Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • ingestion of contaminated foods
  • infant age group
  • biologic terrorism
  • blurred vision and diplopia
  • impaired accommodation
  • ptosis
  • oculobulbar weakness
  • hypoglossal weakness
  • dysarthria
  • dysphagia
  • symmetrical descending flaccid paralysis

Other diagnostic factors

  • hypotonia
  • weakened cry in infants
  • feeding difficulties in infants
  • postural hypotension
  • hypothermia
  • urinary retention
  • constipation
  • dry mouth and throat
  • GI illness
  • diminished or absent deep tendon reflexes
  • absence of fever
  • respiratory dysfunction
  • pupillary dilation

Risk factors

  • ingestion of contaminated foods
  • ingestion of honey in infants
  • ingestion of soil in infants
  • intravenous drug use
  • crush injury
  • infant age group
  • abnormal bowel anatomy
  • therapeutic or cosmetic use of botulinum toxin
  • biologic terrorism
  • exposure to reptiles

Diagnostic investigations

1st investigations to order

  • mouse bioassay of serum, gastric secretions, stool, or food samples
  • culture of food samples, gastric aspirates, or fecal material
Full details

Investigations to consider

  • electrophysiologic testing
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Professor of Neurological Sciences, Neurosurgery, Medicine, and Anesthesiology

Rush Medical College

Director of Clinical Neurophysiology

Rush University Medical Center

Chicago

IL

Disclosures

TPB declares that he has no competing interests.

Assistant Professor

Division of Infectious Diseases

Department of Medicine

Rush University Medical Center

Chicago

IL

Disclosures

AH declares that she has no competing interests.

Dr Thomas P. Bleck and Dr Aimee Hodowanec would like to gratefully acknowledge Dr Pavani Reddy and Dr Teresa Zembower, the previous contributors to this monograph. PR and TZ declare that they have no competing interests.

Peer reviewers VIEW ALL

Research Fellow and Medical Microbiologist

Wellcome Trust Sanger Institute

Department of Microbiology

Addenbrooke's Hospital

Cambridge

UK

Disclosures

FC declares that she has no competing interests.

Associate Professor of Pediatrics

West Virginia University School of Medicine

Morgantown

WV

Disclosures

LN is an author of a reference cited in this monograph.

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont College of Medicine

Burlington

VT

Disclosures

CDH declares that he has no competing interests.

Chief and Professor of Medicine

Division of Infectious Diseases and International Health

University of Virginia Health System

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

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