Botulism: neurological symptoms under the guise of poisoning
The development of the disease is closely related to the transmission vehicle—most often home-canned mushrooms. The incubation period can be about 21 hours. The disease begins with dyspeptic phenomena (nausea, bloating, abdominal discomfort), followed rapidly by neurological symptoms.
The leading mechanism in pathogenesis is damage to the nervous system by botulinum toxin. Two main syndromes are distinguished:
- Ophthalmoplegic syndrome: manifests as double vision (diplopia), blurred vision, pupil dilation (mydriasis), drooping of the upper eyelid (ptosis), and restricted eye movement.
- Bulbar syndrome: characterized by impaired swallowing of solid food and choking on water (dysphagia), voice changes—hoarseness and nasal tone (dysphonia), and speech impairment (dysarthria). The pharyngeal reflex is diminished, and the soft palate has limited mobility.
Diffuse muscle weakness, dry mucous membranes, and amimia (smoothing of the nasolabial folds) are observed. Body temperature often remains subfebrile (around 37.2°C). The pre-hospital stage requires gastric lavage with sodium bicarbonate solution and urgent hospitalization in an infectious diseases department. Specific therapy consists of the administration of botulinum antitoxin.
Acute shigellosis (dysentery): clinical features and diagnostics
Shigellosis (pathogens — Shigella flexneri, Shigella sonnei) presents with pronounced gastroenterocolitic or colitic syndrome.
Key clinical manifestations:
- Acute onset with intoxication (high fever, chills) and pain in the lower abdomen.
- Frequent liquid stools with pathological impurities—mucus and blood.
- Specific local status: abdominal palpation reveals marked tenderness along the colon, and the sigmoid colon is spastic and palpable as a firm cord.
- Rapid development of grade II dehydration (dry tongue, thirst, decreased tissue turgor, hypotension).
The treatment plan includes diet No. 4, etiotropic antibacterial therapy (e.g., ciprofloxacin), rehydration with glucose-saline solutions, and antispasmodics. Discharge of convalescents is possible only after two negative bacteriological stool tests performed 2 days after completion of therapy.
Foodborne toxicoinfections (FTI)
The gastroenteritic variant of FTI is characterized by acute onset, repeated vomiting, diffuse abdominal pain, and frequent profuse fecal stools, but without mucus and blood (unlike dysentery).
The severity of the condition is driven by dehydration. The mainstay of treatment is rehydration therapy with polyionic solutions (e.g., intravenous administration of Quatasol). The infusion volume is calculated based on compensating for the initial body weight deficit (4–6% loss) and ongoing pathological losses from stool and vomit. In the typical course of FTI, the disease resolves rapidly with adequate rehydration even without etiotropic antibacterial drugs.
Yersiniosis: a multitude of clinical masks
Yersiniosis is widespread and often associated with the consumption of vegetables (e.g., green onions from greenhouses fertilized with livestock waste). The disease tends to have a protracted, recurrent, and chronic course with the development of immunopathological conditions.
The clinical presentation is notable for polymorphism:
- Abdominal syndrome: pain predominantly in the right iliac region (ileocecal zone), rumbling, dullness on percussion, requiring differential diagnosis from acute appendicitis.
- Extraintestinal manifestations: hyperemia and puffiness of the face, scleral injection. Arthralgia and arthritis are observed (swelling of the ankle and wrist joints).
- Specific changes in the skin and mucous membranes: the tongue is coated with a white plaque at the root, while the periphery is bright red with prominent papillae ("strawberry tongue"). Characterized by oropharyngeal enanthema and exanthema (large confluent or pinpoint rash), as well as the "gloves", "socks", and "hood" signs.
Due to objective difficulties in clinical and laboratory diagnostics, official morbidity rates for yersiniosis are often underestimated (the problem of underdiagnosis).
Briefly: answers to topical questions
What clinical forms of escherichiosis are distinguished in adults and children?
Sources identify the following clinical variants of escherichiosis:
- Enterotoxigenic Escherichia coli infection — in young children, it proceeds in a cholera-like scenario (acute onset, vomiting, watery stool without pathological impurities).
- Enteroinvasive Escherichia coli infection — shigellosis-like picture (fever, cramping pain, spastic sigmoid colon, scant stool with mucus and possible blood).
