Botulism physical examination

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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.

Physical Examination

Physical examination	Adult botulism	Infantile botulism
Appearance of the patient
Vital signs	Botulism patients have normal vital signs.
Skin
HEENT	Absent or decreased gag reflex Weakness of tongue muscle Weakness of the eye muscles Nystagmus
	Eyelid drooping
Lungs	Respiratory muscle paralysis
Heart	Normal heart sounds No murmurs, gallops or rubs
Neuro-muscular		Flobby baby syndrome:
Extremities

Appearance of the patient

Patients of botulism may appear lethargic and dizzy.

HEENT

• Eyelid drooping
• Absent or decreased gag reflex
• Weakness of tongue muscle
• Weakness of the eye muscles
• Nystagmus

Abdomen

• Paralytic ileus: Decreased or absent bowel sounds

Neuromuscular

• Absent or decreased deep tendon reflexes
• Loss of muscle function/ feeling
• Speech impairment
• Facial nerve impairment
• Abscent of tendon reflexes may present

Extremities

• Weakness lower and upper extremities

Gallery

• 
  Six week old infant with botulism. From Public Health Image Library (PHIL).