Materiały źródłowe

• #1 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Botulism is a rare, neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. […] Diagnosis of botulism depends on high clinical suspicion and a thorough neurologic examination. The timeliness of diagnosis is crucial to successful treatment because botulinum antitoxin, the only specific therapy for botulism, must be administered to patients as quickly as possible. […] The recommendations in these guidelines address the conventional standard of care, in which medical resources are not limited, as well as settings of contingency and crisis standards of care, with limited medical resources. […] Botulism typically produces a distinctive syndrome of cranial nerve palsies that can be followed by bilateral, symmetric, descending flaccid paralysis, affecting proximal before distal limb musculature, that might progress to respiratory failure and death.

• #2 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  Botulism is a clinical syndrome characterised by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits. […] The diagnosis of botulism is a clinical one, confirmed by the detection of toxin in clinical samples. […] Key diagnostic factors include presence of risk factors, blurred vision and diplopia, impaired accommodation, ptosis, oculobulbar weakness, hypoglossal weakness, dysarthria, dysphagia, and symmetrical descending flaccid paralysis. […] Other diagnostic factors include hypotonia, feeding difficulties in infants, weakened cry in infants, hypothermia, urinary retention, constipation, dry mouth and throat, postural hypotension, gastrointestinal illness, diminished or absent deep tendon reflexes, absence of fever, respiratory dysfunction, and pupillary dilation.

• #3 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Because diagnosing botulism can be challenging, a tool with evidence-based clinical criteria has been developed to aid clinicians in early identification of botulism in settings of crisis or contingency standards of care, when the probability of botulism increases above the level of extremely rare. […] The only specific therapy for botulism is botulinum antitoxin. When administered early in the course of illness (within 48 hours of symptom onset and ideally within 24 hours), botulinum antitoxin can stop the progression of paralysis and prevent respiratory compromise in certain patients. […] Administer botulinum antitoxin to patients with suspected botulism as early as possible in the course of illness. The greatest benefit accrues to those who receive it within the first 2 days of illness onset.

• #4 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #5 Botulism – Diagnosis & Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/botulism-diagnosis-treatment/

  Botulism is a rare, potentially fatal disease caused by the toxin produced by Clostridium botulinum spores – a bacteria found in soil and honey, and on fruits, vegetables, meats, and fish. […] Diagnosis of botulism is made based on clinical findings of acute onset of cranial neuropathy and symmetric descending weakness, particularly in the absence of fever. […] The decision to administer treatment is based on the clinical diagnosis of botulism and must not be delayed by laboratory confirmation of botulinum toxin in serum, stool, gastric aspirate, wound, or food or isolation of C. botulinum from stool, gastric aspirate, or wound.

• #6 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  Botulism is a clinical syndrome characterised by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits. […] The diagnosis of botulism is a clinical one, confirmed by the detection of toxin in clinical samples. […] Key diagnostic factors include presence of risk factors, blurred vision and diplopia, impaired accommodation, ptosis, oculobulbar weakness, hypoglossal weakness, dysarthria, dysphagia, and symmetrical descending flaccid paralysis. […] Other diagnostic factors include hypotonia, feeding difficulties in infants, weakened cry in infants, hypothermia, urinary retention, constipation, dry mouth and throat, postural hypotension, gastrointestinal illness, diminished or absent deep tendon reflexes, absence of fever, respiratory dysfunction, and pupillary dilation.

• #7 Botulism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/botulism/diagnosis-treatment/drc-20370266

  To diagnose botulism, your health care provider checks you for muscle weakness or paralysis. Your provider looks for symptoms such as drooping eyelids and a weak voice. Your provider asks about foods you’ve eaten in the past few days. They try to find out if you were exposed to any bacteria through a wound. […] In cases of possible infant botulism, the provider may ask if your child has eaten honey recently. The provider may also ask if your infant has constipation or has been less active than usual. […] Analysis of blood, stool, or vomit for evidence of the toxin may help confirm a diagnosis of infant or foodborne botulism. But getting these test results may take days. So the provider’s exam is the main way to diagnose botulism.

• #8 EM@3AM: Botulism – emDocs

  https://www.emdocs.net/em3am-botulism/

  Diagnosis: Botulism […] Botulism should be suspected in a patient with acute onset of signs and symptoms of a cranial neuropathy and symmetric descending weakness, particularly in the absence of fever. […] In infants, botulism should be suspected when there is acute onset of weak suck, ptosis, inactivity, and constipation (eg, floppy baby syndrome). […] The presumptive diagnosis can be made on clinical findings alone. […] In a study that included 241 cases of botulism recorded in the National Botulism Surveillance Database in the United States, three clinical criteria (lack of fever, at least one specific symptom of cranial neuropathy, and at least one specific sign of cranial neuropathy) were met in 89 percent of patients. […] The diagnosis of botulism is confirmed by identification of toxin in serum, stool, vomitus, or food sources which requires one to four days and anaerobic cultures often take up to six days for growth and identification of the organism. […] These confirmatory tests do not yield timely results, therefore, the decision to administer antitoxin should be based on the presumptive clinical diagnosis of botulism and not be delayed while awaiting results of confirmatory diagnostic studies.

• #9 Botulism: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/food-recipes/food-poisoning/what-is-botulism

  Your doctor will likely start with a physical exam, looking for signs of botulism such as muscle weakness, a weak voice, or drooping eyelids. They might also ask you about foods you (or your baby) have eaten. […] They may order a lab test to analyze either your blood or a stool sample to confirm their diagnosis. Other tests may be needed. […] If you happened to have saved the food you suspect caused the botulism, you can take it in for testing. […] Lab tests may take a couple of days. In the meantime, your doctor may try to rule out other possible conditions. Botulism symptoms are similar to those of stroke and Guillain-Barre syndrome, in which your immune system attacks your nerves, causing possible paralysis. […] Other tests that may be done to diagnose botulism include: […] A magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain can help rule out other reasons for your symptoms, such as a stroke.

• #10 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Botulism-Diagnosis.aspx

  In cases of food-borne botulism, recent consumption of canned or undercooked foods and infection among family members are often indicators. […] Wound botulism is usually characterized by the presence of an infected wound. […] An outline of the steps taken in diagnosing botulism is given below: A detailed history of possible exposure is obtained and symptoms are assessed. […] Samples from wounds are sent for culture and toxicity testing in the laboratory. […] Routine tests that may be performed include serum electrolytes, renal and liver function tests, urinanalysis, analysis of the cerebrospinal fluid (CSF) and electrocardiograms. […] Electromyography (EMG) can be used to detect muscle weakness and paralysis. This test can also help distinguish myasthenia gravis and Guillain-Barr syndrome from botulism. […] Blood or stool samples may be taken and sent for analysis.

