Diagnostic Considerations

The diseases most frequently confused with botulism are those that produce generalized weakness. Differentiating botulism from other diseases is essential for early initiation of therapy. Botulism should be considered in patients who are afebrile and mentally intact and who have symmetric descending paralysis without sensory findings. The diagnosis should be suspected on clinical grounds in the context of an appropriate history. Other conditions often confused with botulism include the following:

Guillain-Barré syndrome
Fisher variant of Guillain-Barré syndrome
Myasthenia gravis
Lambert-Eaton syndrome
Poliomyelitis
Tick paralysis
Cerebrovascular disease of the brainstem
Basilar artery stroke
Encephalitis
Diphtheria
Neurasthenia
Progressive external ophthalmoplegia
Intracranial mass lesions
Drugs, penicillamine
Aminoglycosides: Very large doses can induce neuromuscular blockade.
Poisonings by atropine, scopolamine, organophosphate insecticides, shellfish, amanita mushrooms, carbon monoxide, methyl alcohol, methyl chloride, and sodium fluoride
Congenital neuropathy or myopathy

Workup

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Author

William N Bennett, V, MD Staff Physician, Infectious Disease Service, Chair, Antimicrobial Stewardship, Department of Medicine, Wright-Patterson Medical Center; Assistant Professor of Medicine, Uniformed Services University of the Health Sciences School of Medicine

William N Bennett, V, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph M Yabes, Jr, MD, FACP Deputy Director, USAF HIV Medical Evaluation Unit, Associate Program Director, Infectious Disease Fellowhip, Brooke Army Medical Center; Core Faculty, Infectious Disease Fellowship, Chair, Virtual Health Subcommittee, San Antonio Uniformed Services Health Education Consortium (SAUSHEC); Assistant Professor, Department of Medicine, Uniformed Services University of the Health Sciences; Adjunct Assistant Professor, Department of Medicine, University of Texas Health Science Center at San Antonio

Joseph M Yabes, Jr, MD, FACP is a member of the following medical societies: American College of Physicians, Armed Forces Infectious Diseases Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

Kirk M Chan-Tack, MD Medical Officer, Division of Antiviral Products, Center for Drug Evaluation and Research, Food and Drug Administration

Disclosure: Nothing to disclose.

David Hall Shepp, MD Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine

David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Received salary from Gilead Sciences for management position.

John Bartlett, MD † Professor Emeritus, Johns Hopkins University School of Medicine

John Bartlett, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Clinical Pharmacology, American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, American Thoracic Society, American Venereal Disease Association, Association of American Physicians, Infectious Diseases Society of America, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The views expressed herein are those of the author(s) and do not reflect the official policy or position of Wright Patterson Medical Center, Brooke Army Medical Center, the Defense Health Agency, Uniformed Services University of the Health Sciences, U.S. Army Medical Department, U.S. Army Office of the Surgeon General, the Department of the Army, the Department of the Air Force, the DoD, or the U.S. Government.