Botulism physical examination

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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 physical examination is very important in order to suggest or exclude the disease. The patients with botulism appear dizzy and tired. The following signs are observed in the botulism patients: eyelid dropping, weakness of tongue muscle, nystagmus and decreased gag reflex. Paralytic ileus also may present. Botulism presentation shows many neurological manifestations like: generalized muscle weakness, abscent tendon reflexes, facial nerve impairment and speech impairment.

Physical Examination

Botulism physical examination is similar in both adults and infants. However, it is more severe in the infants and floppy baby syndrome is observed.

Physical examination	Adult botulism	Infantile botulism
Appearance of the patient	Patients of botulism may appear lethargic and dizzy.	Infants appear pale with less crying and unable to eat.
Vital signs	Botulism patients have normal vital signs.	Unstable blood pressure and heart rate.
Skin	In wound botulism, the following may be observed: Wounds Bruises Subcutaneous abscesses	Pale skin with bruises and signs of penetrating trauma.
HEENT	Absent or decreased gag reflex Tongue hypotonia Weakness of the eye muscles Nystagmus Ptosis
Abdome	Paralytic ileus: Decreased or absent bowel sounds (Foodborne botulism)
Lungs	Bradypnea due to respiratory muscle paralysis
Cardiovascular	Normal heart sounds No murmurs, gallops or rubs
Neuromuscular	Absent or decreased deep tendon reflexes Motor deficit Facial nerve impairment
	Speech impairment	Hypotonia causing "Floppy baby syndrome"
Extremities	Weakness of lower and upper extremities

Gallery

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  Six week old infant with botulism. From Public Health Image Library (PHIL).