• #11 Botulism – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/botulism/diagnosis-treatment/drc-20370266

  To diagnose botulism, your health care provider checks you for muscle weakness or paralysis. Your provider looks for symptoms such as drooping eyelids and a weak voice. Your provider asks about foods you’ve eaten in the past few days. They try to find out if you were exposed to any bacteria through a wound. […] In cases of possible infant botulism, the provider may ask if your child has eaten honey recently. The provider may also ask if your infant has constipation or has been less active than usual. […] Analysis of blood, stool, or vomit for evidence of the toxin may help confirm a diagnosis of infant or foodborne botulism. But getting these test results may take days. So the provider’s exam is the main way to diagnose botulism.

• #12 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #13

  https://www.who.int/news-room/fact-sheets/detail/botulism

  Diagnosis is usually based on clinical history and clinical examination followed by laboratory confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or a culture of C. botulinum from stool, wound or food. […] Misdiagnosis of botulism sometimes occurs as it is often confused with stroke, Guillain-Barr syndrome, or myasthenia gravis. […] Antitoxin should be administered as soon as possible after a clinical diagnosis. Early administration is effective in reducing mortality rates. […] Severe botulism cases require supportive treatment, especially mechanical ventilation, which may be required for weeks or even months.

• #14 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #15 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Botulism-Diagnosis.aspx

  In cases of food-borne botulism, recent consumption of canned or undercooked foods and infection among family members are often indicators. […] Wound botulism is usually characterized by the presence of an infected wound. […] An outline of the steps taken in diagnosing botulism is given below: A detailed history of possible exposure is obtained and symptoms are assessed. […] Samples from wounds are sent for culture and toxicity testing in the laboratory. […] Routine tests that may be performed include serum electrolytes, renal and liver function tests, urinanalysis, analysis of the cerebrospinal fluid (CSF) and electrocardiograms. […] Electromyography (EMG) can be used to detect muscle weakness and paralysis. This test can also help distinguish myasthenia gravis and Guillain-Barr syndrome from botulism. […] Blood or stool samples may be taken and sent for analysis.

• #16 What Is Botulism? Symptoms, Causes, Diagnosis, Treatment, and Prevention

  https://www.everydayhealth.com/botulism/guide/

  The first step in any botulism diagnosis is a thorough patient history. Your doctor will check you for signs and symptoms and then ask you about the foods you’ve eaten recently or if you may have been exposed to the bacteria via an open wound. […] In some cases, lab testing of a blood, stool (feces), or vomit specimen for evidence of Clostridium botulinum toxin can confirm infant or foodborne botulism. […] The symptoms of botulism are similar to those of conditions such as Guillain-Barr syndrome, stroke, myasthenia gravis, and opioid overdose. To rule out these other conditions, your doctor may recommend: […] Evaluation and testing can take several days, so a medical exam may be the best way to diagnose botulism and, if your doctor suspects you have botulism, you may start treatment immediately. […] In general, you should seek medical care immediately if you think you may have botulism, as early treatment increases your chances of survival and lessens your risk of complications.

• #17 Botulism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459273/

  Botulism is primarily categorized into 3 primary types based on the source of toxin exposure: foodborne, wound-related, and infant botulism. […] Laboratory confirmation of botulism may be obtained with serum and stool assays for BoNT, gastric aspirates or rectal swabs, stool microscopy for spores, stool cultures, and wound cultures for wound botulism. […] Treatment of botulism consists of antitoxin administration, hospital admission, close monitoring, respiratory support as required, and debridement with antibiotic coverage in the case of wound botulism. […] Antitoxin therapy available to healthcare professionals currently exists in 2 forms: heptavalent equine serum antitoxin, indicated for patients older than 1 year, and human-derived immunoglobulin, indicated for infants younger than 1 year. […] The administration of antitoxin will not reverse neurological paralysis, given that BoNT binds irreversibly, but it will help stop disease progression.

• #18 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The extreme potency of botulinum neurotoxin necessitates rigid requirements to ensure the safety of laboratory workers. […] While the mouse lethality assay has remained the standard test for the detection of botulinum neurotoxins, there has been tremendous progress in the development of alternative tests during the past decade. […] The latest advances in assay development have successfully aimed at rapidity and sensitivity; the fastest tests are now performed in 20 min, and the test sensitivities have surpassed that of the mouse bioassay. […] However, further research is warranted to gain speed and sensitivity with a single test that would optimally detect all seven neurotoxin types simultaneously. […] The standard procedure for the detection of botulinum toxin is the mouse lethality assay.

• #19 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The test is based on an intraperitoneal injection into laboratory mice of sample diluted in phosphate buffer. […] The toxin type is determined by neutralization of the toxin with specific antitoxins. […] The mouse bioassay is very sensitive, with one intraperitoneal mouse 50% lethal dose corresponding to 5 to 10 pg and the detection limit being 0.01 ng/ml of sample eluate. […] However, the assay is laborious and expensive and naturally presents an ethical dilemma due to the use of laboratory animals. […] In suspected clinical cases of botulism where immediate treatment is required, the mouse assay may also be too slow to make a diagnosis. […] A wealth of immunoassay formats for the detection of botulinum neurotoxins have been reported. […] Although many of the earliest assays have poor sensitivities or specificities, the recent developments in signal amplification have enabled sensitivities equal to that of the mouse bioassay.

• #20 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The test is based on an intraperitoneal injection into laboratory mice of sample diluted in phosphate buffer. […] The toxin type is determined by neutralization of the toxin with specific antitoxins. […] The mouse bioassay is very sensitive, with one intraperitoneal mouse 50% lethal dose corresponding to 5 to 10 pg and the detection limit being 0.01 ng/ml of sample eluate. […] However, the assay is laborious and expensive and naturally presents an ethical dilemma due to the use of laboratory animals. […] In suspected clinical cases of botulism where immediate treatment is required, the mouse assay may also be too slow to make a diagnosis. […] A wealth of immunoassay formats for the detection of botulinum neurotoxins have been reported. […] Although many of the earliest assays have poor sensitivities or specificities, the recent developments in signal amplification have enabled sensitivities equal to that of the mouse bioassay.

