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Clostridium Botulinum Infection: Treatment and Prevention


The article was written by Dr. Vu Huu Thang - Emergency Resuscitation Department - Vinmec Ha Long International Hospital

Clostridium Botulinum is a gram-positive, rod-shaped, spore-forming, facultative anaerobic and motile bacterium.

1. Overview of Clostridium Botulinum (C. Botulinum)


Clostridium Botulium was first recognized and isolated in 1896 by Emile Van Ermengem, originating from a facility that processed pork thighs (ham) contaminated with toxins from C. Botulium bacteria. Spores of C. Botulium exist quite commonly in nature: soil, water, air, animal feces... they have high viability, can withstand temperatures of 1000C for many hours. The most basic feature of C. Botulium is the production of neurotoxins, 7 of which have been identified (A, B, C, D, E, F, G). Botulium toxin is essentially a protein, with a molecular weight of about 150 thousand Daltons, easily destroyed by boiling temperature (1000C). Only types A, B, E, and F cause disease in humans.

2. The risk of Clostridium Botulinum infection


Food: especially canned meat, vacuum food (seafood, sausage, vegetables...), anaerobic environment creates conditions for bacteria to produce toxins. Wounds infected with C. Botulium, especially deep wounds, many nooks and crannies (common in subjects who inject drugs). Newborns < 12 months old: susceptible to C. Botulium infection from the environment, this child's digestive system is also a favorable environment for bacterial growth (weak acid, anaerobic). Honey consumption during the first years of life is a risk factor for C. Botulium infection.
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3. Botulinum poisoning mechanism


Botulinum irreversibly binds to presynaptic terminals, cleaves important structural proteins on the asteroid terminal membranes and membranes of acetylcholine-containing vesicles, prevents the release of acetylcholine into the synaptic cleft, and inhibits neurotransmission. nerves in the motor, parasympathetic, and autonomic ganglia. Damaged synapses may require regrowth of axons and formation of new synapses. The central nervous system and sensation are not affected. Toxic dose: a dose of 0.09 mcg intravenously can cause death in a person weighing 70 kg.

4. Definitive diagnosis


Epidemiological factors: eating suspect food, undercooked, or left out for a long time, or sharing food with someone who is confirmed positive for C. Botulium. Usually onset after eating 12 - 36 hours (maybe 6 hours to 8 days after eating). Main clinical symptoms: + Gastrointestinal: early appearance, vomiting, abdominal pain, abdominal distension, functional bowel paralysis, constipation.
+ Nerve: the patient is awake, bilaterally symmetrical paralysis, originating from the head - face - neck area spreading to the legs, tendon reflexes are reduced, pupils on both sides are dilated, no sensory disturbances...
Respiratory: sputum sputum, respiratory muscle paralysis, respiratory failure ...
+ Urinary: urinary retention, bladder bridge
Tests: + Find C. Botulium in food or specimens (gastric fluid, vomit, feces...)
+ Find Botulium toxin in the blood
Lấy máu xét nghiệm
Tìm độc tố Botulium trong máu giúp bác sĩ chẩn đoán xác định

5. Treatment


Principles: + First aid and respiratory resuscitation are key: early detection of respiratory muscle paralysis, airway control, mechanical ventilation and associated resuscitation problems
+ Use of specific antidotes as soon as possible as soon as possible when there are indications
+ Report to the relevant authorities to jointly solve
Specific treatment: + Induce vomiting: recently eaten suspect food (before 2 hours)
+ Activated charcoal: 1g/kg body weight (combined with sorbitol equivalent dose)
+ Respiratory: Early intubation, often long-term mechanical ventilation
+ Digestion: feeding through gastric tube (pharyngeal paralysis)
+ Balance nutrition, electrolytes
+ Anti-ulcer, hospital infection

6. Antidote


Antitoxin botulinum is antibody/antibody fragments that specifically neutralize botulinum toxin
Current priority is Botulism Antitoxin Heptavalent (made from horses, neutralizing F(ab')2 antibody fragments. botulinum toxin types A, B, C, D, E, F, and G) Use when symptoms are evident, as early as possible, preferably before symptoms become severe Do not wait for results Toxicology test or new bacterial culture indicated for patient use
Botulism Antitoxin Heptavalent
Giải độc tố botulinum bằng Botulism Antitoxin Heptavalent

7. Prognosis


Food poisoning caused by botulinum toxin is severe poisoning, high mortality rate, prolonged paralysis time. The average time of mechanical ventilation is about 2 months before we can be weaned from the ventilator, but patients need many months to recover.

8. Prevention


With the authorities: strengthen the control of food hygiene and safety For the people: + Choose foods of clear origin
+ Be careful with sealed foods such as canned goods
+ Eat cooked , boiled (cooked will destroy Botulium toxins (if any))
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading doctors, medical system modern technological equipment. The hospital provides comprehensive and professional medical examination, consultation and treatment services, with a civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests here can be completely assured of the accuracy of test results.

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