Diagnosis and treatment are challenging.
According to Dr. Le Quoc Hung, Head of the Department of Tropical Diseases at Cho Ray Hospital, by noon on March 20th, the three critically ill patients in the botulinum poisoning incident in Quang Nam had received Botulism Antitoxin Heptavalent (BAT) to detoxify the toxin and were all responding well to the medication. The patients were poisoned after eating the same fermented salted carp dish.
Previously, in August 2020, a similar poisoning incident occurred due to consuming Minh Chay pâté, resulting in many patients being hospitalized in critical condition. Tests revealed the presence of Clostridium Botulinum type B bacteria in the pâté. This is an obligate anaerobic bacterium that produces spores and has a potent toxin, severely affecting patients' health and easily leading to death.
Having treated many patients with botulinum poisoning, Dr. Nguyen Trung Nguyen, Director of the Poison Control Center at Bach Mai Hospital, said that botulinum toxin poisoning is a classic type of poisoning in medical literature, but it does not occur frequently; epidemiological factors and characteristic symptoms of the disease are often difficult to ascertain, making diagnosis and identification very challenging. Furthermore, botulinum toxin is an extremely potent neurotoxin, so after a patient consumes unsafe food containing botulinum, this toxin is absorbed into the body, binds tightly to nerves, causing paralysis of all muscles.
Symptoms of poisoning appear approximately 12-36 hours after consumption, with the patient beginning to experience paralysis starting from the head, face, and neck (difficulty swallowing, sore throat, difficulty speaking, hoarseness, inability to open eyes), spreading to both arms and legs, followed by paralysis of the respiratory muscles (wheezing, phlegm buildup in the throat, difficulty breathing) leading to respiratory failure (which can easily be fatal).
According to experts, diagnosing and treating botulinum poisoning is difficult because it is a unique type of poisoning that occurs infrequently. The symptoms are similar to those of many other diseases such as tetrodotoxin poisoning (pufferfish, blue-ringed octopus), polyneuropathy, and myasthenia gravis, making misdiagnosis easy. "Some patients with this type of poisoning may also be overlooked because paralysis appears quickly, there are no witnesses, and by the time they are discovered, they have already died or are severely paralyzed and unable to communicate, so they cannot recount the suspected food," Dr. Nguyen Trung Nguyen explained.
The Department of Medical Examination and Treatment Management ( Ministry of Health ) has just issued a document requesting Cho Ray Hospital and the Quang Nam Provincial Department of Health to continue directing the Northern Quang Nam Mountainous Region General Hospital and other medical facilities in the area to focus all resources and efforts on continuing to treat patients and investigate the cause of botulinum poisoning. In case professional support from other hospitals is needed, the Ministry of Health will mobilize hospitals to provide assistance. The Quang Nam Provincial Department of Health is directed to instruct relevant agencies and units to strengthen communication and raise awareness; advise people and the community on ensuring food safety and hygiene to prevent similar incidents from occurring in the area.
High risk from sealed food
According to experts, botulinum is extremely toxic; less than 0.1mg can be fatal. The most common "culprit" is the botulinum bacteria (as it initially occurred mainly with canned meat). This bacteria is abundant in the environment and can be found in many types of food ingredients, in which case the bacteria are in a spore form that withstands normal cooking well.
Processed foods may contain a few bacterial spores due to unsanitary production processes. These foods, then sealed in airtight containers (bottles, jars, boxes, cans, bags) and lacking sufficient acidity and salt content, create conditions for bacteria to grow and produce botulinum toxin.
In addition, fermented and canned foods such as vegetables, fruits, meat, and seafood that do not meet food safety standards are at risk of being contaminated with Clostridium Botulinum bacteria and producing Botulinum toxin.
Concurring with this view, Dr. Le Quoc Hung stated that canned foods are most likely to cause botulinum poisoning. In addition, all other types of food, such as vegetables, fruits, and seafood, still risk contamination with Clostridium botulinum bacteria if they are stored, sealed tightly, and do not meet food safety standards. Foods processed and packaged manually, produced on a small scale, by households, or under substandard production conditions pose an even higher risk of poisoning.
"Botulinum toxin is not broken down by boiling temperatures, so it always poses a risk of food poisoning. When symptoms of poisoning are detected, patients should immediately go to medical facilities for treatment as soon as possible," said Dr. Le Quoc Hung.
To prevent botulinum poisoning, the Food Safety Department (Ministry of Health) recommends using only food products and ingredients with clear origins and sources. Absolutely do not use canned products that have expired, are swollen, dented, deformed, rusty, no longer intact, or have an unusual change in smell, taste, or color.
Furthermore, avoid sealing food tightly and storing it for extended periods without freezing. For fermented foods, traditionally packaged or sealed (such as pickled cucumbers, bamboo shoots, and eggplant), ensure they retain their sour and salty properties. Do not eat food that has lost its sourness.
Homemade meals should be stored in a very cool environment and should not be left at room temperature for too long. Be cautious with sealed food products; choose products with clear origins and recognized quality and safety standards. When preparing food, prioritize eating freshly cooked meals, as botulinum toxin is rapidly broken down at 100°C within 15 minutes.
Treatment for Botulinum poisoning
According to Dr. Nguyen Trung Nguyen, patients with botulinum poisoning will experience digestive disorders, but the most characteristic symptoms are vomiting, abdominal pain, fatigue, and weakness in the limbs, leading to difficulty walking. In the most severe cases, patients will experience rapid respiratory failure and may die if not treated promptly. Once botulinum poisoning is diagnosed, the focus should be on treating respiratory failure due to muscle paralysis, initiating mechanical ventilation and resuscitation, and preventing complications. When the patient is clearly paralyzed, a specific antidote should be used to remove botulinum toxin from the body. The medication should be administered as early as possible to alleviate symptoms, shorten the duration of mechanical ventilation, and reduce the risk of death.
Rare disease, expensive medication, difficult to store.
According to the Ministry of Health, botulinum poisoning is an infrequent occurrence, so very few companies produce and supply antidotes, leading to a scarcity of supply. These drugs are difficult to obtain and expensive (approximately $8,000 per vial). When no poisoning occurs and the medication expires, it must be discarded. However, in the event of severe poisoning or major incidents affecting many people, the lack of antidotes poses a significant danger. Therefore, a national reserve policy for these rare and specialized drugs is necessary. Previously, in 2020, to promptly support Vietnam in treating patients poisoned by botulinum toxin from the Minh Chay pate poisoning, the World Health Organization donated 12 vials of BAT antidote to Vietnam. Currently, Vietnam only has 5 vials of BAT remaining at Cho Ray Hospital. Recently, all five vials of this medicine were delivered to the Northern Quang Nam Mountain Region General Hospital and doctors prescribed them for three critically ill patients who were on ventilators.
Ho Chi Minh City: Strengthening measures to prevent food poisoning.
On March 20th, Ms. Pham Khanh Phong Lan, Head of the Ho Chi Minh City Food Safety Management Board, stated that the unit had sent a document to the People's Committees of districts, counties, and Thu Duc City regarding strengthening the prevention of food poisoning caused by natural toxins. Accordingly, it requested units to coordinate with relevant functional agencies in their areas to strengthen supervision and implement solutions to control food safety in the use and consumption of agricultural products; and the use of natural mushrooms, plants, roots, and fruits as food. At the same time, it directed health facilities in the area to prepare plans, standby forces, equipment, supplies, and chemicals to promptly address and minimize the impact should food poisoning occur.
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