• #21 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The extreme potency of botulinum neurotoxin necessitates rigid requirements to ensure the safety of laboratory workers. […] While the mouse lethality assay has remained the standard test for the detection of botulinum neurotoxins, there has been tremendous progress in the development of alternative tests during the past decade. […] The latest advances in assay development have successfully aimed at rapidity and sensitivity; the fastest tests are now performed in 20 min, and the test sensitivities have surpassed that of the mouse bioassay. […] However, further research is warranted to gain speed and sensitivity with a single test that would optimally detect all seven neurotoxin types simultaneously. […] The standard procedure for the detection of botulinum toxin is the mouse lethality assay.

• #22 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The sensitivity of the conventional ELISAs for botulinum neurotoxin detection is some 10- to 100-fold lower than that of the mouse bioassay. […] The limitations of each assay should be borne in mind; for example, the ELISA-ELCA that employs chicken and biotinylated antibodies is not suitable for investigation of foods containing chicken meat, egg yolk, egg white, and milk. […] The property of the botulinum neurotoxin of having a highly specific zinc-endopeptidase activity with selected targets in the synaptic cleft has inspired the development of in vitro assays for toxin detection. […] The endopeptidase assays are based on specific cleavage of synaptic proteins by different botulinum neurotoxins, combined with immunological detection of the cleaved peptide, or detection of fluorescence released when a peptide labeled with a quenched chromophore is cleaved.

• #23 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  1st investigations to order include mouse bioassay of serum, gastric secretions, stool, or food samples, and culture of food samples, gastric aspirates, or faecal material. […] Investigations to consider include electrophysiological testing. […] Emerging tests include enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR).

• #24 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  The sensitivity of the conventional ELISAs for botulinum neurotoxin detection is some 10- to 100-fold lower than that of the mouse bioassay. […] The limitations of each assay should be borne in mind; for example, the ELISA-ELCA that employs chicken and biotinylated antibodies is not suitable for investigation of foods containing chicken meat, egg yolk, egg white, and milk. […] The property of the botulinum neurotoxin of having a highly specific zinc-endopeptidase activity with selected targets in the synaptic cleft has inspired the development of in vitro assays for toxin detection. […] The endopeptidase assays are based on specific cleavage of synaptic proteins by different botulinum neurotoxins, combined with immunological detection of the cleaved peptide, or detection of fluorescence released when a peptide labeled with a quenched chromophore is cleaved.

• #25 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  C. botulinum requires strict anaerobic conditions for growth. […] The identification and isolation of C. botulinum from samples with high levels of competitive bacterial flora, such as fecal and environmental samples, are laborious and time-consuming. […] The presence of nontoxigenic C. botulinum-like strains disturbs the culture of C. botulinum. […] DNA-based detection methods have overtaken conventional techniques, with numerous molecular detection protocols published for C. botulinum. […] Molecular detection techniques are based merely on the detection of the botulinum neurotoxin gene in the sample, and thus they do not detect the activity of the gene nor the toxin. […] The findings obtained with the different genetic typing tools suggest that group I and II strains may have different epidemiological behavior in the environment, resulting in a narrower diversity of group I strains than of group II.

• #26 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  1st investigations to order include mouse bioassay of serum, gastric secretions, stool, or food samples, and culture of food samples, gastric aspirates, or faecal material. […] Investigations to consider include electrophysiological testing. […] Emerging tests include enzyme-linked immunosorbent assay (ELISA) and polymerase chain reaction (PCR).

• #27 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Botulism-Diagnosis.aspx

  In cases of food-borne botulism, recent consumption of canned or undercooked foods and infection among family members are often indicators. […] Wound botulism is usually characterized by the presence of an infected wound. […] An outline of the steps taken in diagnosing botulism is given below: A detailed history of possible exposure is obtained and symptoms are assessed. […] Samples from wounds are sent for culture and toxicity testing in the laboratory. […] Routine tests that may be performed include serum electrolytes, renal and liver function tests, urinanalysis, analysis of the cerebrospinal fluid (CSF) and electrocardiograms. […] Electromyography (EMG) can be used to detect muscle weakness and paralysis. This test can also help distinguish myasthenia gravis and Guillain-Barr syndrome from botulism. […] Blood or stool samples may be taken and sent for analysis.

• #28 Botulism: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/213311-overview

  Botulism is an acute neurologic disorder manifested by life-threatening paralysis due to a neurotoxin produced by Clostridium botulinum or related species (C baratii and C butyricum). […] The diagnosis initially must be made clinically, as waiting for laboratory confirmation would harmfully delay therapy. […] The standard for laboratory diagnosis is a mouse neutralization bioassay confirming botulism by isolation of the toxin. Toxin may be identified in the following: Serum, Stool, Vomitus, Gastric aspirate, Suspected foods. […] Clostridium botulinum may be grown on selective media from samples of stool or foods. […] Characteristic electromyographic findings in patients with botulism include the following: Brief, low-voltage compound motor-units, Small M-wave amplitudes, Overly abundant action potentials. […] An incremental increase in M-wave amplitude with rapid repetitive nerve stimulation may help to localize the disorder to the neuromuscular junction.

• #29 Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review

  https://www.mdpi.com/2072-6651/13/12/860

  In patients with botulism, high-rate RNS (>20 Hz) given for seconds (tetanic facilitation) or post-tetanic facilitation post-exercise single supramaximal stimulations (SSSs) may be able to produce the typical > 120% incremental increase in the CMAP amplitude compared to the basal CMAP. […] The specific ENMG tests confirming the presynaptic block typical of IB and distinguishing it from other neuromuscular disorders are repetitive nerve stimulation (RNS) at high-rate and stimulated single-fiber electromyography (sSFEMG). […] In the present paper, we report the first IB case associated with Cytomegalovirus (CMV) coinfection and transient hypogammaglobulinemia and discuss the meaning of these associations in terms of risk factors. […] We suggest investigating IgA, IgG, and IgM levels in the blood of patients with suspected botulism and CMV DNA in their specimens.

• #30 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #31 Botulism Facts | Texas DSHS

  https://www.dshs.texas.gov/foodborne-illness/botulism/botulism-facts

  Immediately report any suspect cases of botulism to your local health authority or call the Texas Department of State Health Services Infectious Disease Control Unit at 800-252-8239 during business hours. Call 888-963-7111 after hours, weekends, and holidays for routing to the epidemiologist on call. Clinicians should use the Foodborne Botulism Alert Summary form to report suspect cases. […] A temporal cluster of healthy patients with bulbar and neuromuscular disease should alert healthcare providers to the possibility of botulism. Cases might be confused with myasthenia gravis or Lambert-Eaton myasthenic syndrome, but these conditions are rarely fulminant and lack autonomic features. Guillain-Barr syndrome (GBS) and other acute inflammatory polyneuropathies are similar but rarely begin with cranial nerve dysfunction. A normal CSF and a negative Tensilon test suggest botulism rather than GBS or myasthenia gravis, respectively.

