Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- visão turva e diplopia
- acomodação deficiente
- ptose
- fraqueza óculo-bulbar
- fraqueza da área hipoglossa
- disartria
- disfagia
- paralisia flácida descendente simétrica
Other diagnostic factors
- hipotonia
- dificuldades na alimentação em lactentes
- choro enfraquecido em lactentes
- hipotermia
- retenção urinária
- constipação
- ressecamento da boca e garganta
- hipotensão postural
- doença gastrointestinal
- reflexos tendinosos profundos diminuídos ou ausentes
- ausência de febre
- disfunção respiratória
- dilatação pupilar
Risk factors
- ingestão de alimentos contaminados
- ingestão de mel por lactentes
- ingestão de solo em lactentes
- uso de substâncias por via intravenosa
- lesão por esmagamento
- faixa etária de lactentes
- anatomia intestinal anormal
- uso terapêutico ou cosmético da toxina botulínica
- terrorismo biológico
- exposição a répteis
Diagnostic tests
1st tests to order
- bioensaio em camundongos de amostras séricas, secreções gástricas, fezes e alimentos
- cultura de amostras de alimentos, aspirados gástricos ou materiais fecais
Tests to consider
- teste eletrofisiológico
Emerging tests
- ensaio de imunoadsorção enzimática (ELISA)
- reação em cadeia da polimerase
Treatment algorithm
botulismo de origem alimentar
botulismo de ferida
botulismo iatrogênico
botulismo inalatório (ataque biológico)
Contributors
Authors
Linda S. Nield, MD, FAAP
Professor of Pediatrics and Medical Education
West Virginia University School of Medicine
Morgantown
WV
Disclosures
LSN is an author of a reference cited in this topic.
Acknowledgements
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.
Disclosures
TPB, AH, PR, and TZ declare that they have no competing interests.
Peer reviewers
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
Disclosures
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
Disclosures
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
Disclosures
WAP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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.Full text Abstract
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. Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Síndrome de Guillain-Barré (GBS)
- Miastenia gravis
- Paralisia do carrapato (Dermacentor)
More DifferentialsGuidelines
- Clinical guidelines for diagnosis and treatment of botulism, 2021
- Botulism - guide for healthcare professionals
More Guidelines
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