Botulism laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.

Overview

Clinical diagnosis of botulism is confirmed by specialized laboratory testing that often requires days to complete. Routine laboratory test results are usually unremarkable. Therefore, clinical diagnosis is the foundation for early recognition of and response to a bioterrorist attack with botulinum toxin, and all treatment and management decisions should be made based on clinical diagnosis.

Laboratory Findings

Lab tests should not be relied upon for diagnosis of botulism. The diagnosis will be done by a physical exam.

The typical routine lab tests, such as CBC, electrolytes, LFTs, urinalysis, will not be helpful for botulism.
Cerebrospinal fluid tests will basically be normal, but there might be a bit of protein elevation.
Laboratory confirmation is done by demonstrating the presence of toxin in serum, stool, or food, or by culturing C. botulinum from stool, a wound or food.
Laboratory testing may take hours or days. Initial diagnosis and appropriate treatment depend on clinical diagnosis through a thorough history and physical examination.

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]