• #32 Botulism: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/food-recipes/food-poisoning/what-is-botulism

  Your doctor will likely start with a physical exam, looking for signs of botulism such as muscle weakness, a weak voice, or drooping eyelids. They might also ask you about foods you (or your baby) have eaten. […] They may order a lab test to analyze either your blood or a stool sample to confirm their diagnosis. Other tests may be needed. […] If you happened to have saved the food you suspect caused the botulism, you can take it in for testing. […] Lab tests may take a couple of days. In the meantime, your doctor may try to rule out other possible conditions. Botulism symptoms are similar to those of stroke and Guillain-Barre syndrome, in which your immune system attacks your nerves, causing possible paralysis. […] Other tests that may be done to diagnose botulism include: […] A magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain can help rule out other reasons for your symptoms, such as a stroke.

• #33 Botulism: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/food-recipes/food-poisoning/what-is-botulism

  A cerebrospinal fluid (CSF) study, sometimes called a spinal tap, may show a slight increase in the level of protein. But a CSF study is essentially normal in people with botulism. […] Electromyography can help confirm a diagnosis of botulism. […] This is done to rule out myasthenia gravis, which can cause similar symptoms. […] If these tests don’t confirm whether you have botulism, your doctor may have lab tests done to look for bacteria or toxins.

• #34 Botulism: Types, Symptoms, Diagnosis, Treatment

  https://www.webmd.com/food-recipes/food-poisoning/what-is-botulism

  Your doctor will likely start with a physical exam, looking for signs of botulism such as muscle weakness, a weak voice, or drooping eyelids. They might also ask you about foods you (or your baby) have eaten. […] They may order a lab test to analyze either your blood or a stool sample to confirm their diagnosis. Other tests may be needed. […] If you happened to have saved the food you suspect caused the botulism, you can take it in for testing. […] Lab tests may take a couple of days. In the meantime, your doctor may try to rule out other possible conditions. Botulism symptoms are similar to those of stroke and Guillain-Barre syndrome, in which your immune system attacks your nerves, causing possible paralysis. […] Other tests that may be done to diagnose botulism include: […] A magnetic resonance imaging (MRI) or computed tomography (CT) scan of the brain can help rule out other reasons for your symptoms, such as a stroke.

• #35 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Although the progression of paralysis in patients with botulism is described as unique and recognizable, in practice, when a patient is first seen by the health care provider, the neurologic symptoms and the sequence of progression both are sometimes misdiagnosed. […] The critical initial treatment and management decisions for patients with suspected botulism must be made based on clinical findings. Botulinum antitoxin, the only specific therapy for botulism, should be administered as quickly as possible. […] Laboratory confirmation can take several days, and delaying administration of antitoxin to a patient with a high or medium likelihood of botulism while awaiting laboratory results can worsen the patient’s outcome. […] Clinicians should ask patients about possible exposures to well-described sources of botulinum toxin, while keeping in mind that absence of such exposures does not exclude the possibility of botulism.

• #36 EM@3AM: Botulism – emDocs

  https://www.emdocs.net/em3am-botulism/

  Diagnosis: Botulism […] Botulism should be suspected in a patient with acute onset of signs and symptoms of a cranial neuropathy and symmetric descending weakness, particularly in the absence of fever. […] In infants, botulism should be suspected when there is acute onset of weak suck, ptosis, inactivity, and constipation (eg, floppy baby syndrome). […] The presumptive diagnosis can be made on clinical findings alone. […] In a study that included 241 cases of botulism recorded in the National Botulism Surveillance Database in the United States, three clinical criteria (lack of fever, at least one specific symptom of cranial neuropathy, and at least one specific sign of cranial neuropathy) were met in 89 percent of patients. […] The diagnosis of botulism is confirmed by identification of toxin in serum, stool, vomitus, or food sources which requires one to four days and anaerobic cultures often take up to six days for growth and identification of the organism. […] These confirmatory tests do not yield timely results, therefore, the decision to administer antitoxin should be based on the presumptive clinical diagnosis of botulism and not be delayed while awaiting results of confirmatory diagnostic studies.

• #37

  https://www.health.vic.gov.au/infectious-diseases/botulism

  Clostridium botulinum infection is an urgent notifiable condition and must be notified by medical practitioners and pathology services immediately by telephone upon initial diagnosis (presumptive or confirmed). Pathology services must follow up with written notification within 5 days. […] Diagnosis of foodborne botulism is made by demonstration of botulinum toxin in serum, gastric aspirate, stool, implicated food or tissue derived from the wound or by culture of C. botulinum from gastric aspirate or stool in clinical cases. […] Identification of the organism in suspected food is helpful but not diagnostic because botulinum spores are ubiquitous in the environment. The presence of toxin in suspected food is highly significant. […] Electromyography may be useful in corroborating the clinical diagnosis.

• #38 Botulism – Infections – MSD Manual Consumer Version

  https://www.msdmanuals.com/home/infections/bacterial-infections-anaerobic-bacteria/botulism

  Doctors examine samples of blood, stool, or tissue from a wound, and electromyography may be done. […] When possible, tests to detect toxins in food, blood, or stool. […] Sometimes electromyography. […] Doctors suspect botulism based on symptoms. However, other disorders can cause similar symptoms, so additional information is needed. […] For foodborne botulism, a likely food source provides a clue. For example, when botulism occurs in two or more people who ate the same food prepared in the same place, the diagnosis is clearer. The diagnosis is confirmed when the toxins are detected in the blood or when the bacteria or toxins are detected in a sample of stool. Toxins may also be identified in food that was eaten. […] For wound botulism, doctors ask whether people have had an injury that broke the skin. Doctors may inspect the skin for puncture marks suggesting use of an illicit drug. The diagnosis is confirmed when the toxins are detected in the blood or when the bacteria are detected in a culture of tissue from the wound.

• #39 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  In addition to the detection of botulinum toxin and C. botulinum in the patient, the diagnostics should aim at physiological and genetic typing of the disease isolates. […] The diagnosis is based on positive laboratory findings. Of these, detection of toxin in the patient’s serum and/or feces remains the standard method. The detection of C. botulinum in patient samples, such as feces, gastric and intestinal contents, and wound swabs and tissues, supports the diagnosis, but should not exclusively be considered pathognomonic of the disease. […] In some cases of infant botulism, the presence of C. botulinum alone in the feces or intestinal content of the patient may be sufficient for diagnosis even if the neurotoxin could not be detected in samples from the patient. […] Whereas a rapid diagnosis of botulism is a prerequisite for the patient to survive and recover, a more thorough investigation of botulism outbreaks is needed to provide epidemiological information about the disease. This includes the isolation of C. botulinum from the patient and from vehicle foods or other sources of spores or toxin and genotypic analysis of the disease isolates.

