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
- gastrointestinal 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 tests
1st tests to order
- mouse bioassay of serum, gastric secretions, wound exudates, tissue specimens, stool, or food samples
- culture of food samples, gastric aspirates, wound exudates, tissue specimens, or fecal material
Tests to consider
- electrophysiologic testing (electromyography)
Emerging tests
- enzyme-linked immunosorbent assay (ELISA)
- polymerase chain reaction (PCR)
Treatment algorithm
foodborne botulism
wound botulism
iatrogenic botulism
inhalational botulism (biological attack)
Contributors
Authors
Maria Carrillo-Marquez, MD
Associate Professor
Department of Pediatrics
Division of Infectious Diseases
University of Tennessee Health Science Center
Le Bonheur Children’s Hospital
Memphis
TN
Declarações
MCM is a site principal investigator for a phase 2A multicenter study of Aztreonam-Avibactam (Pfizer) with no contractual obligation to disseminate product information. She has also conducted sponsored clinical research for activities unrelated to this topic, for which she does not personally receive honoraria.
Agradecimentos
Dr Maria Carrillo-Marquez would like to gratefully acknowledge Dr Linda S. Nield, Dr Thomas P. Bleck, Dr Aimee Hodowanec, Dr Pavani Reddy, and Dr Teresa Zembower, previous contributors to this topic.
Declarações
LSN is an author of a reference cited in this topic. TPB, AH, PR, and TZ declare that they have no competing interests.
Revisores
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
Declarações
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
Declarações
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
Declarações
WAP declares that he has no competing interests.
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
World Health Organization. Botulism. Sep 2023 [internet publication].Texto completo
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.Texto completo Resumo
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. Resumo
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.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Guillain-Barre syndrome (GBS)
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- Tick paralysis (Dermacentor)
Mais Diagnósticos diferenciaisDiretrizes
- Clinical overview of botulism
- Botulism - guide for healthcare professionals
Mais Diretrizes
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