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
其他诊断因素
- hypotonia
- weakened cry in infants
- feeding difficulties in infants
- postural hypotension
- hypothermia
- urinary retention
- constipation
- dry mouth and throat
- gastrointestinal illness
- diminished or absent deep tendon reflexes
- absence of fever
- respiratory dysfunction
- pupillary dilation
危险因素
- 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
诊断性检查
首要检查
- mouse bioassay of serum, gastric secretions, stool, or food samples
- culture of food samples, gastric aspirates, or fecal material
需考虑的检查
- electrophysiologic testing
新兴检查
- enzyme-linked immunosorbent assay (ELISA)
- polymerase chain reaction (PCR)
治疗流程
foodborne botulism
wound botulism
iatrogenic botulism
inhalational botulism (biological attack)
撰稿人
作者
Linda S. Nield, MD, FAAP
Professor of Pediatrics and Medical Education
West Virginia University School of Medicine
Morgantown
WV
利益声明
LSN is an author of a reference cited in this topic.
鸣谢
Dr Linda S. Nield would like to gratefully acknowledge Dr Thomas P. Bleck, Dr Aimee Hodowanec, Dr Pavani Reddy, and Dr Teresa Zembower, previous contributors to this topic.
利益声明
TPB, AH, PR, and TZ declare that they have no competing interests.
同行评议者
Fiona Cooke, MA, PhD, MSc, FRCPath, MRCP, DTM&H
Research Fellow and Medical Microbiologist
Wellcome Trust Sanger Institute
Department of Microbiology
Addenbrooke's Hospital
Cambridge
UK
利益声明
FC declares that she has no competing interests.
Christopher D. Huston, MD
Assistant Professor of Medicine
Division of Infectious Diseases
University of Vermont College of Medicine
Burlington
VT
利益声明
CDH declares that he has no competing interests.
William A. Petri, Jr, MD, PhD, FACP
Chief and Professor of Medicine
Division of Infectious Diseases and International Health
University of Virginia Health System
Charlottesville
VA
利益声明
WAP declares that he has no competing interests.
参考文献
关键文献
Rao AK, Sobel J, Chatham-Stephens K, et al. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021 May 7;70(2):1-30.全文 摘要
Arnon SS, Schechter R, Inglesby TV, et al. Botulinum toxin as a biological weapon: medical and public health management. JAMA. 2001 Feb 28;285(8):1059-70. 摘要
Centers for Disease Control and Prevention (CDC). Investigational heptavalent botulinum antitoxin (HBAT) to replace licensed botulinum antitoxin AB and investigational botulinum antitoxin E. MMWR Morb Mortal Wkly Rep. 2010 Mar 19;59(10):299.全文 摘要
Arnon SS, Schechter R, Maslanka SE, et al. Human botulism immune globulin for the treatment of infant botulism. N Engl J Med. 2006 Feb 2;354(5):462-71.全文 摘要
参考文献
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
鉴别诊断
- Guillain-Barre syndrome (GBS)
- Myasthenia gravis
- Tick paralysis (Dermacentor)
更多 鉴别诊断指南
- Clinical guidelines for diagnosis and treatment of botulism, 2021
- Botulism - guide for healthcare professionals
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