Be careful of foods containing Botulinum toxin

Diagnosis and treatment are difficult.

According to Dr. Le Quoc Hung, Head of the Department of Tropical Diseases, Cho Ray Hospital, by noon on March 20, 3 people in critical condition in the Botulinum poisoning case in Quang Nam had been injected with Botulism Antitoxin Heptavalent (BAT) to neutralize the toxin and all responded well to the drug. The patients were poisoned after eating the same pickled carp dish.

Previously, in August 2020, a similar poisoning incident occurred due to eating Minh Chay pate, causing many patients to be hospitalized in critical condition. Test results detected Clostridium Botulinum type B bacteria in the pate. This is an absolutely anaerobic, spore-forming, highly toxic bacterium that severely affects the patient's health and can easily cause death.

Having treated many patients with Botulinum poisoning, Dr. Nguyen Trung Nguyen, Director of the Poison Control Center, Bach Mai Hospital, said that Botulinum toxin poisoning is a classic type of poisoning in medical literature but does not occur often; epidemiological factors and typical manifestations of the disease are often difficult to exploit, making diagnosis and identification very difficult. Furthermore, Botulinum toxin is an extremely strong neurotoxin, so after the patient eats unsafe food containing Botulinum, this toxin is absorbed into the body, attaches tightly to the nerves, causing paralysis of all muscles.

Symptoms of poisoning are that after eating about 12-36 hours, the patient begins to show symptoms of paralysis from the head, face, neck (difficulty swallowing, sore throat, difficulty speaking, hoarseness, unable to open eyes), spreading to the arms and legs, then paralysis of the respiratory muscles (wheezing, phlegm retention in the throat, difficulty breathing) causing respiratory failure (easily fatal).

According to experts, diagnosing and treating patients with Botulinum poisoning is very difficult because this is a special type of poisoning that does not occur often. The symptoms of poisoning are similar to many other diseases such as Tetrodotoxin poisoning (puffer fish, blue-ringed octopus), polyradiculoneuritis, myasthenia gravis, so it is easy to confuse. "Some patients with this type of poisoning can also be missed when paralysis appears quickly, there are no witnesses, when discovered they are dead or severely paralyzed, unable to communicate, so they do not report the suspected food," Dr. Nguyen Trung Nguyen informed.

The Department of Medical Examination and Treatment ( Ministry of Health ) has just issued an official dispatch requesting Cho Ray Hospital and the Department of Health of Quang Nam province to continue directing the Northern Quang Nam Mountainous Regional General Hospital and medical facilities in the area to focus all resources, efforts, and coordination to continue treating patients and investigating the cause of Botulinum poisoning. In case of needing professional support from other hospitals, the Ministry of Health will mobilize hospitals to support. The Department of Health of Quang Nam province directs relevant agencies and units to strengthen communication, raise awareness; advise people and the community on ensuring food safety and hygiene, avoiding similar cases occurring in the area.

High risk from sealed food

According to experts, Botulinum is an extremely toxic substance, less than 0.1 mg can cause death. The most common "culprit" can be identified as meat poisoning bacteria (because it initially occurred mainly with canned meat). This bacteria exists in the environment and can be mixed in many types of food ingredients, at this time the bacteria is in a shelled form that can withstand normal cooking (called spores).

Processed foods contain a few bacterial spores due to unclean production processes, then are tightly packaged (in bottles, jars, boxes, cans, bags), and do not have enough acidity or saltiness, creating conditions for bacteria to grow and secrete Botulinum toxin.

In addition, fermented and canned foods made from vegetables, tubers, fruits, meat, seafood, etc. that do not meet food safety conditions are at risk of being contaminated with Clostridium Botulinum bacteria and producing Botulinum toxin.

