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PROBLEMS OF COURSE, CLINICAL AND DIAGNOSTIC PROBLEMS
OF BOTULISM IN FERGANA PROVINCE
Babadjanova H.M.
Khabibullaeva S.A.
Fergana Medical Institute of Public Health
https://doi.org/10.5281/zenodo.15254043
Abstract:
In this article, the complicated course of botulism in children of
school age is presented in clinical observation. Also, the tactics of laboratory
tests, treatment approach and clinical effectiveness of treatment are indicated.
Key words:
botulism, botulotoxin, dysphagia, aphonia, apnea, tachypnea,
ptosis, diplopia, mydriasis, anisocoria.
Relevance:
Botulinum neurotoxin is one of the most potent and lethal
substances. As little as 1 ng/kg can be fatal to humans. Scientists estimate that
about 1 g of botulinum toxin is capable of killing 1 million people. Since even
small amounts of the toxin are lethal, it could be used as a weapon of
bioterrorism. All forms of botulism are fatal and are considered emergencies.
The toxin is rapidly absorbed by the digestive system, so many people are
poisoned even after consuming small amounts of contaminated food.
The surviving history of botulism: The disease was first linked to German
sausage in 1735. The infectious disease was associated with food poisoning after
eating sausage. In 1870, a German physician named Müller named the disease
botulism, after the Latin word for sausage. The Clostridium bacteria were first
identified in 1895, and the neurotoxin was isolated by Dr. Edward Schantz in
1944. Botox was approved for use by the Food and Drug Administration in 2002
for cosmetic improvement and wrinkle reduction.
According to statistics, from 1735 to 1924 there were 4144 cases of
botulism in Western Europe, of which 1271 people died. There have been 417
botulism outbreaks in France, with more than 1,000 deaths. There were 101
outbreaks of botulism in Russia from 1818 to 1913, during this period, 609
people fell ill and 283 people died (46.8%). From 1920 to 1939, according to
press reports, there were 62 botulism epidemics in the former USSR, 674 people
fell ill and 244 people died (36.2%).
Clinical features:
The incubation period of the disease is from 2 hours to 8
days. Symptoms of foodborne botulism usually begin 18-36 hours after eating
contaminated food, but symptoms can appear as early as 6 hours or as late as 10
days.
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The classic symptoms of botulism include: blurred vision, drooping eyelids,
slurred speech, difficulty swallowing, dry mouth, and muscle weakness (leading
to flaccid paralysis).
Differential diagnosis:
The patient's history and physical examination may
suggest botulism, but these tests alone are not sufficient to diagnose botulism.
The symptoms of botulism are similar to those of other diseases, such as stroke,
Guillain-Barré syndrome (another disease that causes muscle paralysis), and
myasthenia gravis (a condition that causes drooping eyelids). Special tests are
required to rule out these other diseases. The most direct way to confirm the
diagnosis is to detect botulinum neurotoxin in the patient's blood or feces. This
is done by injecting the patient's blood or feces into a mouse. An equal amount of
blood or feces is taken from the patient, neutralized with antitoxin, and injected
into the mice. The same sample is injected into another mouse without
neutralization. If the disease is present, the first mouse survives and the second
dies. These tests help distinguish botulism from infectious diseases caused by
Escherichia coli, salmonella and other bacteria.
Results of a special study:
Botulism is considered a seasonal disease, and
botulism cases among the population are mainly recorded from November to
May.
Биз 1-жадвалда Республика ихтисослаштирилган эпидемиология,
микробиология, юқумли ва паразитар касалликлар илмий-амалий маркази
Фарғона филиалида 2017-2023 йилларда ботулизм ташхиси билан ётиб
даволанган беморлар тўғрисидаги маълумотларни келтирдик.
