Botulism physical examination

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Botulism Microchapters


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Michael Maddaleni, B.S.


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.[1][2]

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.[3]

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.[2]
Skin In wound botulism, the following may be observed: Pale skin with bruises and signs of penetrating trauma.
Abdome Paralytic ileus: Decreased or absent bowel sounds (Foodborne botulism)
Lungs Bradypnea due to respiratory muscle paralysis
  • Normal heart sounds
  • No murmurs, gallops or rubs
  • Absent or decreased deep tendon reflexes
  • Motor deficit
  • Facial nerve impairment
  • Speech impairment
Extremities Weakness of lower and upper extremities



  1. Hughes JM, Blumenthal JR, Merson MH, Lombard GL, Dowell VR, Gangarosa EJ (1981). "Clinical features of types A and B food-borne botulism". Ann Intern Med. 95 (4): 442–5. PMID 7283294.
  2. 2.0 2.1 Fenicia L, Anniballi F (2009). "Infant botulism". Ann Ist Super Sanita. 45 (2): 134–46. PMID 19636165.
  3. Midura TF (1996). "Update: infant botulism". Clin Microbiol Rev. 9 (2): 119–25. PMC 172885. PMID 8964030.
  4. "Public Health Image Library (PHIL)".

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