Botulism physical examination: Difference between revisions
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{{CMG}}; {{AE}}{{MJM}} | {{CMG}}; {{AE}}{{MJM}} | ||
==Overview== | ==Overview== | ||
Botulism physical examination is very important in order to suggest or exclude the disease. The patients with botulism appear dizzy and tired. The following signs are observed in the botulism patients: eyelid dropping, weakness of tongue muscle, nystagmus and decreased gag reflex. Paralytic ileus also may present. Botulism presentation shows many neurological manifestations like: generalized muscle weakness, abscent tendon reflexes, facial nerve impairment and speech impairment.<ref name="pmid7283294">{{cite journal| author=Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ| title=Clinical features of types A and B food-borne botulism. | journal=Ann Intern Med | year= 1981 | volume= 95 | issue= 4 | pages= 442-5 | pmid=7283294 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7283294 }} </ref> | Botulism physical examination is very important in order to suggest or exclude the disease. The patients with botulism appear [[dizzy]] and [[tired]]. The following signs are observed in the botulism patients: [[Ptosis|eyelid dropping]], weakness of [[tongue]] muscle, [[nystagmus]] and decreased [[gag reflex]]. [[Paralytic ileus]] also may present. Botulism presentation shows many [[neurological]] manifestations like: [[Hypotonia|generalized muscle weakness]], [[Areflexia|abscent tendon reflexes]], facial nerve impairment and [[Stuttering|speech impairment]].<ref name="pmid7283294">{{cite journal| author=Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ| title=Clinical features of types A and B food-borne botulism. | journal=Ann Intern Med | year= 1981 | volume= 95 | issue= 4 | pages= 442-5 | pmid=7283294 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7283294 }} </ref><ref name="pmid19636165">{{cite journal| author=Fenicia L, Anniballi F| title=Infant botulism. | journal=Ann Ist Super Sanita | year= 2009 | volume= 45 | issue= 2 | pages= 134-46 | pmid=19636165 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19636165 }} </ref> | ||
==Physical Examination== | ==Physical Examination== | ||
| Line 14: | Line 14: | ||
|- | |- | ||
|Appearance of the patient | |Appearance of the patient | ||
|Patients of botulism may appear lethargic and dizzy. | |Patients of botulism may appear [[lethargic]] and [[dizzy]]. | ||
|Infants appear pale with less crying and unable to eat. | |Infants appear pale with less crying and unable to eat. | ||
|- | |- | ||
|Vital signs | |Vital signs | ||
|Botulism patients have normal vital signs. | |||
|Unstable [[blood pressure]] and [[heart rate]].<ref name="pmid19636165">{{cite journal| author=Fenicia L, Anniballi F| title=Infant botulism. | journal=Ann Ist Super Sanita | year= 2009 | volume= 45 | issue= 2 | pages= 134-46 | pmid=19636165 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19636165 }} </ref> | |||
|- | |- | ||
|Skin | |Skin | ||
|In wound botulism, the following may be observed: | |In wound botulism, the following may be observed: | ||
* | *Wounds | ||
*Bruises | *[[Bruises]] | ||
*Subcutaneous abscesses | *[[Subcutaneous]] [[abscesses]] | ||
|Pale skin with bruises and signs of trauma. | |[[Pale skin]] with bruises and signs of penetrating [[trauma]]. | ||
|- | |- | ||
|HEENT | |||
| colspan="2" | | | colspan="2" | | ||
*Absent or decreased [[gag reflex]] | *Absent or decreased [[gag reflex]] | ||
* | *Tongue [[hypotonia]] | ||
*Weakness of the eye muscles | *Weakness of the [[eye muscles]] | ||
*Nystagmus | *[[Nystagmus]] | ||
*[[Ptosis]] | |||
|- | |- | ||
|Abdome | |Abdome | ||
| colspan="2" |[[Paralytic ileus]]: Decreased or absent bowel sounds (Foodborne botulism) | | colspan="2" |[[Paralytic ileus]]: Decreased or absent [[bowel sounds]] (Foodborne botulism) | ||
|- | |- | ||
|Lungs | |Lungs | ||
| colspan="2" | | | colspan="2" |[[Bradypnea]] due to respiratory muscle paralysis | ||
|- | |- | ||
| | |Cardiovascular | ||
| colspan="2" | | | colspan="2" | | ||
*Normal heart sounds | *Normal heart sounds | ||
*No murmurs, gallops or rubs | *No murmurs, gallops or rubs | ||
|- | |- | ||
| | | rowspan="2" |Neuromuscular | ||
| colspan="2" | | | colspan="2" | | ||
*Absent or decreased deep tendon reflexes | *Absent or decreased deep tendon reflexes | ||
*[[ | *Motor deficit | ||
*[[Facial nerve]] impairment | |||
|- | |- | ||
| | | | ||
* Speech impairment | |||
| | | | ||
*[[Hypotonia]] causing "[[Floppy baby syndrome]]" | |||
|- | |- | ||
|Extremities | |Extremities | ||
| colspan="2" |Weakness of lower and upper extremities | | colspan="2" |Weakness of lower and upper extremities | ||
|} | |} | ||
==Gallery== | ==Gallery== | ||
Latest revision as of 12:54, 24 May 2017
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Botulism Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Botulism physical examination On the Web |
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American Roentgen Ray Society Images of Botulism physical examination |
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Risk calculators and risk factors for Botulism physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.
Overview
Botulism physical examination is very important in order to suggest or exclude the disease. The patients with botulism appear dizzy and tired. The following signs are observed in the botulism patients: eyelid dropping, weakness of tongue muscle, nystagmus and decreased gag reflex. Paralytic ileus also may present. Botulism presentation shows many neurological manifestations like: generalized muscle weakness, abscent tendon reflexes, facial nerve impairment and speech impairment.[1][2]
Physical Examination
Botulism physical examination is similar in both adults and infants. However, it is more severe in the infants and floppy baby syndrome is observed.[3]
| Physical examination | Adult botulism | Infantile botulism |
|---|---|---|
| Appearance of the patient | Patients of botulism may appear lethargic and dizzy. | Infants appear pale with less crying and unable to eat. |
| Vital signs | Botulism patients have normal vital signs. | Unstable blood pressure and heart rate.[2] |
| Skin | In wound botulism, the following may be observed:
|
Pale skin with bruises and signs of penetrating trauma. |
| HEENT |
| |
| Abdome | Paralytic ileus: Decreased or absent bowel sounds (Foodborne botulism) | |
| Lungs | Bradypnea due to respiratory muscle paralysis | |
| Cardiovascular |
| |
| Neuromuscular |
| |
|
| |
| Extremities | Weakness of lower and upper extremities | |
Gallery
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![Six week old infant with botulism. From Public Health Image Library (PHIL). [4]](/images/1/17/Botulism17.png)
Six week old infant with botulism. From Public Health Image Library (PHIL). [4]
![Six week old infant with botulism. From Public Health Image Library (PHIL). [4]](/index.php/File:Botulism17.png)
References
- ↑ Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ (1981). "Clinical features of types A and B food-borne botulism". Ann Intern Med. 95 (4): 442–5. PMID 7283294.
- ↑ 2.0 2.1 Fenicia L, Anniballi F (2009). "Infant botulism". Ann Ist Super Sanita. 45 (2): 134–46. PMID 19636165.
- ↑ Midura TF (1996). "Update: infant botulism". Clin Microbiol Rev. 9 (2): 119–25. PMC 172885. PMID 8964030.
- ↑ "Public Health Image Library (PHIL)".