Botulism is a notifiable, life-threatening poisoning caused by a potent neurotoxin. Botulism is also known colloquially as meat poisoning or sausage poisoning.
What is botulism?
Botulism is the technical word for poisoning caused by the metabolic product of the bacterium Clostridium (Cl.) botulinum,. This is the most potent neurotoxin known to us. The disease is caused by germs that were found in spoiled sausages when they were first described. This is the origin of the Latin name Botulus for sausage. In Germany, only a few cases of botulism in humans are reported each year. Consumers can prevent the disease to a large extent by handling food correctly. Botulism occurs very rarely in Germany. Approximately 20 cases are reported to the Robert Koch Institute each year. However, since an illness often leads to the death of the person affected, botulism is a serious disease that requires immediate treatment by a physician. Even the suspicion of botulism is reportable. Botulism is not contagious. Botulism does not only occur in humans. Also among our domestic and farm animals, especially ruminants, there is an outbreak of the disease in again and again.
Causes
If certain circumstances come together, the botulism bacterium can produce toxins in the absence of oxygen, which damage the nerves and result in the actual poisoning. Today, various routes are known by which the pathogens for botulism can enter the human body. In Germany, the cause is usually the consumption of food contaminated with toxins, especially meat. Canned foods can also be affected. The problem is that contaminated foods cannot be distinguished from harmless foods in terms of odor or appearance, and a possible health risk cannot be guessed at by the layperson. The botulism toxin can also enter the bloodstream via open wounds and later reach the nerves. In newborn babies, intestinal colonization with Cl. botulinum is also conceivable in very rare cases. This is due to the fact that the bacterium can only germinate in the intestine during the first few months and form toxins there. In children who have completed the first year of life as well as in adults, this form of botulism is unlikely. Recently, a connection between high-input farming and the development of botulism has also been discussed in our country. However, there are no official results or recommendations on this yet.
Symptoms, complaints, and signs
In foodborne botulism, the first symptoms appear about 2 to 48 hours after the body has absorbed the bacterial toxin. The toxin causes severe impairment in the transmission of signals between nerves and muscles. This in turn results in paralysis of the affected muscles. In most patients, the eye muscles are affected first, as evidenced by blurred vision, sensitivity to light, or the perception of double vision. In addition, the eyelids become heavy and can hardly be held open. Botulism is accompanied by typical symptoms. These primarily include nausea, vomiting and diarrhea. In addition, the nerve cells are also damaged by the bacterial toxins, resulting in signs of paralysis all over the body. The palate, lips and larynx are particularly affected. As a result, the patient suffers from dysphagia. This in turn increases the risk of the sufferer swallowing. Another common sign of botulism is the cessation of saliva production, resulting in dry mouth. If the poisoning progresses further, the internal organs also suffer. After three to eight days, there is even a threat of life-threatening respiratory paralysis. Without professional treatment, this can have a fatal outcome. Although the symptoms of botulism are extremely severe, the patient’s consciousness is not affected.
Diagnosis and course
In botulism, the physician usually makes the diagnosis based on the typical symptoms. For this purpose, he asks the patient what foods he has recently eaten. A blood sample is then taken and tested for botulinum toxin in the blood serum. If necessary, a further stool sample is also taken.In most cases, the result of the diagnosis has already been established. Occasionally, a differential diagnosis for other gastrointestinal diseases must also be made in order to exclude them. First, the neurotoxin travels through the bloodstream to the site where it exerts its damaging effect – the nerve cell. Here, the toxin blocks signal transmission from the central nervous system. Within a few hours, sufferers complain of nausea, diarrhea, constipation, dysphagia and dry mouth. Paralysis of the muscles occurs. The muscles become flaccid. This can eventually affect the respiratory muscles, which are vital to us.
Complications
Botulism can lead to several complications. First, botulism makes it difficult to speak and swallow, which can cause inflammation to develop in the throat. In extreme cases, the symptoms develop into pneumonia, which, in conjunction with the underlying condition, can be fatal. Frequently, meat poisoning results in respiratory paralysis, which leads to death if left untreated. In severe cases, botulism can lead to cardiac arrest. Food poisoning often continues to affect those affected long after recovery. Physical lassitude often remains and paralytic symptoms can develop into permanent paralysis. Breathing problems often occur after respiratory paralysis, which can lead to headaches, difficulty concentrating and panic attacks. Less commonly, respiratory paralysis can lead to oxygen deprivation and its consequences. Because of its far-reaching complications, botulism should be treated as soon as possible. If food poisoning is treated and cured early, there is usually no long-term damage left behind. If left untreated, the disease takes a fatal course in 25 to 70 percent of cases. A medical clarification of the complications is therefore recommended in any case
When should you go to the doctor?
