Botulism: treatment

Mode and diet with botulism

Treatment of botulism in the first place consists in the appointment of a bed or half-bed regime.

Diet: table number 10, probing or parenteral nutrition, depending on the patient's condition.

Enteral feeding through the nasogastric tube is carried out, and it must be remembered that gastric feeding is preferable to duodenal. The method is infusion for 16 hours. Nutrient mixtures with a high energy density are preferred (for example, Isocal HCN, Osmolite HN), respiratory failure is Pulmocare. The volume of protein per day is determined from the calculation of 25 kcal / kg body weight and 1.5 g / kg body weight. With stagnant discharge from the stomach, they switch to parenteral nutrition with compulsory partial enteral nutrition at a rate of 2000-2500 calories per day per adult patient. Parenteral nutrition is carried out by concentrated solutions of glucose (10-40%), mixtures of amino acids and fatty emulsions.

Medicamentous treatment of botulism

Treatment of botulism consists in the introduction of antitoxic antibotulinum serum. Heterologous (horse) antitoxic monovalent sera are used. With an unknown type of toxin, a mixture of monovalent sera or polyvalent serum (10,000 ME of type A and E toxoid and 5,000 NLE of E type toxoid) is administered. Regardless of the severity of the flow, one treatment dose of serum is diluted intravenously, diluted in 200 ml of heated isotonic sodium chloride solution. To prevent anaphylactic reactions before the introduction of serum, 60-90 mg of prednisolone is administered. Serum is administered once. Before the introduction of serum, a test is carried out on Beside with serum diluted 100-fold. The presence of an allergic reaction in the formulation of a sample serves as a relative contraindication to the administration of a therapeutic dose of serum. In these cases, the preliminary dose of prednisolone is increased to 240 mg.

The specific antitoxic treatment of botulism is the administration of human anti-botulinum immunoglobulin.

In severe course, botulism treatment is primarily aimed at replacing or activating temporarily lost functions of the body. To do this, use certain principles of therapy.

• Reduction of the risk and consequences of aspiration of gastric contents in the respiratory tract.
  • Permanent nasogastric tube, with stagnant discharge - periodic gastric lavage.
  • At a high risk of aspiration, a prolonged intubation with a constantly inflated cuff. (25 cm of water is the maximum pressure that does not lead to tracheal injury.) It should be remembered that inflating the cuff of the tracheal tubes does not exclude the risk of aspiration of the secretion of the oral cavity into the lower respiratory tract.) Breathing in this case is carried out through the fan circuit (usually at This is one of the methods of auxiliary ventilation), since adequate heating and moistening of the respiratory mixture is necessary.
  • Assign drugs that reduce the acidity of gastric juice: ranitidine. Famotidine, proton pump blockers (omeprazole, esomeprazole, rabeprazole).
  • Preparations that improve the motor function of the digestive tract (domperidone, metoclopramide).
• Therapy of respiratory failure.
  • Fatigability of the patient with breathing, minimal feeling of lack of air, increased pCO2,> 53 mmHg. Serve as an indication for the transfer of the patient to auxiliary ventilation (even if there is no shortness of breath, participation of ancillary muscles, cyanosis and other symptoms of acute respiratory failure). Examples: CPAP (constant positive airway pressure), reduces the work of breathing; MMV (guaranteed minute volume). Patient set a stable minute volume - an allowable 6 l / min. If the volume of spontaneous ventilation 4 liters. Min. The remaining 2 l / min the patient will receive with the help of a respirator. PS (pressure support): for each attempt of inhaling the patient, the respirator brings the respiratory volume to the set pressure (permissible 20 cm of water).
  • Warming and moistening of the respiratory mixture, sputum stimulation (percussion of the chest, vibrating, vacuum massage), sputum removal (postural drainage, aspiration), oxygenation.
  • Normalization of acid-base balance, hemoglobin level, volume of circulating blood, cardiac output, body temperature, electrolyte composition of plasma.

When the myocardium is affected, it is necessary to appoint myocardial cytoprotectors (trimetazidine, carnitine, meldonium). The development of bacterial complications requires the appointment of antibacterial drugs with a wide spectrum of action. The introduction of immunoglobulins (human immunoglobulin is normal: octagam, pentaglobin) is shown in all terms of the disease.

Special intensive treatment of botulism, given the complex nature of hypoxia, is hyperbaric oxygenation.

All patients to suppress the activity of causative agents of botulism in the gastrointestinal tract and prevent the possible formation of toxin, prescribe chloramphenicol 0.5 g four times a day for 5 days. Instead of chloramphenicol, ampicillin can be administered 0.5-1 g four times a day inwards.

In cases of wound botulism, appropriate surgical treatment of the wound is performed, higher doses (up to 12-16 million units / day) of penicillin or other antibiotics are used.

Patients are discharged after clinical recovery.

Approximate terms of incapacity for work

The terms of incapacity for work vary greatly and are determined individually.

[1], [2], [3], [4], [5], [6]

Clinical examination

Not regulated. It is advisable to observe at least 6 months with the participation of a neurologist, an ophthalmologist and a cardiologist.

[7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]

What is the prognosis of botulism?

With the early introduction of anti-Buttulinum serum is favorable. Lethal outcomes are observed with late hospitalization, in persons with a burdened premorbid background.

How to prevent botulism?

Specific prophylaxis of botulism

In case of detection of cases of suspected products, they are subject to seizure and laboratory control, and those who used them together with the sick persons - medical supervision within 10-12 days. It is advisable to treat botulism with the help of intramuscular injection of 2000 IU of antitoxic anti-botulinum sera of types A, B and E, the appointment of enterosorbents. Active immunization is indicated only to persons who have or may have contact with botulinum toxins. Vaccinations are carried out with polyanatoxin three times at intervals of 45 days between the first and second and 60 days between the second and third vaccinations.

Nonspecific prevention of botulism

The prevention of botulism is strict adherence to the rules for the preparation and storage of fish and meat semi-finished products, canned products, smoked products, etc. Dangerous are canned home-made preparations, especially mushroom, since their home production does not provide heat treatment that has a harmful effect on the spores of botulinum pathogens. That is why before consuming such products, it is advisable to boil them in a water bath for 10-15 minutes, thereby achieving complete neutralization of botulinum toxin. However, it must be remembered that toxin perishes, and not spore forms, so when using the product again boiling should be repeated. In the prevention of botulism, it is essential to educate the public about the preparation of food that can cause poisoning with botulinum toxins.