Botulism diagnosis

Suggested Alternatives for Differential Diagnosis Rabies, hepatoencephalopathy, leukoen-cephalomalacia, protozoal encephalomyelitis, equine herpes virus 1, verminous men-ingoencephalomyelitis, cranial trauma, botulism, and meningitis. In birds Newcastle disease virus, avian encephalomyelitis virus, botulism, and listeriosis. 

Suggested Alternatives for Differential Diagnosis African horse sickness, anthrax, botulism, pasteurellosis, equine influenza, peracute equine herpesvirus 1 infection, and ingestion of plant or agricultural poisons. 

Pitfalls in the diagnosis of botulism include failure to recognize the symptoms and to institute adequate ventilatory support. Botulism is likely underdiagnosed and can be mistaken for a number of neuromuscular and neurologic disorders. Diphtheria, encephalitis, poliomyelitis, Guillain-Barre syndrome, congenital... 

Hatheway, C.L. (1988). Botulism. In Laboratory Diagnosis of Infectious Diseases Principles and Practice, Vol. I (A. Balows, W.J. Hausler, Jr., M. Ohashi, eds), pp. 111-33. Springer-Verlag, Berlin. 

In the hospital or other health care setting, patient care requires standard precautions. Botulism patients do not require isolation, although before definitive diagnosis, those with flaccid paralysis suspected as having meningitis require droplet precautions (36). 

Although the number of outbreaks has been relatively constant, the case to fatality ratio has improved markedly. From 1899 to 1950, foodborne botulism was associated with 60% mortahty from 1950 to 1996, the average annual mortahty fell to 15.5% (Shapiro et al., 1998), and decreased to 4% during the last decade (Sobel et al., 2004). These advances in survival have come primarily from improvements in critical care (Tacket et al., 1984 Sobel et al., 2004). Further reductions in morbidity and mortahty from botuhnum intoxication wiU require better methods for detection and diagnosis of BoNT outbreaks and availability of speciftc pharmacological treatments (Franz et al., 1997 Dickerson and Janda, 2006). 

Severe abdominal cramping, nausea, vomiting, and diarrhea are the symptoms of botulism, but it has not been determined that this is the diagnosis in the triage area. Determining whether the clients ate in the same place recently is the first step in determining if the client has been exposed to botulism. 

Shapiro RL et al Botulism in the United Stales a clinical and epidemiologic review. Ann Intern Med 1998 129(3) 221-228. [MID 9696731] (Review of the diagnosis, latiotatory analysis, presentation, and treatment of txrtulism.)... 

Detection and identification of the botulism neurotoxin have been essential for diagnosis of the illness and for identifying the causative food. When van Ermengem showed the lethality for animals of the ham that caused the Ellezelles botulism outbreak in 1895 (73), the bioassay naturally became the standard test for botulism neurotoxin. The mouse is very sensitive, and the mouse LD50 determined by i.p. injection became the quantitative unit. 

The various methods used to detect botulism toxin are listed in Table 2. Some of the assays for toxin can be modified for detection and measurement of antitoxin. Although detection of toxin is often the primary purpose of the test, sometimes it is secondary to identification of toxigenic organisms. In the investigation of botulism, detection of substantial amounts of toxin in the suspected food is confirmatory of the diagnosis. This is also true for detection of any demonstrable amount in the patient s blood or feces. 

Dezfulian et al. (8) evaluated ELISA for detecting type Aand B toxins in fecal samples from infants for diagnosis of infant botulism. The ELISA gave positive results for all 22 infant specimens that had been confirmed as toxic by bioassay, and for 5 specimens confirmed by culture but not by bioassay. Positive ELISA results were obtained with specimens not confirmed by conventional means these were possibly false positives. Rubin et al. reported detecting of antibodies reactive to botulism toxin preparations in serum samples from two infants who had recovered from infant botulism (59). 

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