Clinical Signs and Symptoms of Botulism

The toxin affects the central nervous system: medulla oblongata, nuclei of the cranial nerves. The following is affected more often:

· nuclei of oculomotor nerve — ptosis (a sinking down of the upper eyelid), anisocoria (unequal pupils of the eyes), ill-sustain accommodation;

· nuclei of ophthalmic nerve — blurring of vision, visual impairment;

· nuclei of glossopharyngeal and hypoglossal nerve — speech disturbance up to aphonia (the person cannot speak), difficulty in swallowing — dysphagia (the person cannot drink water);

· nuclei of facial nerve — disappearance of mimic and chewing muscle tonus of one half of the face;

· nuclei of vagus nerve — the increase of pulse rate at a normal or lowered temperature, defecation is normal or there is a tendency to constipation (as compared to other microbe food poisonings, it is a very important differential symptom!).

Then there may be spasms, pains in muscles, affection of vasomotor, respiratory centers of the central nervous system and death. The mortality of non-treated botulism is up to 70 %, at treatment — up to 30 %.

Treatment of Botulism

It includes introduction of antibotulinic serum or anatoxin (15,000 IU, recurrent introduction of a 5,000 IU dose in 5 hours). On taking suspicious food prophylaxis is necessary, namely introduction of serum in a dose of 2,000 IU.

Prevention of Botulism

There should be strict observance of temperature technology in cooking tinned goods, dried fish, meat. At household conservation small jars should be used and long boiling should be applied, the storage of canned food should be at temperature less than 10°C.

Food Poisonings of a Non-Microbe Etiology

Poisonings with Poisonous Mushrooms (Toadstools)

Poisoning with Death-cup

It is the most poisonous mushroom containing ammonitotoxinand ammonitohemolysin. They block all kinds of metabolism, primarily carbohydrate and water ones. This type of poisoning results in acute gastroenteritis — a cholera-like diarrhea, dehydration of organism, disturbance of the central nervous system and cardiovascular system (a sharp fall of the arterial blood pressure). In blood hemolysis (destruction of erythrocytes) occurs manifested in skin paleness, as well as acute hepatic insufficiency (destroyed parts of erythrocytes go with blood to liver) manifested in icteritiousness of skin. Death may result from collapse at affection of the CNS.

Poisoning with Fly-agaric

This mushroom has an atypical appearance, sometimes disguising itself as an edible mushroom. It contains muscarine and mycoatropine causing changes of m-cholinergic nervous system. The symptoms include: gastroenteritis, perspiration, lacrimation and salivation, mydriasis. Affection of the central nervous system is according to the type of alcoholic intoxication. Death results from paralysis of the respiratory centre of CNS.

Prevention of Poisonings with Poisonous Mushrooms

· The population should get acquainted with poisonous mushrooms in the course of sanitary-educational work, including lectures, conversations, posters, mass media (TV, radio).

· Supervision of markets, places of mushroom sale — mushrooms should be sold only with the sanction of the sanitary physician's assistant. The sale of mushroom salads and mixtures is forbidden.

Poisonings with Poisonous Wild Plants

These poisonings are most common in a child's age.

Plants containing m-cholinolytics, i.e. atropine, hyosyamine, scopolamine are belladonna, henbane, stramonium. The symptoms are gastroenteritis and mydriasis (belladonna is from Latin “a beautiful woman” — in the Middle centuries women dropped the solution of belladonna into their eyes which thus became dark and beautiful), spasm of accommodation (visual impairment for close distance), dryness and reddening of skin and mucous membranes. At poisoning with stramonium, henbane there are also visual and acoustic hallucinations with central nervous system depression. Death occurs from cardiac abnormalities. In case of recovery the remote effects on CNS, e.g. amnesia (loss of memory), etc., may occur.

Cicuta (cicutoxin). In Ancient Greece it was used for suicide. Children use its stems as whistles. In case of poisoning excitation is changed by CNS depression. Loss of consciousness, spasms, mydriatic pupils, cold perspiration, breathlessness, cyanosis are characteristic. Death may occur in 2-3 hours from respiratory paralysis.

Spurge-flax. Myserin producesan irritating action resulting in bloody vomiting, diarrhea. Daphin causes CNS and cardiac abnormalities. 10-12 berries cause a lethal outcome.

Wild grapes. They contain brionin causing severe gastroenteritis, excitation, then CNS depression. Death is due to collapse. A lethal dose for adults is 40 berries, for children — 15 berries.

Prevention of Poisonings with Poisonous Plants

· Destruction of these plants on the territory of children's preschool establishments

· Supervision over children in the parks. Carrying out the sanitary-instructive work with tutors.