What is Botulism in Children?
Botulism is an acute infectious disease that affects the central and vegetative nervous systems of the type of flaccid paralysis.
Botulism first affects the bulbar musculature, and then somatic.
Infections are mainly transmitted by herbivores, for example, goats, cows, horses, etc. Clostridium hotulinus, the causative agent of the disease, which accumulates in the environment and turns into spores, accumulates in their intestines. As such, it can persist for many years. From the soil Clostridium hotulinus enters the food, where under the condition of lack of air, it germinates and releases toxins.
A person can be poisoned by any food that contains live microorganisms and free toxin. In most cases, poisoning occurs due to home-made canned food: eggplant caviar, pickled mushrooms, home-smoked fish, pumpkin juice, pork sausage, etc.
No infection is transmitted from person to person. The person is highly sensitive to botulinum toxin.
Causes of Botulism in Children
There are 7 types of botulism pathogens, which are indicated by Latin letters of the alphabet: A, B, C, D, E, F, G. The length of botulism sticks is from 4 to 8 microns, width is from 0.6 to 0.8 microns. They are mobile, in a form similar to tennis rackets because of the dispute, which is located at the end of them.
Botulinum toxin is destroyed within half an hour when heated to 80 ° C. In the stomach of a person, the toxin is not destroyed, but only enhances its action. Toxins A, B, C and E are dangerous for humans.
Pathogenesis during Botulism in Children
The disease begins when botulinum toxin enters the gastrointestinal tract. Rarely, infection can occur when microorganisms are injected into extensive wounds (with wound botulism) or into the respiratory tract (if the toxin is sprayed in the air). A person can become infected if he chewed contaminated food but did not swallow it.
The toxin is absorbed in the stomach and, to a small extent, in the upper small intestine. Botulinum toxin is a strong vascular poison. It leads to a sharp spasm of blood vessels, which leads to pallor of the skin, impaired vision, dizziness, unpleasant sensations in the heart.
The blood vessels toxin reaches all organs and tissues, which leads to their defeat. Nervous tissue is most sensitive to botulinum toxin. The disease primarily affects the motor neurons of the spinal and medulla. This leads to paralytic syndrome and bulbar disorders (impaired speech, swallowing).
After the transfer of the disease, the anti-toxic and antimicrobial antibodies remain in the child’s body. Formed type-specific immunity. Repeated diseases occur – when infected with other serovars of the pathogen.
All organs are hyperemic and edematous, with many small and large hemorrhages in the gastrointestinal tract, liver, kidneys, lungs, spleen, etc. There is a plethora of brain tissue, with blood clots, hemorrhages, stasis, degeneration and necrosis of the vascular epithelium. Maximum changes are recorded in the region of the medulla oblongata and the brain bridge.
Symptoms of Botulism in Children
From several hours to 10 days the incubation period can last. On average, it is from 5 to 24 hours. Its duration depends on the dose of infection that has entered the body, on the presence of living microorganisms in food and susceptibility, which is determined by the state of the gastrointestinal tract, overall reactivity, etc.
If a large dose of botulinum toxin has been infected, the incubation period lasts from 2 to 10 hours. In such cases, the disease is particularly difficult. First of all, symptoms such as bulbar disorders and visual impairment occur. Before the eyes can be “flashing”, “fog” or “grid”, objects “split”. Reading is difficult due to the above violations.
Pupils are dilated, react poorly to light or do not react at all. Also observed are the following symptoms:
- swallowing violation
- slurred speech
- extended words
- tongue immobility
- aphonia (sometimes)
- dry mouth
- dry mouth mucous membranes
- soft sky dangling
- decrease or absence of the pharyngeal reflex.
The progression of the disease leads to respiratory disorders:
- lack of air
- pauses during a conversation
- chest tightness
- shallowness of breath
- intermittent breathing
- increasing cyanosis.
Paralysis of the respiratory muscles can occur, leading to respiratory failure and death.
If a small amount of toxin enters the gastrointestinal tract, dyspeptic symptoms occur first. In such cases, the incubation period is longer – 2-10 days or longer.
The disease begins with these symptoms:
- abdominal pain (cramping)
- relaxation of the stool without pathological impurities in the feces
- likely constipation.
The patient is very thirsty, complains of dryness of the mucous membranes of the oral cavity, experiences general weakness, dizziness, headache, anxiety. Temperature is normal or slightly elevated. In rare cases, it can rise to 38–39 ° C in the first two days of illness. Also in these patients in the first 2 days of the disease dyspeptic disorders are noted. Then symptoms that reflect CNS damage, such as a disorder of swallowing, vision, respiration, etc., appear.
In botulism, the pathological process applies to all organs and systems. Myasthenia is manifested by severe weakness, increased fatigue. In frequent cases, the child does not hold his head, can not stand.
Due to vasospasm, the patient’s skin is pale. The deafness of heart tones, systolic murmur as a result of toxic myocarditis, expansion of the borders of the heart are recorded.
Some sick children may have urination problems due to spasm of sphincters. Enlarged liver and spleen is not observed. Consciousness is maintained, despite the severe damage to the central nervous system.
A blood test shows moderate leukocytosis with neutrophilia and a stab shift, a slightly increased ESR.
The severity of botulism in children depends on the severity of the nervous system. In severe cases, the symptoms of respiratory failure, which often leads to death, are exacerbated. If the outcome is favorable, the body is restored 3-5 months. For a long time, increased fatigue, general weakness, palpitations during physical exertion, pain in the region of the heart.
Disease relapses may occur (rarely). There are also erased forms of botulism in children – there are no signs of CNS damage, there are visual and swallowing disorders that quickly pass.
Diagnosis of Botulism in Children
The main characteristic manifestations of botulism in children are disorders of swallowing, vision, breathing and speech. Botulism is indicated by a combination of symptoms of the central nervous system with pale skin, severe muscle weakness, dizziness, and dry mouth. Doctors need to be informed about canned foods that the child consumed in the coming days.
Diagnosis requires the use of laboratory techniques. The toxin or pathogen is found in the biological material of a sick child — vomit, blood, feces, urine, etc., and in food that the patient consumed and could get infected with.
Botulism is distinguished from food toxicoinfections by staphylococcal, salmonella, and other etiologies, poisoning by fungi, atropine, and belladonna. Differentiation of botulism with viral encephalitis, polio, diphtheria is also necessary.
Treatment of Botulism in Children
Patients with suspected botulism must be hospitalized. To remove the toxin, immediately wash the stomach and clean the intestines. To neutralize the botulinum toxin, specific serum according to the card is used. Since in the first days of the disease the type of botulinum toxin is unknown, a polyvalent anti-totulinic serum is prescribed. When the type of pathogen is installed, apply a specific serum.
Simultaneously with serum treatment, chloramphenicol is applied for a course of 1 week. Doctors can prescribe ATP to the patient, heart remedies, multivitamins. The fight against intoxication is carried out with intravenous infusions of reopolyglucine, etc. Physiotherapy procedures are also recommended.
Prevention of Botulism in Children
Among the preventive measures is important sanitary and educational work. People should be aware of the rules for preparing food at home – what hygienic standards should be followed when canning, handling and storing food.
Can not be used in food canned swollen cans. Contamination of meat products, fish, vegetables, etc. should be avoided. For group diseases of botulism, all individuals who have consumed a suspicious product are injected with intramuscular prophylactic serum of 500-1000 IU of each type for preventive purposes. In the outbreak establish observation during the maximum incubation period, most often the period is 10-12 days. Conduct active immunization with the use of tetra – and trianatoxin.