the cells. The light chain , once inside, disrupts the action of the SNARE protein complex involved in the release of transmitters from the endings of motor neurons. Most often, acetylcholine acts as a mediator [4]. If its release is disrupted, the transmission of the neuromuscular impulse is blocked. When the nerve cannot transmit the signal to cause the muscle to move, the muscle becomes paralyzed [5–7]. Together with the blood, the toxin spreads throughout the body, paralyzing many muscles at the same time.

Acetylcholine is an important transmitter that is released into the synaptic cleft between neurons and carries out further impulse transmission.

How and after how long does botulism appear?

How long it takes before the first symptoms of the disease appear depends on the resistance of the macroorganism to adverse environmental factors and the number of bacteria ingested.

Botulism is asymptomatic from several hours to 7-10 days. Bacteria are activated in the body, actively multiply, and adapt to the new environment. The first signs of botulism appear when nerve cells colonize.

If the number of microorganisms is small or the human body is hardened, the infection occurs without complications. The clinical picture corresponds to the ocular variant without involving the respiratory and digestive systems.

Moderate and severe course occurs with a pronounced disturbance in the general condition of the patient. They manifest themselves as dyspeptic, ophthalmological, respiratory syndromes with the development of complications.

Symptoms of the disease

Botulism begins to appear after an incubation period, which can last from 12 hours to 10–15 days. Leads to muscle paralysis. The primary stage of intoxication involves the cranial nerves and facial muscles, which is why paralysis begins from the upper part of a person’s torso and spreads downward, affecting the muscles of the neck, chest, arms and legs.

In a poisoned person:

• pupils dilate;
• vision blurs;
• floaters appear before the eyes;
• speech is disrupted;
• it becomes difficult to swallow;
• the facial muscles lose mobility, so the face begins to resemble a frozen mask.

Ultimately, if paralysis reaches the respiratory muscles and heart muscles, the person dies.

Main manifestations of the disease

Over time (everything is purely individual here), the patient begins to experience a sharp worsening of the clinical picture. Symptoms become more pronounced, and health becomes even worse.

If we consider individual systems of the body, describing the effect of toxins from the causative agent of botulism, then a clear deterioration in health often affects vision. It is expressed in the following aspects:

• drooping eyelids;
• strabismus that converges;
• double vision of objects before the eyes even in a calm state;
• inability to focus in a given direction.

After the initial artificial farsightedness and other signs develop into these, you must immediately call an ambulance if you still have doubts right away. Otherwise, the chances of a successful recovery will begin to fade exponentially.

In addition to unstable vision, the patient will also begin to experience a number of problems associated with swallowing. Initially, it will be difficult for him to swallow solid food, but a little later even the absorption of liquid food will become impossible. The tongue becomes inactive due to inhibition of the function of the tongue in the pharynx.

All this leads to the fact that the poisoned person cannot not only eat independently, but also express himself clearly. Instead he:

• feels hoarse,
• nasal,
• cannot clearly pronounce individual sounds.

The latter occurs due to decreased mobility of the vocal cords.

A characteristic manifestation of botulism is the absence of any disturbances in the sensitivity of the skin. In addition, the patient remains conscious all the time and hears others well, and his body temperature remains within normal limits.

Much less often, a person who has been poisoned may exhibit facial asymmetry. This occurs due to the fact that different facial muscles tense differently, outwardly expressing themselves in a distorted facial expression. Also, some people entering hospital treatment cannot fully show their teeth, baring their teeth to do so.

Among other typical manifestations during the height of the disease, the following should be highlighted:

• muscle weakness throughout the body;
• unsteady gait;
• problems with urination due to urinary retention;
• constipation;
• increased heart rate.

Diagnostics

Early diagnosis of Botulism is extremely important. Botulism often wears “masks”, hiding under other diseases: Guillain-Barré syndrome, encephalitis, polio, Lambert-Eaton syndrome, meningitis. This significantly complicates diagnosis [5], [9–11], [14], [15].

In search of botulinum toxin, antibodies to the pathogen or DNA of the pathogen, material (urine, feces, vomit or blood) is collected from the patient and clinical and laboratory tests are carried out. An important method for confirming botulism is to demonstrate the effect of the toxin in mice. To do this, bacteria are isolated from patient material and injected into mice. In the presence of botulinum toxins, mice develop paralysis within 48 hours, which can be suppressed by administration of toxoid [12].

Folk remedies

Photo: sublimebliss.com

If you experience symptoms that indicate the possibility of botulism, you should immediately seek help from a medical facility. All patients require mandatory hospitalization, since it is necessary to carry out specific therapy, the purpose of which is to prevent possible severe complications of the disease.

