How to Test for Botulism

Four Methods:Assessing SymptomsGetting a Professional DiagnosisTreating BotulismPreventing Botulism

Botulism poisoning is caused by the toxin produced by the bacteria Clostridium botulinum. The bacteria can gain entrance to your body via your gastrointestinal tract or a penetrating injury to the skin. Once botulism enters the body, it will be absorbed by your blood and spread throughout your organs and body systems, with potentially fatal consequences. Adult cases are rare and usually due to foodborne illness, typically from home-canning, or even more rarely from penetrating injury caused by a contaminated object or infection of a previous wound by contaminated soil.[1] To determine whether or not you are suffering from botulism, know the signs and symptoms and get a professional diagnosis.

Method 1
Assessing Symptoms

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    Notice if you feel muscle weakness or can't move. Difficulty coordinating movements, such as walking, is a common sign of botulism. Muscle tone is lost when the body is affected by botulism.
    • Usually, muscle tone loss spreads from your shoulders to your arms and down to the legs. The toxin acts on the nervous system impacting both voluntary and involuntary nervous system functions. It causes a descending paralysis, meaning it acts from head to toe, in that order.
    • The paralysis is symmetric, meaning it affects both sides of the body the same, in contrast to the neurologic symptoms one may see in a stroke, which affect only one side of the body.
    • Muscle weakness is one of the first symptoms and can manifest as difficulties with speech, vision, and breathing.
    • These symptoms are all caused by the toxin affecting the nerves and their receptors that control organs and muscles.
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    Speak and see if your speech is slurred. Speech is affected because the neurotoxin produced by C. botulinum can affect the speech centers in your brain. When these cranial nerves are affected, it causes problems with speech and mouth movement.
    • The neurotoxin affects the cranial nerves 11 and 12, the nerves responsible for speech.
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    Look in the mirror to see if your eyelids are drooping. Ptosis (drooping of eyelids) happens because of the neurotoxin affecting cranial nerve 3, which is responsible for the eye’s movement, pupil size and eyelid motion. An affected person's pupils will be dilated and vision will be blurry, too.
    • Eyelid drooping can occur in one eye or both eyes at the same time.
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    Breathe deeply to see if you have any trouble or shortness of breath. Problems with breathing can occur due to the effect of botulism on your respiratory system. The botulism neurotoxin can cause reduced respiratory muscle activity and impaired gas exchange.
    • This damage can cause respiratory failure and breathing problems.
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    Check your vision to see if you are seeing blurry or double. Blurry and double vision can occur when botulism damages cranial nerve number 2. This nerve is responsible for your sense of sight, carrying images to the brain.
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    Assess symptoms in infants differently. In infants progressive decreased muscle tone can present as a “floppy” infant that feels similar to a “rag doll.” Symptoms can also present as decreased or poor feeding due to decreased muscular ability to nurse or take the bottle.[2]
    • Other symptoms in infants include: a weak cry, dehydration, and decreased tear production.
    • The immature immune system is unable to mount an immune response to this spore, which then germinates in the digestive tract and excretes its toxin.[3]

