Botulism Differential Diagnoses

Updated: Dec 07, 2022
  • Author: William N Bennett, V, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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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

  • Poliomyelitis

  • Tick paralysis

  • Cerebrovascular disease of the brainstem

  • Basilar artery stroke

  • Encephalitis

  • Diphtheria

  • Neurasthenia

  • 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