Non-specific therapy in acute foodborne toxic infections
In cases of consumption of potentially hazardous products (e.g., dried mushrooms), the initial clinical picture often includes nausea, vomiting, spasmodic abdominal pain, and profuse watery stool. In such situations, pathogenetic and symptomatic therapy at the pre-hospital stage comes down to the following measures:
- Self-administered gastric lavage.
- Abundant fluid intake to correct water-electrolyte imbalances.
These measures may lead to temporary or sustained improvement in well-being. However, if the disease progresses and symptoms such as bloody stools, severe weakness, convulsions, skin jaundice, hemorrhages, hepatomegaly, and oliguria appear (as in the case of the 15-year-old patient), immediate hospitalization in an infectious diseases hospital is required for differential diagnosis between acute intestinal infection (AII), food poisoning, and other acute pathologies.
Specific and non-specific therapy for botulism
If typical neurological symptoms indicating botulism are present, the patient management strategy changes drastically. Dynamic monitoring in an infectious diseases hospital setting is mandatory.
The main rule: comprehensive botulinum antitoxin therapy, including specific and non-specific detoxification, must be initiated immediately, without waiting for the results of laboratory tests (ELISA, biological assay).
Suspected botulism (including wound botulism, with potential contamination of a wound by anaerobic flora) is based on the following signs:
- Acute onset of visual impairment (bilateral ptosis, mydriasis, accommodation disorder, increased farsightedness).
- Progressive muscle weakness.
- Ocular symptoms (strabismus, convergence disorder).
- Bulbar syndrome (dysphagia — swallowing disorder, dysphonia — phonation disorder, diminished gag reflex).
- Facial muscle paresis and signs of respiratory impairment.
Differential diagnosis: analysis of clinical masks
Symptomatology requiring emergency therapy is often masked as food poisoning or botulism. It is critically important to analyze the anamnesis and objective status:
Case 1: Combined poisoning In patients who consumed an unknown alcohol-containing liquid and mushrooms, nausea and vomiting were accompanied by decreased visual acuity, diplopia, and mydriasis with a sluggish reaction to light. Additionally, convulsions and calf muscle pain, limb hypertonus, nuchal rigidity, cyanosis of dry mucous membranes, tachycardia, and agitation were recorded. This presentation requires differentiation among botulism, diphtheria, tetanus, and meningococcemia.
Case 2: Vascular catastrophe A 72-year-old female patient was admitted with a diagnosis of "Botulism?" after consuming fish patties and vacuum-packed berries. Despite complaints of diplopia, nausea, and dizziness, physical examination revealed asymmetric neurological symptoms: decreased muscle strength and sensation in the limbs on the left side only, unevenly constricted pupils (anisocoria), nystagmus, and restricted mobility of the right eye against the background of high blood pressure (190/110 mm Hg). In this case, the symptoms point not to a toxic infection, but to an acute cerebrovascular accident.
Briefly: answers to topical questions
What solutions are used for oral rehydration in AII at the pre-hospital stage?
Specialized salt complexes are used for oral rehydration in acute intestinal infections (including mild forms and bacterial food poisoning).
- Glucose-salt solutions — Regidron, Citraglucosolane, and analogous preparations. They are used to compensate for water and electrolyte losses.
It is important to note that in rotavirus infection, oral intake of these solutions is considered undesirable. Rehydration therapy is always carried out exclusively with polyionic solutions, and the use of colloidal solutions at the simple rehydration stage is not indicated.
What types of botulinum antitoxins are used for the specific therapy of botulism?
Equine botulinum antitoxins are used for the specific therapy of botulism to neutralize the botulinum toxin.
- Polyvalent antitoxins — contain a mixture of antibodies against types A, B, and E. They are administered before laboratory confirmation of the pathogen or when the toxin type is unknown.
- Monovalent antitoxins — specific antitoxins for a specific type (A, B, or E). They are prescribed after establishing the exact type of botulinum toxin.
Single therapeutic doses are 10,000 IU for types A and E antitoxins, and 5,000 IU for type B antitoxin.
Which groups of drugs are used for the pathogenetic therapy of AII in a hospital setting?
The following are used for the pathogenetic therapy of acute intestinal infections:
- Polyionic solutions — for rehydration; for parenteral rehydration, Chлосоsol (Quartasol), Acesol, Lactasol, and Trisol are used.
- Glucose-salt solutions — for oral rehydration: Regidron, Citraglucosolane, etc.
- Enterosorbents — for the elimination of toxins: polyphepan, activated charcoal, enterodez; for diarrhea, diosmectite, colloidal silicon dioxide, and hydrolyzed lignin are also indicated.
- Colloidal anti-shock solutions — dextran/Polyglucukin; used if shock phenomena persist or worsen after rehydration.
- Fresh frozen blood plasma and corticosteroid drugs — are used if shock phenomena persist or worsen.
Class and exam questions
When is it necessary to start administering botulinum antitoxin?
Treatment is initiated immediately upon the appearance of typical neurological symptoms, without waiting for the results of laboratory diagnostics.
Which laboratory methods confirm botulism?
A biological assay and enzyme-linked immunosorbent assay (ELISA) are used to confirm the diagnosis.
Which symptoms are part of bulbar syndrome in botulism?
Bulbar syndrome includes dysphagia (swallowing disorder), dysphonia (phonation disorder), and a diminished gag reflex.
What else to study on this topic
- Criteria for the differential diagnosis of botulism and acute cerebrovascular accidents (ACVA).
- Complications of severe food poisoning (development of hemorrhagic syndrome and acute renal failure).
- Pathogenesis features of wound botulism.
- Algorithm for specimen collection for biological assay and ELISA in suspected botulism.
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