Botulism differential diagnosis: Difference between revisions
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| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test | | style="background: #F5F5F5; padding: 5px; text-align:center" |Toxin test | ||
| style="background: #F5F5F5; padding: 5px;" |Blood, Wound, or Stool culture | | style="background: #F5F5F5; padding: 5px; text-align:center" |Blood, Wound, or Stool culture | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" |CSF: ↑Protein | | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF: ↑Protein | ||
↓Cells | ↓Cells | ||
| style="background: #F5F5F5; padding: 5px;" |Clinical & Lumbar Puncture | | style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical & Lumbar Puncture | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent | | style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" |AB | | style="background: #F5F5F5; padding: 5px; text-align:center" |AB | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Myasthenia gravis]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent | | style="background: #F5F5F5; padding: 5px; text-align:center" |Intermittent | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" |Ach receptor antibody | | style="background: #F5F5F5; padding: 5px; text-align:center" |Ach receptor antibody | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Electrolyte disturbance]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | Electrolyte panel | | style="background: #F5F5F5; padding: 5px; text-align:center" | Electrolyte panel | ||
| style="background: #F5F5F5; padding: 5px;" |↓Ca++, ↓Mg++, ↓K+ | | style="background: #F5F5F5; padding: 5px; text-align:center" |↓Ca++, ↓Mg++, ↓K+ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Organophosphate poisoning|Organophosphate toxicity]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]]) | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]]) | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Tetrodotoxin]] poisoning | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |UL | | style="background: #F5F5F5; padding: 5px; text-align:center" |UL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | | style="background: #F5F5F5; padding: 5px; text-align:center" |Sudden | ||
| style="background: #F5F5F5; padding: 5px;" | MRI +ve for ischemia or hemorrhage | | style="background: #F5F5F5; padding: 5px; text-align:center" | MRI +ve for ischemia or hemorrhage | ||
| style="background: #F5F5F5; padding: 5px;" |MRI | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Poliomyelitis]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/> | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious<nowiki/> | ||
| style="background: #F5F5F5; padding: 5px;" |MRI & Lumbar puncture | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & Lumbar puncture | ||
| style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc | | style="background: #F5F5F5; padding: 5px; text-align:center" |CSF [[VDRL]]-specifc | ||
CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" |[[Muscular dystrophy]] | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | Genetic testing | | style="background: #F5F5F5; padding: 5px; text-align:center" | Genetic testing | ||
| style="background: #F5F5F5; padding: 5px;" |Muscle biopsy | | style="background: #F5F5F5; padding: 5px; text-align:center" |Muscle biopsy | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''CSF IgG levels | | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑'''CSF IgG levels | ||
(monoclonal bands) | (monoclonal bands) | ||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref> | | style="background: #F5F5F5; padding: 5px; text-align:center" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]] | | style="background: #F5F5F5; padding: 5px; text-align:center" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]] | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center | | style="background: #DCDCDC; padding: 5px; text-align:center" |[[Amyotrophic lateral sclerosis]] | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" | - | | style="background: #F5F5F5; padding: 5px; text-align:center" | - | ||
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| style="background: #F5F5F5; padding: 5px; text-align:center" |BL | | style="background: #F5F5F5; padding: 5px; text-align:center" |BL | ||
| style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | | style="background: #F5F5F5; padding: 5px; text-align:center" |Insidious | ||
| style="background: #F5F5F5; padding: 5px;" | Normal LP (to rule out DDx) | | style="background: #F5F5F5; padding: 5px; text-align:center" | Normal LP (to rule out DDx) | ||
| style="background: #F5F5F5; padding: 5px;" |MRI & LP | | style="background: #F5F5F5; padding: 5px; text-align:center" |MRI & LP | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px; text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] |
Revision as of 21:32, 22 May 2017
Botulism Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Botulism differential diagnosis On the Web |
American Roentgen Ray Society Images of Botulism differential diagnosis |
Risk calculators and risk factors for Botulism differential diagnosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.
Overview
Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity.
Differentiating Botulism from other Diseases
Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity, such as:
Diseases | History and Physical | Diagnostic tests | Other Findings | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Motor Deficit | Sensory deficit | Cranial nerve Involvement | Autonomic dysfunction | Proximal/Distal/Generalized | Ascending/Descending/Systemic | Unilateral (UL)
or Bilateral (BL) or No Lateralization (NL) |
Onset | Lab or Imaging Findings | Specific test | ||
Adult Botulism | + | - | + | + | Generalized | Descending | BL | Sudden | Toxin test | Blood, Wound, or Stool culture | |
Infant Botulism | + | - | + | + | Generalized | Descending | BL | Sudden | Toxin test | Blood, Wound, or Stool culture | |
Guillian-Barre syndrome | + | - | - | - | Generalized | Ascending | BL | Insidious | CSF: ↑Protein
↓Cells |
Clinical & Lumbar Puncture | |
Eaton Lambert syndrome | + | - | + | + | Generalized | Systemic | BL | Intermittent | AB | ||
Myasthenia gravis | + | - | + | + | Generalized | Systemic | BL | Intermittent | Ach receptor antibody | ||
Electrolyte disturbance | + | + | - | - | Generalized | Systemic | BL | Insidious | Electrolyte panel | ↓Ca++, ↓Mg++, ↓K+ | |
Organophosphate toxicity | + | + | - | + | Generalized | Ascending | BL | Sudden | |||
Tick paralysis (Dermacentor tick) | + | - | - | - | Generalized | Ascending | BL | Insidious | |||
Tetrodotoxin poisoning | + | - | + | + | Generalized | Systemic | BL | Sudden | |||
Stroke | +/- | +/- | +/- | +/- | Generalized | Systemic | UL | Sudden | MRI +ve for ischemia or hemorrhage | MRI | |
Poliomyelitis | + | + | + | Proximal > Distal | Systemic | BL or UL | Sudden | PCR of CSF | |||
Transverse myelitis | + | + | + | + | Proximal > Distal | Systemic | BL or UL | Sudden | MRI & Lumbar puncture | MRI | |
Neurosyphilis[1][2] | + | + | - | Generalized | Systemic | BL | Insidious | MRI & Lumbar puncture | CSF VDRL-specifc
CSF FTA-Ab -sensitive[3] |
||
Muscular dystrophy | + | - | - | - | Proximal > Distal | Systemic | BL | Insidious | Genetic testing | Muscle biopsy | |
Multiple sclerosis exacerbation | + | + | + | + | Generalized | Systemic | NL | Sudden | ↑CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [4] | Blurry vision, urinary incontinence, fatigue |
Amyotrophic lateral sclerosis | + | - | - | - | Generalized | Systemic | BL | Insidious | Normal LP (to rule out DDx) | MRI & LP | |
Myositis | + | - | - | - | Proximal > Distal | Systemic | UL or BL | Insidious | Elevated CK & Aldolase | Muscle biopsy |
References
- ↑ Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG; et al. (2012). "Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients". J Neurol Sci. 317 (1–2): 35–9. doi:10.1016/j.jns.2012.03.003. PMID 22482824.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ Ho EL, Marra CM (2012). "Treponemal tests for neurosyphilis--less accurate than what we thought?". Sex Transm Dis. 39 (4): 298–9. doi:10.1097/OLQ.0b013e31824ee574. PMC 3746559. PMID 22421697.
- ↑ Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH; et al. (1994). "Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group". Arch Neurol. 51 (1): 61–6. PMID 8274111.