Botulism: diagnosis

Diagnosis of botulism is based on epidemiological data (the use of canned food at home, group diseases) on a comprehensive analysis of the clinical picture of the disease: the characteristic localization and symmetry of lesions of the nervous system, the absence of febrile-intoxication, cerebral and meningeal syndromes.

Detection of botulinum toxin in the blood serves as an absolute confirmation of the diagnosis. The pH of botulinum toxins is used by antitoxic sera by bioassay on white mice. For this, it is necessary to take the patient 15-30 ml before the administration of the antitoxic antitoxic antitoxic serum. Venous blood. The study allows for 8 hours to determine the presence in it of botulinum toxin and its type. Similar studies are carried out with gastric washings or vomit, bowel movements, remnants of a suspicious product.

To isolate the causative agent of botulism, cultures of the contents of the stomach, feces, and suspicious products are produced on special nutrient media: (Kitta-Tarozzi, casein-mushroom, Hottingera broth, etc.). However, additional time is required to determine the serological type produced by the toxin pathogen. Studies on the determination of toxin and the isolation of the causative agent are subject to sectional material, and in cases of wound botulism, it separates from the wound, pieces of tearing off necrotic tissue, tampons from the wound. Botulism of infants is confirmed by determining the botulinum toxins in their blood and / or pathogens in the bowel movements.

[1], [2], [3]

Indications for consultation of other specialists

If necessary, consultation of the surgeon (permanent pain syndrome at the onset of the disease), a neurologist (cranial nerves paresis, peripheral polyneuropathy), a cardiologist (myocardial damage syndrome), an intensive care specialist (respiratory disorders, multiple organ failure) are indicated.

Indications for hospitalization

If suspected of botulism, emergency admission to the intensive care unit or intensive care unit is indicated. All patients, regardless of the timing of the disease, already need a probe stomach flushing at the pre-hospital stage, after which they should be given orally injected with enterosorbents (activated carbon, dioctahedral smectite, lignin hydrolyzed, povidone, microcrystalline cellulose, etc.). Activation of diuresis due to hemodilution (intravenous infusion of crystalloids and 5% albumin in a 3: 1 ratio) is shown.

Example of the formulation of the diagnosis

Botulism, severe course; respiratory insufficiency II degree, aspiration pneumonia.

[4], [5], [6], [7], [8], [9]

Differential diagnosis of botulism

Differential diagnosis of botulism should take into account the signs that exclude botulism. These include meningeal symptoms, pathological changes in the cerebrospinal fluid, central (spastic) paralysis, sensitivity disorders (alternating paralysis), convulsions, impaired consciousness, mental disorders, as well as the syndrome of general infectious intoxication with a developed picture of neurological disorders (in the absence of signs of secondary bacterial complications).

Certain difficulties in diagnosis may occur in the initial period of botulism in acute gastroenteritis syndrome. In such cases, there is a need for differential diagnosis with food-borne diseases. With botulism, vomiting, diarrhea short-term, are rarely accompanied by a febrile-intoxication syndrome, and close examination and subsequent targeted monitoring can reveal muscle weakness, hyposalization, as well as neurological disorders, especially visual acuity disorders.

Differential diagnosis of botulism with myasthenic syndrome uses samples with acetylcholinesterase drugs (neostigmine methyl sulfate). Which, with botulism, do not have a therapeutic effect. It should be borne in mind that with botulism pareses or paralysis are always bilateral, although they may differ in their severity.

Differential diagnostics of botulism with diphtheritic polyneuritis is necessary. It is necessary to take into account the angina with high fever preceding neurological disorders, as well as frequent severe myocardial lesions, the timing of development of polyneuropathy (in the case of toxic forms of diphtheria, peripheral nervous system damage, with the exception of cranial nerves, is observed after the 40th day of the disease).

Viral encephalitis is distinguished from botulism by the presence of focal asymmetric symptoms, which appears a few days after systemic symptoms, such as headache, myalgia. General malaise, etc .; aggravation of symptoms of cerebral symptoms (headache, nausea, vomiting, meningeal signs), disorders of consciousness (stunning, sopor, stupor, psychoemotional agitation), fever with neurological deficit; inflammatory changes in the cerebrospinal fluid.

Acute disorders of cerebral circulation in the basin of vertebral and basilar arteries also often have to be differentiated from botulism, since in the symptom complex usually register diplopia, dysphonia, dysphagia, dysarthria. Distinguishing symptoms - asymmetry of the lesion, frequent prevalence of severe dizziness and / or ataxia, sensitivity disorder in the trunk and extremities of the hemitipype (hemiparesis is rare), and this pathology does not affect the respiratory musculature.

Guillain-Barre syndrome is an acute demyelinating polyneuropathy (most cases are caused by herpes viruses). Especially difficult is the differential diagnosis of botulism with a variant of Guillain-Barre syndrome, which occurs with ophthalmoplegia, areflexia and ataxia (Fischer syndrome). The distinctive features are that sensitivity is almost always impaired, and the protein content in CSF is often increased.

[10], [11], [12], [13], [14], [15]