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
Headache Loss of Consciousness Muscle pain Abnormal sensory Motor Deficit Sensory deficit Speech difficulty Gait abnormality Cranial nervesInvolvement Unilateral (UL)

or Bilateral (BL)

Onset CT /MRI CSF Findings Gold standard test
Adult Botulism + - - - + + + - + Weight loss, fatigue + Cancer cells[1] MRI Cachexia, gradual progression of symptoms
Infant Botulism
Guillian-Barre syndrome + + + + + - - - + Trauma, fall + Xanthochromia[2] CT scan without contrast[3][4] Confusion, dizziness, nausea, vomiting
Hypothyroidism + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Eaton Lambert syndrome + - + + - - + - - Family history of migraine - - Clinical assesment Presence of aura, nausea, vomiting
Myasthenia gravis + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Electrolyte disturbance + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Organophosphate toxicity + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Tick paralysis (Dermacentor tick) + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Tetrodotoxin poisoning + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Stroke + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Poliomyelitis
Transverse myelitis
Neurosyphilis[5][6] + - + + + + - + - STIs + ↑ Leukocytes and protein CSF VDRL-specifc

CSF FTA-Ab -sensitive[7]

Blindness, confusion, depression,

Abnormal gait

Muscular dystrophy + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Multiple sclerosis exacerbation - - + + - + + + + History of relapses and remissions + ↑ CSF IgG levels

(monoclonal bands)

Clinical assesment and MRI [8] Blurry vision, urinary incontinence, fatigue
Amyotrophic lateral sclerosis + + + + + + + + - Hypertension + - CT scan without contrast[3][4] Neck stiffness
Myositis

References

  1. ↑ Weston CL, Glantz MJ, Connor JR (2011). "Detection of cancer cells in the cerebrospinal fluid: current methods and future directions". Fluids Barriers CNS. 8 (1): 14. doi:10.1186/2045-8118-8-14. PMC 3059292. PMID 21371327.
  2. ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.
  5. ↑ 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.
  6. ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
  7. ↑ 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.
  8. ↑ 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.


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