Editing Clostridium botulinum (section)

== Diagnosis ==
Physicians may consider the diagnosis of botulism based on a patient's clinical presentation, which classically includes an acute onset of bilateral cranial neuropathies and symmetric descending weakness.<ref name="pmid9585323">{{cite journal | vauthors = Cherington M | title = Clinical spectrum of botulism | journal = Muscle & Nerve | volume = 21 | issue = 6 | pages = 701–710 | date = June 1998 | pmid = 9585323 | doi = 10.1002/(sici)1097-4598(199806)21:6<701::aid-mus1>3.0.co;2-b }}</ref><ref>{{cite journal | vauthors = Cai S, Singh BR, Sharma S | title = Botulism diagnostics: from clinical symptoms to in vitro assays | journal = Critical Reviews in Microbiology | volume = 33 | issue = 2 | pages = 109–125 | date = April 2007 | pmid = 17558660 | doi = 10.1080/10408410701364562 | s2cid = 23470999 }}</ref> Other key features of botulism include an absence of fever, symmetric neurologic deficits, normal or slow heart rate and normal blood pressure, and no sensory deficits except for blurred vision.<ref>{{Cite web |title=Diagnosis and Treatment {{!}} Botulism |url=https://www.cdc.gov/botulism/testing-treatment.html |access-date=2017-10-08 |publisher=CDC |language=en-us}}</ref><ref>{{Cite news |title=Botulism: Rare but serious food poisoning |url=https://www.mayoclinic.org/diseases-conditions/botulism/basics/symptoms/con-20025875 |access-date=2017-11-18 |publisher=Mayo Clinic |language=en}}</ref> A careful history and physical examination is paramount to diagnose the type of botulism, as well as to rule out other conditions with similar findings, such as [[Guillain–Barré syndrome]], [[stroke]], and [[myasthenia gravis]].<ref>{{cite journal | vauthors = Rao AK, Sobel J, Chatham-Stephens K, Luquez C | title = Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021 | language = en-us | journal = MMWR. Recommendations and Reports | volume = 70 | issue = 2 | pages = 1–30 | date = May 2021 | pmid = 33956777 | pmc = 8112830 | doi = 10.15585/mmwr.rr7002a1 }}</ref> Depending on the type of botulism considered, different tests for diagnosis may be indicated.
* '''Foodborne botulism:''' serum analysis for toxins by bioassay in mice should be done, as the demonstration of the toxins is diagnostic.<ref>{{cite journal | vauthors = Lindström M, Korkeala H | title = Laboratory diagnostics of botulism | journal = Clinical Microbiology Reviews | volume = 19 | issue = 2 | pages = 298–314 | date = April 2006 | pmid = 16614251 | pmc = 1471988 | doi = 10.1128/CMR.19.2.298-314.2006 }}</ref>
* '''Wound botulism:''' isolation of ''C. botulinum'' from the wound site should be attempted, as growth of the bacteria is diagnostic.<ref>{{cite journal | vauthors = Akbulut D, Grant KA, McLauchlin J | title = Improvement in laboratory diagnosis of wound botulism and tetanus among injecting illicit-drug users by use of real-time PCR assays for neurotoxin gene fragments | journal = Journal of Clinical Microbiology | volume = 43 | issue = 9 | pages = 4342–4348 | date = September 2005 | pmid = 16145075 | pmc = 1234055 | doi = 10.1128/JCM.43.9.4342-4348.2005 }}</ref>
* '''Adult enteric and infant botulism:''' isolation and growth of ''C. botulinum'' from stool samples is diagnostic.<ref>{{cite journal | vauthors = Dezfulian M, McCroskey LM, Hatheway CL, Dowell VR | title = Selective medium for isolation of Clostridium botulinum from human feces | journal = Journal of Clinical Microbiology | volume = 13 | issue = 3 | pages = 526–531 | date = March 1981 | pmid = 7016901 | pmc = 273826 | doi = 10.1128/JCM.13.3.526-531.1981 }}</ref> Infant botulism is a diagnosis which is often missed in the emergency room.<ref name=":2">{{cite journal | vauthors = Antonucci L, Locci C, Schettini L, Clemente MG, Antonucci R | title = Infant botulism: an underestimated threat | journal = Infectious Diseases | volume = 53 | issue = 9 | pages = 647–660 | date = September 2021 | pmid = 33966588 | doi = 10.1080/23744235.2021.1919753 }}</ref>

Other tests that may be helpful in ruling out other conditions are:
* [[Electromyography]] (EMG) or antibody studies may help with the exclusion of [[myasthenia gravis]] and [[Lambert–Eaton myasthenic syndrome]] (LEMS).<ref>{{cite journal | vauthors = O'Suilleabhain P, Low PA, Lennon VA | title = Autonomic dysfunction in the Lambert-Eaton myasthenic syndrome: serologic and clinical correlates | journal = Neurology | volume = 50 | issue = 1 | pages = 88–93 | date = January 1998 | pmid = 9443463 | doi = 10.1212/wnl.50.1.88 | s2cid = 39437882 }}</ref>
* Collection of [[cerebrospinal fluid]] (CSF) protein and blood assist with the exclusion of [[Guillain–Barré syndrome|Guillan-Barre syndrome]] and [[stroke]].<ref>{{cite journal | vauthors = Mechem CC, Walter FG | title = Wound botulism | journal = Veterinary and Human Toxicology | volume = 36 | issue = 3 | pages = 233–237 | date = June 1994 | pmid = 8066973 | url = https://pubmed.ncbi.nlm.nih.gov/8066973/ }}</ref>
* Detailed physical examination of the patient for any rash or tick presence helps with the exclusion of any tick transmitted tick paralysis.<ref>{{cite journal | vauthors = Taraschenko OD, Powers KM | title = Neurotoxin-induced paralysis: a case of tick paralysis in a 2-year-old child | journal = Pediatric Neurology | volume = 50 | issue = 6 | pages = 605–607 | date = June 2014 | pmid = 24679414 | doi = 10.1016/j.pediatrneurol.2014.01.041 }}</ref>