Preventive measures are aimed at strict adherence to sanitary and technological rules for food preservation. Meat and fish must be preserved exclusively fresh. Before canning, vegetables and fruits should be washed several times under running water, which is necessary to remove soil particles that may contain clostridia spores. Fresh fruits and vegetables that show no signs of spoilage should be used for preservation. At home, it is not recommended to seal mushrooms in jars, as it is extremely difficult to clean them from dirt. Sterilization must be carried out in an autoclave, which, thanks to increased pressure and high temperature, allows you to destroy not only the bacteria themselves and their toxins, but also spores. Bombed (swollen) jars must be destroyed, as this is one of the reliable signs of colonization of the jar with microorganisms. Also, you should not purchase home-canned food at markets, as well as meat products that have not undergone preliminary special testing.

It is worth noting that the botulism agent and its toxin do not in any way affect the appearance of the product, its smell or taste, so it is impossible to suspect that the canned product is contaminated. In this regard, it is recommended to pre-boil canned products for 15–20 minutes and sell them no later than within the next 36 hours. Boiling, frying or parboiling food and any canned goods is the main preventive measure aimed at preventing not only botulism, but also a number of other poisonings and intestinal diseases.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Treatment

Treatment for botulism includes:

• disinfection of the gastrointestinal tract (if necessary);
• administration of an antidote (anatoxin);
• in case of pulmonary failure, respiratory support (ventilation) is used.

Anatoxin neutralizes only toxins that are not yet associated with nerve endings and are freely circulating in the blood. Once BoNT binds to nerve endings, the toxoid becomes useless [2], [5].

Even after long-term treatment, most patients have residual symptoms, and the recovery process can take months. The rate of recovery depends on the rate of germination of new branches of motor axons [1].

As a preventative measure, vaccination against botulism can be carried out. Vaccination is rarely used because the effect of the vaccine is short-lived. It provides only temporary immunity and requires repeated administration [13].

Treatment of botulism at JSC "Medicine" (clinic of academician Roitberg)

Treatment of the disease includes the following:

• gastric lavage using a special probe to remove remnants of contaminated food;
• intestinal dialysis using a special solution;
• administration of antitoxic serum in accordance with the type of bacteria detected (A, C or E);
• administration of drugs for infusion therapy to accelerate detoxification, restore water and electrolyte balance, and eliminate protein disturbances;
• introduction of antibacterial drugs;
• measures to eliminate hypoxia and its consequences;
• treatment of complications of botulism.

Depending on the severity of the poisoning and overall health, treatment for botulism takes from several days to a month. However, with timely medical intervention and compliance with clinical recommendations, botulism is sooner or later completely cured, and the activity of the nervous system is restored without the slightest consequences for its functioning.

Therapeutic Uses of BoNT

Despite all the dangerous effects on the human body, BoNT is widely used in medicine and cosmetology. Doctors use BoNT's ability to cause flaccid paralysis.

In cosmetology, BoNT is known as Botox. Botox is a purified form of botulinum toxin A that is often used to treat wrinkles. BoNT blocks the signals that the brain sends to the facial muscles, and wrinkles simply stop appearing. In addition, Botox injections can be useful in combating excessive underarm sweating.

In medicine, BoNT helps eliminate neurological disorders - dystonia, spasticity, strabismus and others, as well as treat migraines and overactive bladder [8].

Christina V. and Toma P. worked on writing the text. Ekaterina B. created these wonderful illustrations, for which special thanks to her! The topic of the article was conceived by Christina V. Editing the text, drawings and creating posters was also done by Christina V. and Toma P.

What diseases can it be associated with?

The most severe complications are respiratory arrest and cardiac arrest. Paralysis of the muscles of the larynx and pharynx can lead to aspiration of vomit, food and sudden death, even in moderate cases. Prolonged hypoxia and excessive administration of fluid against this background cause cerebral edema.

The course of botulism often makes it difficult for a secondary infection to occur. Paralysis of the respiratory muscles contributes to the occurrence of hypostatic pneumonia, impaired salivation leads to activation of the bacterial flora of the oral cavity with the subsequent development of gingivitis, stomatitis, and mumps.

Bladder atony and the need to release urine through a catheter can cause the development of ascending pyelitis and cystitis.

During the period of convalescence, some patients may experience myositis, manifested by compaction and pain on palpation of individual muscles, especially in the places of their skeletal attachment.

Severe forms of botulism are accompanied by high mortality - up to 50% or more. Despite the presence of severe neurological disorders in the acute period, botulism does not lead to disability; all symptoms gradually, at different times, disappear.