• #40 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/IBTPP_Lab_Info.aspx

  The mission of the IBTPP is to provide and improve the treatment of infant botulism and to prevent infant botulism and related diseases. […] The disease infant botulism is first suspected based on clinical features of the infant patient (one year of age or younger). Symptoms such as poor feeding, droopy eyelids, constipation and lethargy, together with hypotonia and loss of head control, prompt physicians to consider botulinum toxin as the causative agent. Accordingly, it is necessary for laboratory analysis to be performed without delay to establish the diagnosis. Prompt laboratory diagnosis of infant botulism is necessary for patient management and rules out the possibility of fatal degenerative neuromuscular diseases. […] The laboratory diagnosis of infant botulism is a two-part process. The first component is to perform a direct toxin analysis. This requires the extraction of toxin directly from the fecal specimen and the use of specialized techniques to identify and type the toxin. The second part is to culture the feces using specialized media and techniques in order to isolate Clostridium botulinum.

• #41 Botulism Facts | Texas DSHS

  https://www.dshs.texas.gov/foodborne-illness/botulism/botulism-facts

  Because diagnostic bioassays are time-consuming and delay in specific treatment may prove quickly fatal, treatment must initially be empiric. The most common test for detecting the presence of C. botulinum toxin is the mouse neutralization test using stool (10g recommended for an infant and 50g recommended for an adult). Serum (10ml) and respiratory secretions may also be helpful, depending on the route of transmission. […] The toxin can be isolated from food. Food samples may be submitted for toxin detection and or isolation of organism. A minimum 25g sample of each food to be tested for each pathogen should be submitted. […] All specimens must be triple contained in an approved shipping container and have biohazard labels. Although there is no specific hazard to personnel handling specimens, the receiving laboratory must be alerted prior to transport.

• #42

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/botulism.aspx

  Public health priority: Urgent. […] PHU response time: Respond to suspected and confirmed cases immediately. Enter confirmed cases on NCIMS within 1 working day. […] Case management: Notify the Communicable Diseases Branch. Identify suspect foods if possible and test for toxin. […] A confirmed case requires laboratory definitive evidence and clinical evidence. […] Isolation of Clostridium botulinum or Detection of C. botulinum toxin in blood or faeces. […] A clinically compatible illness (eg. diplopia, blurred vision, muscle weakness, paralysis, death). […] Foodborne botulism is to be notified by: Hospital CEOs on provisional clinical diagnosis (ideal reporting by telephone within 1 hour of diagnosis) Laboratories on microbiological or toxicological confirmation (ideal reporting by telephone within 1 hour of diagnosis).

• #43 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Because diagnosing botulism can be challenging, a tool with evidence-based clinical criteria has been developed to aid clinicians in early identification of botulism in settings of crisis or contingency standards of care, when the probability of botulism increases above the level of extremely rare. […] The only specific therapy for botulism is botulinum antitoxin. When administered early in the course of illness (within 48 hours of symptom onset and ideally within 24 hours), botulinum antitoxin can stop the progression of paralysis and prevent respiratory compromise in certain patients. […] Administer botulinum antitoxin to patients with suspected botulism as early as possible in the course of illness. The greatest benefit accrues to those who receive it within the first 2 days of illness onset.

• #44 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/IBTPP_Lab_Info.aspx

  Fecal specimens for infant botulism diagnostic testing can be collected before or after antitoxin administration. BabyBIG does not neutralize botulinum toxin present in the lumen of the intestine, nor does it kill or prevent the growth of C. botulinum or inhibit the formation of botulinum toxin in the infants large intestine.

• #45 Foodborne Botulism: Clinical Diagnosis and Medical Treatment

  https://www.mdpi.com/2072-6651/12/8/509

  The confirmation of clinical suspicion cannot be based on routine laboratory tests that would be normal in absence of other complications. In order to distinguish botulism from other similar diseases some tests can be used: (i) normal cerebrospinal fluid (CSF) may differentiate botulism from Guillain–Barré syndrome […] The laboratory confirmation of foodborne botulism is possible with the detection of BoNTs in clinical specimens or food samples and on the isolation of BoNT producing clostridia from stools. The most direct way to confirm the diagnosis is to demonstrate the BoNTs in the patient’s serum or stool by injecting serum or stool into mice and looking for signs of botulism. […] The treatment of botulism includes (i) gastrointestinal decontamination (if indicated), (ii) antidote (antitoxin) and (iii) eventually respiratory support. Antitoxin neutralize only the free circulating toxins in the blood still unbound to the nerve endings (at presynaptic level). The treatment may be started as soon as the clinical suspicion is made.

• #46 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Because diagnosing botulism can be challenging, a tool with evidence-based clinical criteria has been developed to aid clinicians in early identification of botulism in settings of crisis or contingency standards of care, when the probability of botulism increases above the level of extremely rare. […] The only specific therapy for botulism is botulinum antitoxin. When administered early in the course of illness (within 48 hours of symptom onset and ideally within 24 hours), botulinum antitoxin can stop the progression of paralysis and prevent respiratory compromise in certain patients. […] Administer botulinum antitoxin to patients with suspected botulism as early as possible in the course of illness. The greatest benefit accrues to those who receive it within the first 2 days of illness onset.

• #47 Botulism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459273/

  Botulism is primarily categorized into 3 primary types based on the source of toxin exposure: foodborne, wound-related, and infant botulism. […] Laboratory confirmation of botulism may be obtained with serum and stool assays for BoNT, gastric aspirates or rectal swabs, stool microscopy for spores, stool cultures, and wound cultures for wound botulism. […] Treatment of botulism consists of antitoxin administration, hospital admission, close monitoring, respiratory support as required, and debridement with antibiotic coverage in the case of wound botulism. […] Antitoxin therapy available to healthcare professionals currently exists in 2 forms: heptavalent equine serum antitoxin, indicated for patients older than 1 year, and human-derived immunoglobulin, indicated for infants younger than 1 year. […] The administration of antitoxin will not reverse neurological paralysis, given that BoNT binds irreversibly, but it will help stop disease progression.

