wound botulism
Introduction
Introduction to wound botulism Venomous botulism is a neuromuscular poisoning caused by the invasive wounds of Clostridium botulinum into the body. The main features of the following motor nerve palsy are: symptoms of cranial neuropathy, and then downward development There are symptoms of muscle paralysis such as the neck, trunk, and limbs. Respiratory failure is the leading cause of death, and clearing the wound is the key to preventing and treating this disease. The application of botulinum multivalent antitoxin after the onset can reduce the mortality of botulinum botulinum. basic knowledge The proportion of illness: 0.006% - 0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: aspiration pneumonia dysphagia respiratory failure
Cause
Cause of wound botulism
(1) Causes of the disease
The pathogen of wound botulism is Clostridium botulinum, which is coarse, Gram-positive, obligate anaerobic, capable of producing spores, but without capsules, according to exotoxin antigen secreted by Clostridium botulinum Sex, there are 7 types of A, B, C, D, E, F, G, the type A, B, E, F is pathogenic to humans. The botulism of wounds is mainly caused by type A bacteria, followed by type B. The main pathogens are the exotoxin of Clostridium botulinum, blood cell agglutination toxins and neurotoxins, which interfere with the release of acetylcholine from the peripheral nerve terminals, leading to skeletal muscle paralysis.
Decreased redox potential (EH) and local hypotonic tension in localized tissues of contaminated wounds are predisposing factors for wound botulism.
(two) pathogenesis
After contamination of the wound by Clostridium botulinum, the local oxidation and tissue necrosis reduce the focal redox potential difference (Eh) and oxygen tension. The botulinum bacterium germinates in the wound, grows and breeds, secretes exotoxin, and botulinum. Bacterial exotoxin is a molecular weight of 90 000 protein containing hemagglutinin and neurotoxin. Protease can increase its toxicity.
The exotoxin flows through the blood to the whole body, mainly acting on the cerebral nucleus, the neuromuscular junction and the autonomic nerve endings, inhibiting the release of the acetylcholine in the nerve conduction medium, causing the muscle contraction function to be impaired and causing soft palate, but does not affect the nerve conduction. And the sensitivity of the sarcolemma to acetylcholine, the cholinergic channel of the central nervous system is also unaffected.
Prevention
Wound botulism prevention
Thoroughly remove foreign bodies from the wound, remove necrotic tissue, and open the wound if necessary.
Complication
Complications of wound botulism Complications, aspiration pneumonia, dysphagia, respiratory failure
1. Aspiration pneumonia patients due to difficulty swallowing, oral secretions caused by mistakes into the trachea.
2. Respiratory failure The greatest risk of burn botulism is respiratory failure, which can occur rapidly.
Symptom
Symptoms of botulism in wounds Common symptoms Difficulty in breathing, ptosis, high fever, diplopia, abdominal pain, paralysis
1. The typical neurological signs of neuropathy originate from the cranial nerve, diplopia, photophobia, blurred vision, ptosis, ocular dysfunction, dilated pupils, and subsequent language barriers, chewing, swallowing, and difficulty in pronunciation. The descending motor nerve palsy, such as the trunk and limb muscles, appears to be symmetrical, and severe breathing is difficult.
2. Gastrointestinal symptoms are not as obvious as botulism with digestive tract infections, but there are also gastrointestinal discomfort such as vomiting, diarrhea and abdominal pain.
3. Feeling normal, clear consciousness, generally no fever or only slightly hot, and high fever when inhalation pneumonia, the incubation period is 4 to 14 days, usually 7 days, the shorter the incubation period, the heavier the condition.
Examine
Examination of wound botulism
1. Anaerobic culture culture wound exudate is sent to anaerobic bacteria culture, and Clostridium botulinum can be isolated.
2. Exotoxin detection was taken from the serum of early patients, injected into the abdominal cavity of mice, and the control mice were injected with the same type of antitoxin. The former showed quadriplegia, loss of sound and difficulty in breathing, while the mice in the control group did not appear. symptom.
3. Animal test wound secretions 0.5 to 1 ml of physiological saline leaching solution, injected into the abdominal cavity of mice, muscle spasm can also occur.
4. Blood, urine, cerebrospinal fluid examination is generally normal.
5. Electromyography: After a single large dose of nerve stimulation, the amplitude of the action potential of the muscle is reduced and has diagnostic value.
Diagnosis
Diagnostic identification of wound botulism
Diagnostic criteria
1. The wound history is deeper and there are conditions for the growth and reproduction of anaerobic bacteria.
2. Clinical manifestations of neuromuscular disorders.
3. Culture of wound secretion, detection of Clostridium botulinum, etc. for diagnosis.
Differential diagnosis
Need to be differentiated from myasthenia gravis, polio, stroke, etc.
1. Poliomyelitis is more common in children, with fever, limb pain and limb paralysis. Cerebrospinal fluid examination has increased protein and white blood cell count.
2. The incidence of epidemic encephalitis B is seasonal. In the 7th, 8th, and 9th months of each year, there are fever, convulsions and coma, and the number of cerebrospinal fluid protein and white blood cells increases. J-specific IgM antibody is positive.
3. Myasthenia gravis has no obvious history of trauma, slow onset, and elevated thymus levels.
4. Stroke has a heart, the history of cerebrovascular disease is often accompanied by disturbance of consciousness, and most of them are unilateral.