Table 1
The occurrence of botulism in adults and children
№
Years
Total number
of cases
Adults
Children
1
2017
4
3
1
2
2018
12
11
1
3
2019
6
6
4
2020
6
5
1
5
2021
10
8
2
6
2022
6
5
1
7
2023
10
8
2
The table shows that the disease is 3-5 times more common in adults than
in children. The main reason for this is the fact that the elderly population loves
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to consume products such as pickled cucumbers, tomatoes, squash, peppers,
mushrooms, canned cabbage, eggplant caviar, and smoked fish prepared at
home.
Clinical observation:
During practical training at the Fergana branch of
the Republican Specialized Epidemiology, Microbiology, Infectious and Parasitic
Diseases Scientific-Practical Center, M. A 16-year-old patient named.
Patient's complaint: According to the doctor who brought him in - a
resuscitator, relatives (aunt, aunt), and the staff on duty: inability to swallow,
nausea and vomiting, general weakness, helplessness, dizziness, staggering like
a drunk, weakness in the legs and arms, inability to breathe independently,
increased div temperature, drooping eyelids and numbness, seeing things in
pairs and changing his voice in the first few days, and discomfort when moving
his legs and arms while lying down.
Epidemiological history: On 06.12.2023, the patient opened and drank
canned tomato-cucumber juice at home with his father during lunch. In the
morning, he had breakfast and went to school. According to the school nurse, he
complained of headaches and dizziness throughout the day. When he came
home, his brother gave him tea and bread, and he felt nauseous and vomited.
Since the vomit was brown, he was taken to the Zilkha emergency department of
the Altiarik district. He has not received injections in the last 6 months and has
not traveled abroad. The patient has not received blood or blood products.
On examination: The patient's general condition is serious during the
examination. The response to vision is inadequate. He is unconscious, responds
by moving his hands when asked in a loud voice, and the reaction to the
environment is very weak. Muscle tone in the limbs is reduced. Breathing is
through an endotracheal tube. The pupils are OD=OS, dilated, there is no
photoreaction to light. He cannot swallow, a nasogastric tube is inserted. The
patient is lethargic, listless. The palms of the hands and feet are numb, and his
movements are involuntary. He answers questions slowly with gestures. His
eyelids are somewhat numb, drooping (ptosis), and his face is swollen. An
intubation tube is tamponade in the oral cavity. The div is straight, there are
no deformities or peripheral edema. Neck muscle rigidity and meningeal signs
are negative. Peripheral lymph nodes are not enlarged and are not palpable. Lips
and tongue are dry, with a runny nose. Body temperature is 37.0C. The skin and
visible mucous membranes are slightly pale, the skin is clean and dry. Coarse
breathing is heard in the lungs against the background of the ventilator. Heart
sounds are rhythmic, muffled, Pulse - weak, full and tense in the periphery, 96-
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100 times per minute, arterial blood pressure is 96/42 mmHg. The abdomen is
soft, but there is no breath, no pain. The liver and spleen are not palpable.
Intestinal peristalsis is audible. The stool is yellow, slightly liquid, brown in
color. Conclusion: The patient's condition is extremely serious, with intoxication
of the div, bulbar syndrome, respiratory failure grade 3, and heart failure
grade 2 due to respiratory distress syndrome.
Initial diagnosis: Botulism. Bulbar paralytic form. Very severe.
Complications: acute respiratory failure grade 3, acute cardiovascular failure
grade 2.
Conclusions:
1. Due to the rarity of the disease, in many cases, doctors neglect to collect
epidemiological history, leading to diagnostic errors. According to the results of
clinical and epidemiological studies, in many cases, instead of botulism, the
diagnosis is made with acute intestinal infection, acute cerebral circulation
disorder, myasthenia gravis, hypertensive crisis, encephalitis.
2. During the seasonal outbreak of the disease, conduct sanitary and
educational work on the origin and complications of botulism among medical
workers, workers of industrial enterprises, organized and unorganized youth,
and community citizens' meetings.
3. A general practitioner must have the necessary and sufficient knowledge
for early detection of botulism and provision of emergency care. Early diagnosis
and timely pathogenetic treatment reduce the complications and mortality of
botulism.
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