• #48 Early diagnosis and critical management of wound botulism in the emergency department: a single center experience and literature review | International Journal of Emergency Medicine | Full Text

  https://intjem.biomedcentral.com/articles/10.1186/s12245-021-00375-4

  Treatment of wound botulism with the equine-derived heptavalent (types A-G) or trivalent (types A, B, and E) antitoxin is aimed at interrupting the neurologic progression of the disease and mitigating the duration of ventilatory failure in those who are severely afflicted. […] The morbidity and mortality of wound botulism can be drastically reduced if clinicians are adept at recognizing its clinical predictors. […] It is therefore important to swiftly perform an evaluation, make the diagnosis, and initiate treatment.

• #49

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/botulism.aspx

  Immediate administration of antitoxin is the key to successful therapy, because antitoxin arrests the progression of paralysis. […] Human-derived botulism immune globulin for intravenous use (BabyBIG) is licensed by the USFDA for the treatment of infant botulism caused by C. botulinum with serotype A or type B toxins. […] Antibiotics are not indicated in infant botulism. […] The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission. […] Contacts can be defined as those persons who may have eaten suspected food. It is of great urgency to identify both the contacts and the suspected food as quickly as possible to prevent further cases.

• #50 Infant Botulism – Infectious Diseases – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/infant-botulism

  Infant botulism results from ingestion of Clostridium botulinum spores, their colonization of the large intestine, and toxin production in vivo. […] Diagnosis is clinical and by laboratory identification of toxin or organisms in the stool. […] Finding C. botulinum toxin or organisms in the stool establishes the diagnosis of infant botulism. […] Treatment of infant botulism is started as soon as the diagnosis is suspected; waiting for confirmatory test results, which may take days, is dangerous. […] Specific treatment of infant botulism is with human botulism immune globulin (BabyBIG), which is available from the Infant Botulism Treatment and Prevention Program (IBTPPcall 510-231-7600 or visit the IBTPP web site).

• #51 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Patients with suspected botulism whose symptoms or signs (e.g., paralysis) are progressing should be treated with BAT regardless of the time that has elapsed since symptom onset. […] Patients with suspected botulism should be treated with BAT regardless of underlying medical conditions or age, sex, or other demographic characteristics. […] Proactively develop an approach to handle BAT shortages as part of an emergency planning process that incorporates the full range of stakeholders, including local communities.

• #52

  https://www.who.int/news-room/fact-sheets/detail/botulism

  Diagnosis is usually based on clinical history and clinical examination followed by laboratory confirmation including demonstrating the presence of botulinum toxin in serum, stool or food, or a culture of C. botulinum from stool, wound or food. […] Misdiagnosis of botulism sometimes occurs as it is often confused with stroke, Guillain-Barr syndrome, or myasthenia gravis. […] Antitoxin should be administered as soon as possible after a clinical diagnosis. Early administration is effective in reducing mortality rates. […] Severe botulism cases require supportive treatment, especially mechanical ventilation, which may be required for weeks or even months.

• #53 Botulism – NYC Health

  https://www.nyc.gov/site/doh/health/health-topics/botulism.page

  Botulism is usually diagnosed by finding the toxin in blood, or stool, or in the skin of people with wound botulism. Sometimes it can be found in contaminated food (if foodborne botulism). […] If diagnosed early, botulism can be treated with a drug called an antitoxin, which prevents the botulinum toxin from causing any more harm. Antitoxin can only be given in a hospital. Antitoxin is not used to treat infant botulism; however, giving intravenous antibodies may be effective. […] Severe botulism can cause respiratory failure and paralysis, which may require a patient to be on a breathing machine (ventilator) for weeks to months and may require intensive care. Depending on the severity of the illness, the paralysis can slowly improve over the course of weeks to months.

• #54

  https://www.gov.uk/government/publications/botulism-clinical-and-public-health-management/botulism-clinical-and-public-health-management

  Botulism is a clinical diagnosis and treatment with antitoxin should not be delayed for the results of laboratory investigations. Confirmation of a clinical diagnosis is by detection of botulinum toxin in serum or faecal specimens or detection and isolation of C. botulinum from faeces or food samples. […] Confirmation of the clinical diagnosis is by the demonstration of botulinum toxin in blood samples or, in the case of wound botulism, by the identification of C. botulinum in wound specimens. Routine laboratory tests are not helpful and specimens should therefore be sent immediately to the reference laboratory. […] Botulinum antitoxin is effective in reducing the severity of symptoms if administered early in the course of the disease. C. botulinum is sensitive to benzyl penicillin and metronidazole. In cases of wound infection, antimicrobial therapy and surgical debridement should reduce the organism load and therefore toxin production, but circulating toxin can only be neutralised by the early administration of antitoxin. […] Where there is definite clinical suspicion of botulism, treatment with antitoxin should not be delayed for microbiological testing.

• #55 Botulism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK459273/

  Botulism is primarily categorized into 3 primary types based on the source of toxin exposure: foodborne, wound-related, and infant botulism. […] Laboratory confirmation of botulism may be obtained with serum and stool assays for BoNT, gastric aspirates or rectal swabs, stool microscopy for spores, stool cultures, and wound cultures for wound botulism. […] Treatment of botulism consists of antitoxin administration, hospital admission, close monitoring, respiratory support as required, and debridement with antibiotic coverage in the case of wound botulism. […] Antitoxin therapy available to healthcare professionals currently exists in 2 forms: heptavalent equine serum antitoxin, indicated for patients older than 1 year, and human-derived immunoglobulin, indicated for infants younger than 1 year. […] The administration of antitoxin will not reverse neurological paralysis, given that BoNT binds irreversibly, but it will help stop disease progression.

• #56

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/botulism.aspx

  Immediate administration of antitoxin is the key to successful therapy, because antitoxin arrests the progression of paralysis. […] Human-derived botulism immune globulin for intravenous use (BabyBIG) is licensed by the USFDA for the treatment of infant botulism caused by C. botulinum with serotype A or type B toxins. […] Antibiotics are not indicated in infant botulism. […] The case or relevant care-giver should be informed about the nature of the infection and the mode of transmission. […] Contacts can be defined as those persons who may have eaten suspected food. It is of great urgency to identify both the contacts and the suspected food as quickly as possible to prevent further cases.

