Botulism physical examination: Difference between revisions

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Latest revision as of 12:54, 24 May 2017

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: Wounds Bruises Subcutaneous abscesses	Pale skin with bruises and signs of penetrating trauma.
HEENT	Absent or decreased gag reflex Tongue hypotonia Weakness of the eye muscles Nystagmus Ptosis
Abdome	Paralytic ileus: Decreased or absent bowel sounds (Foodborne botulism)
Lungs	Bradypnea due to respiratory muscle paralysis
Cardiovascular	Normal heart sounds No murmurs, gallops or rubs
Neuromuscular	Absent or decreased deep tendon reflexes Motor deficit Facial nerve impairment
Neuromuscular	Speech impairment	Hypotonia causing "Floppy baby syndrome"
Extremities	Weakness of lower and upper extremities

Gallery

Six week old infant with botulism. From Public Health Image Library (PHIL). ^[4]

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)".

Template:WikiDoc Sources

[pmid7283294-1] 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.

[pmid19636165-2] 2.0 ^2.1 Fenicia L, Anniballi F (2009). "Infant botulism". Ann Ist Super Sanita. 45 (2): 134–46. PMID 19636165.

[pmid8964030-3] Midura TF (1996). "Update: infant botulism". Clin Microbiol Rev. 9 (2): 119–25. PMC 172885. PMID 8964030.

[PHIL-4] "Public Health Image Library (PHIL)".

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[2]

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 {{Botulism}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
+{{CMG}}; {{AE}}{{MJM}}
-{{CMG}}
+==Overview==
-{{MJM}}
+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==
-Botulism can be categorized based on the route of transmission. The Clostridium botulinun bacteria can be transmitted through food, by inhalation, and in a wound.
+Botulism physical examination is similar in both adults and infants. However, it is more severe in the infants and floppy baby syndrome is observed.<ref name="pmid8964030">{{cite journal| author=Midura TF| title=Update: infant botulism. | journal=Clin Microbiol Rev | year= 1996 | volume= 9 | issue= 2 | pages= 119-25 | pmid=8964030 | doi= | pmc=172885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8964030  }} </ref>
-The health care provider will perform a physical exam. There may be signs of:
-===Eyes===
+{| class="wikitable"
-*[[Ptosis|Eyelid drooping]]
+!Physical examination
-===Throat===
+!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]].<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
+|In wound botulism, the following may be observed:
+*Wounds
+*[[Bruises]]
+*[[Subcutaneous]] [[abscesses]]
+|[[Pale skin]] with bruises and signs of penetrating [[trauma]].
+|-
+|HEENT
+| colspan="2" |
 *Absent or decreased [[gag reflex]]
-===Abdomen===
+*Tongue [[hypotonia]]
-* [[Paralytic ileus]]: Decreased or absent bowel sounds
+*Weakness of the [[eye muscles]]
-===Neurologic===
+*[[Nystagmus]]
+*[[Ptosis]]
+|-
+|Abdome
+| colspan="2" |[[Paralytic ileus]]: Decreased or absent [[bowel sounds]] (Foodborne botulism)
+|-
+|Lungs
+| colspan="2" |[[Bradypnea]] due to respiratory muscle paralysis
+|-
+|Cardiovascular
+| colspan="2" |
+*Normal heart sounds
+*No murmurs, gallops or rubs
+|-
+| rowspan="2" |Neuromuscular
+| colspan="2" |
 *Absent or decreased deep tendon reflexes
-*[[Paralysis|Loss of muscle function]]/[[Parasthesia|feeling]]
+*Motor deficit
-*Speech impairment
+*[[Facial nerve]] impairment
+|-
+|
+* Speech impairment
+|
+*[[Hypotonia]] causing "[[Floppy baby syndrome]]"
+|-
+|Extremities
+| colspan="2" |Weakness of lower and upper extremities
+|}
+==Gallery==
+<gallery>
+Image: Botulism17.png| Six week old infant with botulism. <SMALL><SMALL>''[http://phil.cdc.gov/phil/home.asp From Public Health Image Library (PHIL).] ''<ref name=PHIL> {{Cite web | title = Public Health Image Library (PHIL) | url = http://phil.cdc.gov/phil/home.asp}}</ref></SMALL></SMALL>
+</gallery>
 ==References==
 {{Reflist|2}}
-[[Category:Pediatrics]]
-[[Category:Neonatology]]
-[[Category:Foodborne illnesses]]
-[[Category:Biological weapons]]
-[[Category:Conditions diagnosed by stool test]]
-[[Category:Poultry diseases]]
-[[Category:Zoonoses]]
-[[Category:Neurology]]
-[[Category:Infectious disease]]
-[[Category:Emergency medicine]]
-[[Category:Disease]]
-[[Category:Needs overview]]
-[[Category:Needs content]]
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