Diagnosis:
The diagnosis is by clinical features supported by neurophysiology and confirmed by toxin testing
Clinical features:
Types: Wound botulism, infant botulism, food botulism,
Descending weakness (ocular opthalmoplegia then pharyngeal then limbs)
Loss of pupil accommodation, constipation, ileus
Reflexes reduced or absent
Normal sensation
Findings on investigations:
NCS/EMG:
- RNST at 20 and 50 Hz: incremental response.
- CMAP: low amplitude
- Sensory conduction: Normal
- EMG, motor unit action potentials MUAP: short duration, low amplitude
- SFEMG single fibre EMG: increased jitter and blocking
Toxin testing for confirmation:
- Serum botulinum toxin
- Food botulinum toxin assay
- Stool: toxin, in infants consider organism culture
Treatment:
Consider respiratory support
Trivalent antitoxin ABE. Note: current antitoxin is made in horses and associated serum sickness. Usually not needed in infants
Guanidine hydrochloride
Inform health authorities
Wound botulism:
- Penicillin
- Surgical debridement