• #57 Botulism: Cause, Effects, Diagnosis, Clinical and Laboratory Identification, and Treatment Modalities | Disaster Medicine and Public Health Preparedness | Cambridge Core

  https://www.cambridge.org/core/journals/disaster-medicine-and-public-health-preparedness/article/botulism-cause-effects-diagnosis-clinical-and-laboratory-identification-and-treatment-modalities/3AD0CFD5CEF61CAE77923B5F1CA7B908

  Botulism may follow ingestion of food contaminated with BoNT, from toxin production of C botulinum present in the intestine or wounds, or from inhalation of aerosolized toxin. […] Early diagnosis is important because antitoxin therapy is most effective when administered early. […] Confirmatory testing of botulism with BoNT assays or C botulinum cultures is time-consuming, and may be insensitive in the diagnosis of inhalational botulism and in as many as 32% of food-borne botulism cases. […] Therefore, the decision to initiate botulinum antitoxin therapy is primarily based on symptoms and physical examination findings that are consistent with botulism, with support of epidemiological history and electrophysiological testing. […] Modern clinical practice and antitoxin treatment has reduced botulism mortality rates from 60% to 10%. […] Neurophysiological assessment in the diagnosis of botulism: usefulness of single-fiber EMG.

• #58 Botulism: Types, Causes, Symptoms & Treatments

  https://my.clevelandclinic.org/health/diseases/17828-botulism

  No specific treatment will cure botulism, though mild nerve damage can heal. Antitoxins can stop further damage from the toxin. […] Botulism can paralyze the muscles that help you swallow and breathe. While antitoxins can help in many cases, some people do die of breathing problems and infections. […] Depending on the severity of your case, recovery from botulism can take weeks, months or even years. Most people who receive prompt treatment recover completely in fewer than two weeks.

• #59 Welcome to the Infant Botulism Treatment and Prevention Program

  https://www.infantbotulism.org/physician/laboratory.php

  The disease infant botulism is first suspected based on clinical features of the infant patient (12 months of age or younger). Symptoms such as poor feeding, droopy eyelids, constipation and lethargy, together with hypotonia and loss of head control, should prompt physicians to consider botulinum toxin as the causative agent. Accordingly, laboratory testing needs to be performed without delay to establish the diagnosis. Prompt laboratory diagnosis of infant botulism is helpful for patient management and excludes the possibility of fatal degenerative neuromuscular diseases. The laboratory diagnosis of infant botulism is a two-step process. The first step is to perform a direct toxin analysis. This requires the extraction of toxin directly from the fecal specimen and the use of specialized techniques to identify and type the toxin. The second step varies between laboratories, some laboratories use PCR techniques to identify Clostridium botulinum in the feces, while others culture the feces using specialized media and techniques in order to isolate C. botulinum.

• #60 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  Botulism is a clinical syndrome characterised by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits. […] The diagnosis of botulism is a clinical one, confirmed by the detection of toxin in clinical samples. […] Key diagnostic factors include presence of risk factors, blurred vision and diplopia, impaired accommodation, ptosis, oculobulbar weakness, hypoglossal weakness, dysarthria, dysphagia, and symmetrical descending flaccid paralysis. […] Other diagnostic factors include hypotonia, feeding difficulties in infants, weakened cry in infants, hypothermia, urinary retention, constipation, dry mouth and throat, postural hypotension, gastrointestinal illness, diminished or absent deep tendon reflexes, absence of fever, respiratory dysfunction, and pupillary dilation.

• #61 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/IBTPP_Lab_Info.aspx

  The mission of the IBTPP is to provide and improve the treatment of infant botulism and to prevent infant botulism and related diseases. […] The disease infant botulism is first suspected based on clinical features of the infant patient (one year of age or younger). Symptoms such as poor feeding, droopy eyelids, constipation and lethargy, together with hypotonia and loss of head control, prompt physicians to consider botulinum toxin as the causative agent. Accordingly, it is necessary for laboratory analysis to be performed without delay to establish the diagnosis. Prompt laboratory diagnosis of infant botulism is necessary for patient management and rules out the possibility of fatal degenerative neuromuscular diseases. […] The laboratory diagnosis of infant botulism is a two-part process. The first component is to perform a direct toxin analysis. This requires the extraction of toxin directly from the fecal specimen and the use of specialized techniques to identify and type the toxin. The second part is to culture the feces using specialized media and techniques in order to isolate Clostridium botulinum.

• #62 Laboratory Diagnostics of Botulism

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1471988/

  In addition to the detection of botulinum toxin and C. botulinum in the patient, the diagnostics should aim at physiological and genetic typing of the disease isolates. […] The diagnosis is based on positive laboratory findings. Of these, detection of toxin in the patient’s serum and/or feces remains the standard method. The detection of C. botulinum in patient samples, such as feces, gastric and intestinal contents, and wound swabs and tissues, supports the diagnosis, but should not exclusively be considered pathognomonic of the disease. […] In some cases of infant botulism, the presence of C. botulinum alone in the feces or intestinal content of the patient may be sufficient for diagnosis even if the neurotoxin could not be detected in samples from the patient. […] Whereas a rapid diagnosis of botulism is a prerequisite for the patient to survive and recover, a more thorough investigation of botulism outbreaks is needed to provide epidemiological information about the disease. This includes the isolation of C. botulinum from the patient and from vehicle foods or other sources of spores or toxin and genotypic analysis of the disease isolates.

• #63 Botulism Information for Health Care Providers

  https://portal.ct.gov/dph/public-health-preparedness/bioterrorism/botulism-information-for-health-care-providers

  Caused by toxin from Clostridium botulinum, a spore-forming, obligate anaerobic bacillus. […] Botulinum toxins are considered one of the most potent lethal substances known. […] There are three naturally occurring forms of botulism foodborne, wound, infant and child or adult intestinal colonization botulism. […] Person-to-person transmission does NOT occur with botulism. […] IF YOU HAVE REASON TO SUSPECT BOTULISM, ALERT YOUR LABORATORY PERSONNEL IMMEDIATELY […] Testing should be performed by the DOH Public Health Laboratories. […] Appropriate clinical samples for botulinum toxin testing at DOH include serum and stool. […] DPH has capacity to report preliminary results within 18-24 hours. […] Confirmation by laboratory testing should always be done, but testing may require up to two days.

• #64 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Because diagnosing botulism can be challenging, a tool with evidence-based clinical criteria has been developed to aid clinicians in early identification of botulism in settings of crisis or contingency standards of care, when the probability of botulism increases above the level of extremely rare. […] The only specific therapy for botulism is botulinum antitoxin. When administered early in the course of illness (within 48 hours of symptom onset and ideally within 24 hours), botulinum antitoxin can stop the progression of paralysis and prevent respiratory compromise in certain patients. […] Administer botulinum antitoxin to patients with suspected botulism as early as possible in the course of illness. The greatest benefit accrues to those who receive it within the first 2 days of illness onset.