If botulism is suspected, a doctor should be consulted immediately. If the poisoning is adequately treated in time, only extremely rarely long-term damage remains. However, the situation is quite different if the poisoning is not treated professionally. Then there is not only a risk of severe complications and long-term damage, but there is also a significant risk of dying from the poisoning. In Germany, botulism is predominantly caused by the consumption of contaminated meat and sausage products, including canned food. For the consumer, the tainted food is not always recognizable by an altered appearance or odor. Therefore, as soon as botulism symptoms appear after consuming meat or sausage products, a doctor must be consulted immediately, even if the food consumed appeared completely normal. Typical signs of meat poisoning are nausea, vomiting and diarrhea, especially in conjunction with muscle paralysis, speech disorders and difficulty swallowing. As soon as patients notice these symptoms, a doctor must be consulted immediately. In severe cases, botulism can lead to acute respiratory paralysis and cardiac arrest. Therefore, if symptoms are pronounced, no time should be wasted and emergency medical attention should be sought immediately.
Treatment and therapy
Affected persons belong immediately to medical treatment. Mostly, however, botulism is recognized late by the doctor, because he initially concludes more harmless gastrointestinal diseases. This is especially true if the person is the only one or the first of several people who have consumed affected food. The attending physician can administer an antidote and detect the pathogen using blood or stool samples. If botulism is detected in time, there is a good chance that affected individuals can be completely cured. Sometimes the neurotoxin can remain in the body for several months, so that treatment takes a long time. Affected persons are cared for in the intensive care unit in the hospital, at least for the first few days. Gastric lavage is used to move food debris out of the body, while medication is used to relieve discomfort and an antidote is used to deactivate the nerve agent.
Outlook and prognosis
The prognosis for botulism depends quite significantly on how severe the poisoning is, how quickly it is recognized, and whether the patient receives immediate intensive medical care.For young children, in the case of infant botulism, as well as older persons or those already in poor health, a prognosis must also be more pessimistic than for healthy patients. If left untreated, the mortality rate for botulism is 70 percent or more because the botulinum toxin causes paralysis that can affect the heart or respiratory muscles. In these cases, cardiac arrest or respiratory paralysis occurs. In survivors, paralysis of the cranial nerves and hypoxia of the brain can lead to permanent damage in some cases. If botulism is detected in time and treated with intensive care, the prognosis is much more positive. The mortality rate is significantly reduced to less than ten percent. However, patients must be prepared for a lengthy rehabilitation period. The paralysis symptoms caused by the botulinum toxin regress only very slowly, over the course of several months. Beyond that, however, permanent damage is rare. As a rule, patients can lead a normal life after overcoming botulism.
Prevention
Botulism can be effectively prevented. For this purpose, attention should be paid to certain things in connection with food. Thus, it is advisable not to consume food from bloated cans. In addition, care should be taken to strictly maintain the cold chain for heat-sensitive foods and to follow the storage recommendations printed on the packaging. Honey does not belong on infants’ pacifiers. When food is preserved in one’s own kitchen, as is the case when canning vegetables, sterilization is recommended. This means heating the food to 100 degrees Celsius for a short time. If this is not possible, double heating can also kill botulism spores and prevent them from multiplying further.
Aftercare
In milder cases, no follow-up care is necessary. The patient can continue to live without symptoms and is discharged from medical care. However, this does not mean that immunity to botulism has developed. Poisoning with the bacterial toxins is possible again. Those affected have no choice but to take suitable precautionary measures. In the Western European world, these include avoiding food from damaged tins and jars. If meat is cured and fish pickled, it is essential to comply with current hygiene standards. Strong heating of the food has been shown to kill the pathogens. Preventing a recurrence of the disease requires a high level of personal responsibility in everyday life. Botulism does not always progress gently. Symptoms such as respiratory weakness and paralysis are sometimes still noticeable months and years later. The patient must then present himself regularly to his attending physician. He orders a blood and stool sample to determine the state of recovery. Paralysis can usually be alleviated with medication. Affected individuals are advised against physical exertion during follow-up care. Botulism does not usually lead to permanent damage, which is why, with appropriate therapy, complete freedom from symptoms is achieved. Especially in older persons, healing often takes an unusually long time.
What you can do yourself
Botulism is a life-threatening disease. Self-treatment is strongly discouraged. Affected persons must seek medical treatment immediately. However, if the general condition improves, measures can be taken to support the body in the healing process. Since the poisoning also paralyzed the gastrointestinal tract and, in addition, often required artificial feeding, it is important to build up the diet slowly. Flatulent and highly irritating foods should be avoided. Sufficient drinking – ideally mineral-rich still water – should be ensured. When digestion gets going again, the diet should contain plenty of fresh vegetables and whole grain products. The body uses up its stores of fat and minerals during the illness, and these need to be replenished. It is also possible to take dietary supplements, which provide micronutrients in concentrated form. Light walks in fresh air stimulate digestion and the immune system again. The body can also be supported in the healing process homeopathically. In the acute phase of the disease Arsenicum album is the first choice remedy for food poisoning.Subsequently, the Schüssler salts number 3 (Ferrum phosphoricum), 6 (Calium sulfuriucim) and 7 (Magnesium phosphoricum) can be taken as an immune cure in tablet form. In order to compensate for the side effects of antibiotic treatment, the accompanying intake of probiotics is recommended. These enable the intestine to be repopulated with healthy intestinal bacteria.