Sharing the same view, Dr. Le Quoc Hung said that canned foods are most at risk of Botulinum poisoning. In addition, all other foods such as vegetables, tubers, fruits, seafood... are still at risk of being contaminated with Clostridium Botulinum bacteria if they are incubated, sealed and do not ensure food safety. Processed foods, hand-packaged, produced on a small scale, in households or under unsafe production conditions have an even higher risk of poisoning.

“Botulinum toxin is not destroyed by boiling temperatures, so there is always a risk of causing food poisoning. When symptoms of poisoning are detected, patients need to go to medical facilities immediately for treatment as soon as possible,” informed Dr. Le Quoc Hung.

To prevent botulinum poisoning, the Food Safety Department (Ministry of Health) recommends using only food products and food ingredients with clear origin and source, and absolutely do not use canned products that have expired, are swollen, flattened, deformed, rusted, are no longer intact, or have unusual flavors or colors.

In addition, you should not pack food tightly and leave it for a long time without freezing. For fermented foods, pack or cover them tightly in the traditional way (such as pickles, bamboo shoots, pickled eggplants...) to ensure they are sour and salty. When the food is no longer sour, it should not be eaten.

Homemade foods should be stored in a cold environment and should not be left in the natural environment for too long. Be careful with sealed food products, choose products with clear origin and provenance, with recognized quality and safety standards. When preparing food, prioritize eating freshly cooked foods because Botulinum toxin will quickly decompose at 100°C for 15 minutes.

Treatment of Botulinum poisoning

Dr. Nguyen Trung Nguyen said that patients with Botulinum poisoning will have symptoms of digestive disorders, but the most typical symptoms of this poisoning are that the patient will have signs of vomiting, abdominal pain, fatigue, and weakness in the limbs, leading to difficulty walking. In the most severe cases, the patient will have rapid respiratory failure and can lead to death if not treated promptly. Once the diagnosis and identification of the patient with Botulinum poisoning have been made, it is necessary to focus on emergency treatment of respiratory failure due to muscle paralysis, perform mechanical ventilation and resuscitation, and prevent complications. When the patient is clearly paralyzed, it is necessary to use a specific antidote to detoxify Botulinum toxin in the body. The drug should be used as soon as possible to help relieve symptoms, shorten the time on mechanical ventilation, and reduce the risk of death.

Rare disease, expensive medicine, difficult to preserve

According to the Ministry of Health, Botulinum poisoning is a type of poisoning that does not occur often, so very few companies produce and supply antidotes, leading to a very limited supply. These drugs are difficult to buy and expensive (about 8,000 USD/bottle). When there is no poisoning and the drugs expire, they must be discarded. When there is a serious poisoning or a major incident with many people affected and there is no medicine, it will be very dangerous, so it is necessary to have a national reserve policy for these rare and special drugs. Previously, in 2020, in order to promptly support Vietnam in treating patients with Botulinum poisoning due to Minh Chay pate poisoning, the World Health Organization donated 12 vials of BAT to Vietnam to treat Clostridium Botulinum toxin. Currently, Vietnam only has 5 vials of BAT left at Cho Ray Hospital. Recently, all 5 bottles of this medicine were transferred to the Northern Quang Nam Mountainous Regional General Hospital and were prescribed by doctors for 3 seriously ill patients on ventilators.

HCMC: Strengthening food poisoning prevention

On March 20, Ms. Pham Khanh Phong Lan, Head of the Food Safety Management Board of Ho Chi Minh City, said that the unit has sent a document to the People's Committees of districts and Thu Duc City on strengthening the prevention of food poisoning caused by natural toxins. Accordingly, the units are required to coordinate with relevant authorities in the area to strengthen supervision and implement solutions to control food safety in the use and consumption of agricultural products; use of mushrooms, plants, tubers, and natural fruits as food. At the same time, direct medical facilities in the area to prepare plans, standing forces, means, supplies, and chemicals to promptly overcome and minimize the impact when poisoning occurs.

Source: https://www.sggp.org.vn/can-trong-thuc-pham-chua-doc-to-botulinum-post682769.html