Botulism: new data on pathogenesis, nearest outcomes and distant consequences of the disease

At present, at least two postulates are axiomatic in relation to the peculiarities of the course of foodborne botulism: botulism is an acute disease and does not turn into a chronic form, and that botulism does not cause persistent residual effects, and its clinical manifestations are reversible and do not lead to disability. However, if the first postulate does not raise objections, then the data of recent decades show that foodborne botulism, at least type A, being a disease of toxic genesis with almost single and simultaneous exposure to botulinum neurotoxin (BnT), can manifest itself for a long-term, up to 7 months or more, persistence of neurological symptoms with a natural decrease in working capacity. This state of affairs is due to the escape of the Type A light chain BcT from the influence of the ubiquitin-proteasome system, designed to destroy foreign proteins in the cell that enter the cytosol.
We analyzed in detail the dynamics of the reverse development of the clinical picture of botulism type A in 97 patients from the moment of their hospitalization to the 7^th month from the onset of the disease, among whom there were 59 patients with the initially severe course of botulism. There were 38 patients with a moderate course of the process. Patients received conventional therapy for botulism, including mandatory administration of 1 dose of intravenous antibotulinum serum. In 56 patients, for the purpose of nonspecific detoxification and restoration of intestinal propulsion function, the administration of saline enteral solution was added to the complex therapy at the hospital stage of treatment.
After 7 months, 34 out of 59 patients with severe forms of botulism (55.9%) and 27 out of 38 patients with a moderate course of the disease (77.1%) considered themselves fully recovered. Residual effects (persistent weakness, near vision impairment and other complaints that the patients associated with the hospital stage of the disease) occurred in 25 patients with severe forms of botulism and in 11 patients with moderate-severe forms of the disease.
It is concluded that the use of saline enteral solution (SAS) significantly reduces the time of repair, but it is not a panacea – the situation urgently requires not only the development of radically new approaches to treatment (including at the molecular level), but also the streamlining of the corresponding stages of dispensary observation and rehabilitation measures.

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