eMedicine Specialties > Ophthalmology > Infectious Disease

Botulism: Differential Diagnoses & Workup

Author: Bhupendra Patel, MD, FRCS, Professor of Ophthalmic Plastic and Facial Cosmetic Surgery, Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine
Coauthor(s): Simon F Taylor, MB, BS, FRANZCO, FRACS, Clinical Senior Lecturer, Oculoplastic Surgery, Save Sight Institute, University of Sydney
Contributor Information and Disclosures

Updated: May 11, 2009

Differential Diagnoses

Myasthenia Gravis

Other Problems to Be Considered

Guillain-Barré syndrome
Lambert-Eaton syndrome
Poliomyelitis
Hypermagnesemia
Mushroom poisoning

Workup

Laboratory Studies

  • The diagnosis of botulism requires a high degree of clinical suspicion. The diagnosis must be considered in an afebrile patient with progressive descending paralysis, especially in the presence of gastrointestinal symptoms.
  • Serum toxin bioassay: The demonstration of toxin in serum involves a bioassay in mice. The identification of the toxin type is performed by a mouse toxin neutralization test.
  • Isolation of organism by culture
    • Food-borne: The demonstration of organism (or its toxin) in vomitus, gastric aspirate, or feces is highly suggestive of the diagnosis of botulism, because intestinal carriage is rare. Anaerobic cultures are required. Early cases of botulism are more likely to involve diagnosis by toxin assay, whereas later cases are more likely to yield a positive specimen culture.
    • Wound culture: In wound botulism, wound cultures yielding the organism are highly suggestive of botulism.
    • Source culture: Isolation of the organism from food without toxin is not sufficient for a diagnosis.

Other Tests

  • Electrophysiology: Nerve conduction velocity is normal. Action potentials on electromyography are decreased with supramaximal stimulus. Single fiber electromyography may be helpful.

More on Botulism

Overview: Botulism
Differential Diagnoses & Workup: Botulism
Treatment & Medication: Botulism
Follow-up: Botulism
References
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References

  1. Laskawi R. The use of botulinum toxin in head and face medicine: an interdisciplinary field. Head Face Med. Mar 10 2008;4:5. [Medline].

  2. Fach P, Micheau P, Mazuet C, Perelle S, Popoff M. Development of real-time PCR tests for detecting botulinum neurotoxins A, B, E, F producing Clostridium botulinum, Clostridium baratii and Clostridium butyricum. J Appl Microbiol. Mar 9 2009;[Medline].

  3. Hatheway CL. Botulism: the present status of the disease. Curr Top Microbiol Immunol. 1995;195:55-75. [Medline].

  4. Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. Nov 2008;23(11):1336-46. [Medline].

  5. Mitchell WG, Tseng-Ong L. Reviews of infant botulism at childrens hospital los angeles. J Child Neurol. Aug 2008;23(8):968. [Medline].

  6. Centers for Disease Control and Prevention. Botulism in the United States, 1899-1996. Handbook for epidemiologists, clinicians, and laboratory workers. Atlanta, Ga: 1998:1-43. [Full Text].

  7. Teismann IK, Steinstraeter O, Warnecke T, et al. Cortical recovery of swallowing function in wound botulism. BMC Neurol. May 7 2008;8:13. [Medline].

  8. Domingo RM, Haller JS, Gruenthal M. Infant botulism: two recent cases and literature review. J Child Neurol. Nov 2008;23(11):1336-46. [Medline].

  9. König H, Gassman HB, Jenzer G. Ocular involvement in benign botulism B. Am J Ophthalmol. Sep 1975;80(3 Pt 1):430-2. [Medline].

  10. Albert DM, Jakobiec FA. Systemic bacterial infections and the eye. In: Ryan ET, Sullivan BA, eds. Principles and Practice of Ophthalmology: Clinical Practice. WB Saunders Co; 1994:3006-10.

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Further Reading

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Keywords

botulism, botulinum toxin, BOTOX®, strabismus, blepharospasm, facial dystonia, Clostridium botulinum, C botulinum

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Contributor Information and Disclosures

Author

Bhupendra Patel, MD, FRCS, Professor of Ophthalmic Plastic and Facial Cosmetic Surgery, Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine
Bhupendra Patel, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Surgeons of England, and Royal Society of Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Simon F Taylor, MB, BS, FRANZCO, FRACS, Clinical Senior Lecturer, Oculoplastic Surgery, Save Sight Institute, University of Sydney
Simon F Taylor, MB, BS, FRANZCO, FRACS is a member of the following medical societies: Australian Medical Association and Royal Australasian College of Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Andrew W Lawton, MD, Medical Director of Neuro-Ophthalmology Service, Section of Ophthalmology, Baptist Eye Center, Baptist Health Medical Center
Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, and Southern Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Simon K Law, MD, PharmD, Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles
Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology
Disclosure: Nothing to disclose.

Managing Editor

Brian R Younge, MD, Professor of Ophthalmology, Mayo Clinic School of Medicine
Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society
Disclosure: Nothing to disclose.

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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