Patients often arrive at the hospital late, misdiagnosed by doctors, with toxins deeply absorbed into their system, and there are no readily available antidotes… these are the reasons that make botulinum poisoning difficult to treat.
According to Dr. Nguyen Van Hao, Head of the Adult Intensive Care Unit for Toxicology at the Tropical Diseases Hospital in Ho Chi Minh City, the mechanism of botulinum toxicity involves the toxin moving through the bloodstream, attacking the peripheral nerves, and causing paralysis of symmetrical muscles on both sides of the body. Patients experience paralysis progressively from top to bottom, starting with the eyelid muscles, leading to drooping eyelids, mouth stiffness, difficulty eating and swallowing, and gradually spreading down to the arms and legs. Ultimately, the respiratory muscles lose function, and patients cannot breathe independently despite being alert and mentally clear.
Dr. Nguyen Van Hao, Head of the Adult Intensive Care Unit for Toxicology at the Tropical Diseases Hospital, Ho Chi Minh City. (Photo: Thu Anh).
The main reason this toxin poses a significant challenge for medicine is that it is very rare in Vietnam. Many medical experts confirm that the disease has not appeared or has only sporadically occurred in the past 30-40 years without proper documentation. Doctors primarily learn about the disease through literature. Even experienced infectious disease specialists initially misdiagnose it with other conditions such as myasthenia gravis or pancreatitis.
Accurate diagnosis requires multiple factors, including epidemiological investigation, clinical examination, laboratory tests, and culture for bacterial isolation. Dr. Hao notes that it took over a month after the first patient appeared for the results to be confirmed, at which point the Food Safety Department of the Ministry of Health publicly announced the information.
Due to the rarity of the disease, Vietnam does not produce or stock the antitoxin serum that is available globally, known as Botulism Antitoxin Heptavalent. Importing the medication from abroad takes considerable time. Meanwhile, the golden period for the antitoxin to be most effective is only the first three days after exposure to the toxin.
Dr. Hao explained that all patients arrived late, compounded by the time it took for doctors to identify the cause of the illness, which often exceeded the time for effective treatment with the antitoxin. The toxin acts strongly, causing severe damage to nerve cells.
When the toxin cannot be neutralized, the only option left is to wait for the affected nerve cells to age, die off, and for the body to eliminate the toxins and regenerate new healthy cells. Depending on the individual’s health status and the degree of poisoning, the regeneration period can take from one to three months. The healthcare system’s role is to prolong the patient’s life by supporting mechanical ventilation… while waiting for this regeneration process to complete.
The shortcomings of prolonged mechanical ventilation pose various risks to patients. Associate Professor, Dr. Pham Khanh Phong Lan, Head of the Food Safety Management Board in Ho Chi Minh City, indicated that patients on mechanical ventilation are at a higher risk of developing pneumonia and lung damage. This is especially true for the elderly and those with multiple underlying health conditions, who may be bedridden for prolonged periods, making hospital-acquired infections difficult to avoid, which could lead to death.
In the past, without mechanical ventilators assisting invasive respiratory pathways, patients were at a high risk of death. However, the availability of support tools such as ventilators makes treatment easier. Nevertheless, the outcomes may not always align with expectations as when using medication.
Moreover, the natural protective barriers, similar to those of normal airways, are disrupted by direct intubation into the lungs via the ventilator. This leads to the risk of secondary infections.
Additionally, complications related to malnutrition from prolonged mechanical ventilation can lead to complete paralysis. As various complications may arise from extended mechanical ventilation, treating physicians face numerous challenges during the monitoring and care of patients.
“Patient fatalities may not be solely due to botulinum, but it certainly acts as a trigger,” Ms. Lan remarked.
Dr. Le Quoc Hung, Head of the Tropical Diseases Department at Cho Ray Hospital, affirmed: “If there were an antidote, the treatment process would be significantly easier. The shorter the paralysis duration, the greater the chance of survival for the patient.”
In cases of non-specific treatment, in addition to supporting mechanical ventilation throughout the recovery period, measures such as enhancing nutrition, supplementing B vitamins, physiotherapy, blood filtering, and plasmapheresis performed five times every other day are also very important. Patients require close monitoring to minimize complications that the toxin may cause.
The botulinum bacteria thrive in anaerobic environments.
How is botulinum toxin produced?
This disease is caused by a type of botulinum bacteria that thrives in anaerobic environments. Normally, this bacteria does not survive in environments with high oxygen levels. However, it can adapt and form spores. These spores create a protective shell that allows the bacteria to remain dormant, inactive, and alive. This bacteria is found everywhere, most abundantly in soil.
Furthermore, certain human activities can cause this bacteria from the ground to become airborne. Fortunately, when this bacteria is in the air, it cannot thrive, so even if inhaled, it does not cause illness. However, in anaerobic conditions, it can reactivate. It will break its spore shell to produce a toxin known as botulinum toxin.
Therefore, all foods that are prepared, packaged, canned, or sealed without oxygen have the potential to allow this bacteria to develop. Thus, the risk of infection is always present.
How to prevent botulinum poisoning?
There are three stages to prevent botulinum poisoning.
- First, when preparing fresh food or making canned goods, it must be done in a clean, hygienic environment.
- Second, sealing tightly creates a favorable environment for the bacteria to reactivate. Therefore, it should not be sealed tightly without proper techniques.
- Third, during the food consumption stage. Manufacturers have expiry dates to ensure that no bacteria develop during that period. Therefore, do not consume anything past its expiration date.
Additionally, cooking food at 100 degrees Celsius for 10-15 minutes can effectively reduce the botulinum toxin and prevent poisoning.
