Botulism laboratory findings

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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

Toxin assay is the prefered method of laboratory work up for diagnosis botulism. Serum, stool, gastric secretions, and suspected food sources should be collected and toxin assay must be performed. However, role of clinical suspicion must not be undertaken.

Laboratory Findings

Toxin assay is the prefered method of laboratory work up for diagnosis botulism. Serum, stool, gastric secretions, and suspected food sources should be collected and toxin assay must be performed. Urine toxicology screen must be performed to rule out other possible diseases, such as substance abuse, medications, and environmental exposure.

In order to diagnose wound botulism, wound exudates and swab sampling must be done in addition to toxin assay. Wound culture should be performed in anaerobic media.
Confirmatory diagnosis of infant botulism is based on serum and stool screening for botulism's toxins or isolation of toxigenic C botulinum in stool.
Cerebrospinal fluid analysis should be performed to rule out other diseases mimicking botulism. However, minimal protein elevation is a common finding in botulism.
Laboratory testing may take hours or days. Initial diagnosis and appropriate treatment depend on clinical diagnosis through a thorough history and physical examination.
The most traditional way for laboratory diagnosis is, injecting the serum sample of suspected person to mouse and following mice up for symptom development. To detect the toxin type, the affected mice must be injected by type-specific anti toxin. Botulism symptoms are absent in mice that received the appropriate anti toxin.
Novel assays use mass spectroscopy instead of mouse bioassay.
Toxin excretion and positive stool culture may be remain for one month after infection.
ELISA and PCR of suspected food source for toxin assay are another helpful method of diagnosis.

The following gallery shows microscopic features of C. botulinum.

Gallery

Clostridium botulinum growing on egg yolk agar showing the lipase reaction 72hrs. From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum spores stained with malachite green stain. From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum spores stained with malachite green stain. From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum Type A colonies blood agar plate 24hrs. From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum Type A colonies blood agar plate 72hrs (5x). From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum Type-A in thioglycollate broth was incubated for 48hrs. From Public Health Image Library (PHIL). ^[1]
Clostridium botulinum Type E colonies displaying an opaque zone grown on a 48hr egg yolk agar plate (1.9x mag). From Public Health Image Library (PHIL). ^[1]
Contaminated Jalapeño peppers involved in an outbreak of botulism. From Public Health Image Library (PHIL). ^[1]
Clostridium sp. Gram-positive bacteria, which had been grown on a 4% blood agar plate (BAP) 48hrs. From Public Health Image Library (PHIL). ^[1]
Clostridium innocuum bacteria cultivated in a thioglycollate fluid medium 24hrs (956x mag). From Public Health Image Library (PHIL). ^[1]
Gram-positive Clostridium subterminale bacteria on BAP medium 48hrs (956x mag). From Public Health Image Library (PHIL). ^[1]
Clostridium sp. Gram-positive bacteria grown on a chopped meat medium 48hrs (956x mag). From Public Health Image Library (PHIL). ^[1]
Clostridium sp. Gram-positive bacteria grown on a chopped meat medium 48hrs (956x mag). From Public Health Image Library (PHIL). ^[1]