Method 2
Getting a Professional Diagnosis

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    Visit your doctor if you recognize the above symptoms. Botulism is a serious disease, and it is important that you see a doctor immediately if you suspect you may have contracted botulism.
    • These symptoms usually manifest 18 to 36 hours after exposure to botulinus.
    • Once symptoms are felt, immediate medical intervention is required.
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    Undergo a physical examination to get a preliminary diagnosis. After you have noticed botulism symptoms, immediately go to a hospital and have yourself checked by a doctor.
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    Your doctor will look for additional symptoms, which include: decreased or absent lachrymation (tearing), fixed and dilated pupils, decreased deep tendon reflexes, extremely dry mouth, urinary retention as unable to empty the bladder, and inability to perform basic functions such as walking, speech and coordinating movements. There may also be decreased or absent bowel sounds on examination of the abdomen, which may be distended.
    • An infant may present with generalized hypotonia (decreased muscle tone).
    • In severe cases, the infected person may have respiratory failure or Hypoxemia (low oxygen level).
    • Your doctor will also ask you if you had an open wound or have ingested contaminated food within 24 – 48 hours.
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    Get a series of diagnostic tests to confirm botulism. There are several diagnostic tests used to confirm botulism that can be ordered by your physician. Your doctor may order one, or all, of them to confirm the infection.
    • Lab: Positive culture of vomit, saliva, nasogastric secretions, stool, or blood or suspicious food for the bacteria, C Botulinum.[4]
    • Electromyography: An electromyelogram will demonstrate neuromuscular findings and assist in confirming the diagnosis. The EMG usually has two parts: a nerve conduction study, which uses electrodes taped to your skin to evaluate your motor neurons and a needle electrode exam, which uses a small needle inserted into your muscles to evaluate your muscles’ electrical activity.[5]
    • Radiography: Abdominal radiographs will show a “paralytic ileus,” or lack of normal gastric motility, which results in the distention of the small bowel. A spinal tap may also be needed to rule out other causes of a patient's symptoms.

Method 3
Treating Botulism

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    Treat the dangerous symptoms of botulism. If the patient has low oxygen levels for any reason, airway management is essential. A breathing tube and ventilation will be used in extreme cases.
    • In some cases it is necessary to insert a nasogastric tube to drain stomach contents and oral secretions. Assisted feeding may also be required.
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    Decrease toxin load. If patient is awake and, still importantly, has bowel sounds, the doctor may consider the cautious use of enemas or antiemetics to decrease the load of toxin. A bladder catheter may be inserted for drainage of urine, as toxins can cause urinary retention.
    • An antitoxin is available for children older than one year and adults, if the diagnosis of botulism is confirmed. [6]
    • Antibiotics are only given for wound botulism.
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    Treat wounds, in appropriate cases. The doctor or surgeon should decontaminate wound causes of botulism via irrigation and debridement. In addition, your doctor should prescribe antibiotics (high dose penicillin) and antitoxin.

Method 4
Preventing Botulism

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    Utilize proper technique for canning and dispose of expired food products properly. Throw away any canned products that appear dented or bulging. This is especially important with home canning products, such as preserves.[7]
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    Do not give infants less than one year old honey or corn syrup. These products can harbor the botulism bacteria. This does not affect most adults but can infect infants, because of small children's weaker immune systems.[8]
    • There are about 115 cases of Infant Botulism each year. There is a caution about giving children under the age of one raw honey, however this was found to be the culprit in only 15% of cases. In 85% of cases, the causes were unknown but included possible contaminated formula, corn syrup, or some form of cross contamination from a caregiver who had contact with spores.[9]
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    Cleanse any wounds with hot-warm water and soap. Keep bandaged if outdoors.[10] If you suspect wound botulism, see a medical professional immediately.
    • Launder soiled clothing appropriately with hot water and detergent if worn by an agriculture worker or laborer.
    • Wound botulism can also infect people who use intravenous needles on a regular basis. Use safer needle handling practices or avoid the use of intravenous needles altogether.

Tips

  • The toxin was first suspected by a German physician who noted cases of food poisoning associated with improperly prepared sausages. In attempts to discern what the cause of the toxin was, he injected himself with the toxin. He termed the toxin “botulus” after the latin name for sausage.[11]

Sources and Citations

  1. Kirk M Chan-Tack MD, Pranatharthri Haran Chandrasekar MBBS, MD, Botulism, emedicine.medscape last updated 3-23-2015.
  2. Nadine Cox MD, Randy Hinkle DO, Infantile Botulism, American Family Physician 2002 April 1;65 (7) 1388-1393)
  3. Nadine Cox MD, Randy Hinkle DO, Infantile Botulism, American Family Physician 2002 April 1;65 (7) 1388-1393
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Article Info

Categories: Infectious Diseases