Botulism differential diagnosis
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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 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 | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Loss of Consciousness | Fever | Motor Deficit | Sensory deficit | Cranial nerve Involvement | Autonomic dysfunction | Proximal/Distal/Generalized | Ascending/Descending/Generalized | Unilateral (UL)
or Bilateral (BL) |
Onset | Lab or Imaging Findings | Specific test | ||
| Adult Botulism | - | - | + | + | + | Descending | BL | Sudden | Blood, Wound, or Stool culture | ||||
| Infant Botulism | - | - | BL | Sudden | Blood, Wound, or Stool culture | ||||||||
| Guillian-Barre syndrome | - | - | + | - | + | BL | Insidious | ||||||
| Hypothyroidism | - | - | + | + | - | BL | Insidious | ||||||
| Eaton Lambert syndrome | - | - | + | - | - | BL | Intermittent | Clinical assesment | |||||
| Myasthenia gravis | - | - | + | + | - | BL | Intermittent | ||||||
| Electrolyte disturbance | - | - | + | + | - | BL | Insidious | ||||||
| Organophosphate toxicity | - | - | + | + | - | BL | Sudden | ||||||
| Tick paralysis (Dermacentor tick) | - | - | + | + | - | BL | Insidious | ||||||
| Tetrodotoxin poisoning | - | - | + | + | - | BL | Sudden | ||||||
| Stroke | +/- | - | + | + | - | UL | Sudden | ||||||
| Poliomyelitis | - | + | Sudden | ||||||||||
| Transverse myelitis | - | - | Sudden | ||||||||||
| Neurosyphilis[1][2] | - | +/- | + | + | - | BL | Insidious | CSF VDRL-specifc
CSF FTA-Ab -sensitive[3] |
|||||
| Muscular dystrophy | - | + | + | - | Proximal | Insidious | |||||||
| Multiple sclerosis exacerbation | - | - | + | + | Intermittent | ↑CSF IgG levels
(monoclonal bands) |
Clinical assesment and MRI [4] | Blurry vision, urinary incontinence, fatigue | |||||
| Amyotrophic lateral sclerosis | - | + | + | - | Insidious | ||||||||
| Myositis | - | +/- | - | Proximal | Insidious | 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.