Related articles: Botulism
Definition
Botulism is an infectious disease caused by the bacterium Clostridium botulinum, responsible for severe flaccid paralysis. This microorganism, in fact, produces 7 types of antigenically distinct neurotoxins, which interfere with the release of acetylcholine in the peripheral nerve endings. Four of these toxins (types A, B, E and, rarely, F) are highly poisonous to humans.
Botulism occurs in 3 main forms: food (the neurotoxin is ingested through contaminated food), wound (caused by the infection of skin lesions) and infantile (due to the ingestion of bacterial spores which subsequently colonize the intestine).
Most common symptoms and signs *
- Respiratory acidosis
- Aphasia
- Anorexia
- Asthenia
- Muscular atrophy and paralysis
- Muscular atrophy
- blepharoptosis
- Dry mouth
- dizziness
- Abdominal cramps
- Diarrhea
- Language difficulties
- Dysarthria
- Dysphagia
- Dysphonia
- Dyspnoea
- Hypercapnia
- weakness
- Lethargy
- Mydriasis
- Nausea
- Wheezing breath
- Stiffness in the muscles of the back and neck
- Drowsiness
- Constipation
- Dizziness
- Double vision
- Blurred vision
- He retched
Further indications
The symptoms of food botulism arise abruptly; usually, they start 12-36 hours after ingestion of the toxin, but the incubation period can vary from 4 hours to 8 days. Nausea, vomiting, abdominal cramps and diarrhea precede neuromuscular disorders. This is followed by general weakness and flaccid paralysis (ie the musculature is hypotonic). The paralysis is typically bilateral, symmetrical and progresses following a descending pattern, starting from the cranial nerves towards the peripheral and respiratory muscles. Neurological symptoms and signs include dry mouth, double or distorted vision, fixed and dilated pupils, lowering of the upper eyelids, difficulty speaking and swallowing. The respiratory muscles, extremities and trunk become progressively weaker. Constipation is frequent. There are no sensory deficits and even fever is absent. The greatest danger to life comes from respiratory damage and its complications (paralysis of the diaphragm, pulmonary infections and respiratory failure).
Similar symptoms are those given by wound botulism, with the difference that gastro-intestinal symptoms are not evident with respect to the diet.
Infant botulism, on the other hand, shows constipation followed by neuromuscular disorders. The newborn is lethargic and shows difficulty both in crying (weak crying) and eating (poor sucking). Other symptoms typically include palpebral ptosis, extraocular muscle paralysis, reduced muscle tone and expressionless face.
Diagnosis is confirmed by isolating the organism or demonstrating the presence of the C. botulinum toxin in serum or faeces. Descending flaccid paralysis, the absence of fever and the maintenance of the state of consciousness are characteristic signs to define a case of botulism. The therapy involves the administration of a specific antitoxin, which binds to the toxin still in circulation making it inactive. In addition, supportive measures are provided, such as artificial ventilation.