- Enterohemorrhagic Escherichia coli infection — proceeds with the development of hemocolitis (appearance of blood in the stool after 1–2 days) and a high risk of developing hemolytic uremic syndrome (HUS).
Pathogenic E. coli are also divided into two main groups: pathogens of parenteral escherichiosis (extraintestinal lesions) and diarrheagenic E. coli.
Which groups of diarrheagenic Escherichia coli are the causative agents of escherichiosis?
Among diarrheagenic Escherichia coli (E. coli) causing escherichiosis, the following groups are distinguished:
- Enterohemorrhagic (EHEC) — serotypes E. coli O157:H7 and non-E. coli O157:H7.
- Enteropathogenic (EPEC).
- Enterotoxigenic (ETEC).
- Enteroaggregative (EAgEC).
- Enteroinvasive (EIEC) — serovars O28, O124, O144, O151.
What diseases are included in the differential diagnosis of escherichiosis?
In the cited sources, escherichiosis is listed in the following differential diagnostic series:
- cholera must be differentiated from escherichiosis, foodborne toxicoinfections, salmonellosis, and viral gastroenteritis;
- the differential search for diseases with syndromes of intoxication, diarrhea, and hemocolitis lists foodborne toxicoinfections, enterohemorrhagic escherichiosis, enteroinvasive escherichiosis, amebiasis, and balantidiasis;
- enteroinvasive escherichiosis is considered in the differential diagnosis of shigellosis;
- the range of diseases with an acute onset, signs of gastritis and/or gastroenteritis, and moderately severe intoxication includes cholera, escherichiosis, salmonellosis, shigellosis, botulism, campylobacteriosis, and viral gastroenteritis.
What are the main symptoms of enteroinvasive escherichiosis?
Enteroinvasive escherichiosis is characterized by a shigellosis-like clinical picture with an incubation period of 1–3 days:
- Acute onset with fever (ranging from subfebrile to febrile levels).
- Cramping abdominal pain, rarely false urges (tenesmus).
- Painful, spastic sigmoid colon upon palpation.
- Scant stool ("rectal spit" type) containing mucus, greenish elements, and possible blood streaks.
What complications are characteristic of enterohemorrhagic escherichiosis?
Enterohemorrhagic escherichiosis is characterized by a high risk of developing hemolytic uremic syndrome (HUS). This complication develops in approximately 10% of cases and is accompanied by acute kidney injury (AKI), hemolytic anemia, and a decrease in platelet count. Mortality in HUS is 3–5% despite ongoing therapy.
What laboratory diagnostic methods are used to confirm escherichiosis?
The following methods are used to confirm escherichiosis:
- Bacteriological method — isolation of Escherichia coli from stool and vomit.
- Serological method — detection of antibodies to Escherichia antigens using indirect hemagglutination assay (IHA) and co-agglutination test (CoAT).
- Molecular biological study of feces is a PCR method for detecting diarrheagenic Escherichia.
To differentiate stool characteristics: foodborne toxic infection presents with copious stool without admixtures, shigellosis presents with scanty stool with mucus and blood, while the sigmoid colon feels like a "painful cord".
Class and exam questions
What is the main difference of ophthalmoplegic syndrome in botulism?
It includes bilateral mydriasis, eyelid ptosis, double vision (diplopia), and restricted eye movements, which are related to toxic damage to the nervous system rather than inflammation.
What are the criteria for discharging a patient with acute shigellosis?
The patient is discharged only after two negative results of bacteriological stool culture, which is initiated no earlier than 2 days after the end of antibiotic therapy.
Why is yersiniosis often confused with surgical pathology?
Due to the predominant localization of pain in the right iliac region, grumbling, and tenderness upon palpation, which mimics the symptoms of acute appendicitis.
What else to study on this topic
- Pathogenesis of metabolic disorders in grade II dehydration.
- Immunological methods for laboratory verification of yersiniosis.
- Principles of using mono- and polyvalent serums in suspected botulism.
- Differential diagnosis of acute intestinal infections with ulcerative colitis and amebiasis.
- Probiotics (eubiotics) in the convalescence period of intestinal infections.
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