Botulism (cont.)
How is botulism diagnosed?
The patient's history and physical examination may suggest
botulism, but these clues are usually not enough to allow a diagnosis
of botulism. Symptoms of other diseases,
such as a stroke, Guillain-Barré syndrome (another disease of muscle
paralysis), and myasthenia gravis (which also causes weakness and
eyelid drooping) can appear similar to those of botulism. Special
tests may be needed to exclude these other conditions. These tests
may include a brain scan, spinal fluid examination, nerve conduction
test
(electromyography, or EMG), and a tensilon test for myasthenia
gravis. However, if botulism is strongly suspected (for example, several patients with botulism symptoms who ate from the same home-preserved food container), samples should be obtained for a mouse inoculation test (see below) and
then the patients should be treated immediately with botulism antiserum.
The most direct way to confirm the diagnosis is to identify the botulinum neurotoxin in the patient's blood, serum, or stool. This is done by injecting the patient's serum or stool into the peritoneal cavity of mice. An equal amount of serum or stool from the patient is treated with multivalent antitoxin and injected in other mice. If the antitoxin-treated serum- or stool-injected mice live while those injected with untreated serum or stool die, then this is a positive test for botulism and is called the mouse inoculation test. The bacteria can also be isolated from the stool of people with food-borne and infant botulism, but this is not a definitive test.
How is botulism treated?
If diagnosed early, food-borne and wound botulism can be treated with an
antitoxin that blocks the action of neurotoxin circulating in the blood.
The trivalent antitoxin (effective against three neurotoxins: A, B, and
E) is dispensed from quarantine stations by the U.S. government's
Centers for Disease Control and Prevention (CDC). The antitoxin can
prevent the disorder from worsening, but recovery still takes many
weeks. Another heptavalent antitoxin (effective against seven
neurotoxins: A, B, C, D, E, F, and G) may be available from the U.S.
Army or FEMA. Physicians may remove whatever contaminated food is still
in the gut by inducing vomiting or by using enemas. Wounds should be
treated, usually surgically, to remove the source of the toxin-producing
bacteria. Good supportive care in a hospital is the mainstay of therapy
for all kinds of botulism.
Antitoxin is not routinely given for the treatment of infant botulism However, a new product that recently became available from the orphan drug program can be used to treat botulism in infants. The product is comprised of immune globulins that can be given
intravenously to infants who have been diagnosed with infant botulism. The new treatment is named BabyBIG (Botulism Immune Globulin, given IV) and is only currently available from a special site. Call 510-231-7600 for specific information about this treatment.
The respiratory failure and paralysis that occur with severe botulism may require a patient to be on a breathing machine (ventilator) for weeks and may require intensive medical and nursing care. After several weeks, the paralysis slowly improves as axons in the nerves are regenerated.
Next: What are complications from botulism? »
- Electromyogram (EMG) - EMG (electromyogram) can detect abnormal muscle electrical activity in conditions such as neuropathy, carpal tunnel syndrome, pinched nerves, herniated discs, peripheral nerve damage, ALS, and more.
- Food Poisoning - Read about the types of food poisoning from bacterium infection from Campylobacter, Salmonella, Shigella, E. coli O157:H7, Listeria, and botulism. Symptoms, diagnosis, treatment and prevention information is included in the information.
- Botox - Botox is the brand name of a toxin produced by the bacterium Clostridium botulinum.Small, diluted amounts can be directly injected into specific muscles causing controlled weakening of the muscles.
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