• #65 Botulism Facts | Texas DSHS

  https://www.dshs.texas.gov/foodborne-illness/botulism/botulism-facts

  Because diagnostic bioassays are time-consuming and delay in specific treatment may prove quickly fatal, treatment must initially be empiric. The most common test for detecting the presence of C. botulinum toxin is the mouse neutralization test using stool (10g recommended for an infant and 50g recommended for an adult). Serum (10ml) and respiratory secretions may also be helpful, depending on the route of transmission. […] The toxin can be isolated from food. Food samples may be submitted for toxin detection and or isolation of organism. A minimum 25g sample of each food to be tested for each pathogen should be submitted. […] All specimens must be triple contained in an approved shipping container and have biohazard labels. Although there is no specific hazard to personnel handling specimens, the receiving laboratory must be alerted prior to transport.

• #66 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Patients with suspected botulism whose symptoms or signs (e.g., paralysis) are progressing should be treated with BAT regardless of the time that has elapsed since symptom onset. […] Patients with suspected botulism should be treated with BAT regardless of underlying medical conditions or age, sex, or other demographic characteristics. […] Proactively develop an approach to handle BAT shortages as part of an emergency planning process that incorporates the full range of stakeholders, including local communities.

• #67 Clostridium botulinum – Botulism: Tests for diagnosis of botulism. – IVAMI

  https://www.ivami.com/en/tests-i-clostridium-botulinum-i/5001-030-clostridium-botulinum-tests-for-diagnosis-of-botulism-overview

  To confirm the presence of botulinum toxin in the culture neutralization tests using specific antisera for each type of botulinum toxin can be performed, or detection for the presence of Clostridium botulinum genes and its type in the culture medium. […] The molecular detection by PCR avoids the time required for calculating the minimum lethal dose (MLD) and neutralization test. […] Detection of anti-botulinum toxin antibodies have interest in the following cases: Patients treated with diluted botulinum toxin, such as those receiving botox for aesthetic or medical treatments, to detect the presence of antibodies that prevent its action. […] Patients with suspected infant botulism or adult botulism who has not been able to find the bacterium Clostridium botulinum toxin in feces or serum.

• #68 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #69 Botulism – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/810

  Botulism is a clinical syndrome characterised by cranial nerve palsies, oculobulbar weakness, and descending, symmetrical flaccid paralysis in the absence of fever. Affected patients do not complain of sensory deficits. […] The diagnosis of botulism is a clinical one, confirmed by the detection of toxin in clinical samples. […] Key diagnostic factors include presence of risk factors, blurred vision and diplopia, impaired accommodation, ptosis, oculobulbar weakness, hypoglossal weakness, dysarthria, dysphagia, and symmetrical descending flaccid paralysis. […] Other diagnostic factors include hypotonia, feeding difficulties in infants, weakened cry in infants, hypothermia, urinary retention, constipation, dry mouth and throat, postural hypotension, gastrointestinal illness, diminished or absent deep tendon reflexes, absence of fever, respiratory dysfunction, and pupillary dilation.

• #70 Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | MMWR

  https://www.cdc.gov/mmwr/volumes/70/rr/rr7002a1.htm

  Although the progression of paralysis in patients with botulism is described as unique and recognizable, in practice, when a patient is first seen by the health care provider, the neurologic symptoms and the sequence of progression both are sometimes misdiagnosed. […] The critical initial treatment and management decisions for patients with suspected botulism must be made based on clinical findings. Botulinum antitoxin, the only specific therapy for botulism, should be administered as quickly as possible. […] Laboratory confirmation can take several days, and delaying administration of antitoxin to a patient with a high or medium likelihood of botulism while awaiting laboratory results can worsen the patient’s outcome. […] Clinicians should ask patients about possible exposures to well-described sources of botulinum toxin, while keeping in mind that absence of such exposures does not exclude the possibility of botulism.

• #71 Clinical Overview of Botulism | Botulism | CDC

  https://www.cdc.gov/botulism/hcp/clinical-overview/index.html

  Initial diagnosis of botulism is based on clinical symptoms. […] If clinical consultation supports botulism, begin treatment as soon as possible. Do not wait for laboratory confirmation. […] Botulism differs from other flaccid paralyses in that it typically manifests initially with prominent cranial nerve palsies. […] Botulism is frequently misdiagnosed, most often as a polyradiculoneuropathy (Guillain-Barr or Miller-Fisher syndrome), myasthenia gravis, or other diseases of the central nervous system. […] Routine laboratory test results are usually unremarkable for people with botulism. […] A normal Tensilon test helps to differentiate botulism from myasthenia gravis; borderline positive tests can occur in botulism. […] Laboratory confirmation is done by demonstrating the presence of botulinum toxin in serum, stool, or food. […] Botulism can also be confirmed by culturing botulinum neurotoxin-producing species of Clostridium (C. botulinum, C. butyricum, or C. baratii) from stool or a wound. […] Diagnostic testing is done through your state public health department laboratory.

• #72

  https://www.health.nsw.gov.au/Infectious/controlguideline/Pages/botulism.aspx

  Public health priority: Urgent. […] PHU response time: Respond to suspected and confirmed cases immediately. Enter confirmed cases on NCIMS within 1 working day. […] Case management: Notify the Communicable Diseases Branch. Identify suspect foods if possible and test for toxin. […] A confirmed case requires laboratory definitive evidence and clinical evidence. […] Isolation of Clostridium botulinum or Detection of C. botulinum toxin in blood or faeces. […] A clinically compatible illness (eg. diplopia, blurred vision, muscle weakness, paralysis, death). […] Foodborne botulism is to be notified by: Hospital CEOs on provisional clinical diagnosis (ideal reporting by telephone within 1 hour of diagnosis) Laboratories on microbiological or toxicological confirmation (ideal reporting by telephone within 1 hour of diagnosis).

• #73 Early diagnosis and critical management of wound botulism in the emergency department: a single center experience and literature review | International Journal of Emergency Medicine | Full Text

  https://intjem.biomedcentral.com/articles/10.1186/s12245-021-00375-4

  Treatment of wound botulism with the equine-derived heptavalent (types A-G) or trivalent (types A, B, and E) antitoxin is aimed at interrupting the neurologic progression of the disease and mitigating the duration of ventilatory failure in those who are severely afflicted. […] The morbidity and mortality of wound botulism can be drastically reduced if clinicians are adept at recognizing its clinical predictors. […] It is therefore important to swiftly perform an evaluation, make the diagnosis, and initiate treatment.

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