Botulism differential diagnosis: Difference between revisions
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==Differentiating Botulism from other Diseases== | ==Differentiating Botulism from other Diseases== | ||
Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity, such as: | Botulism must be differentiated from neuromuscular disorders that present with muscle weakness and flaccidity, such as: | ||
{| | {| | ||
|-style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="2" |<small>Diseases</small> | ! rowspan="2" |<small>Diseases</small> | ||
! colspan="11" |<small>History and Physical | ! colspan="11" |<small>History and Physical | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism | | style="background: #DCDCDC; padding: 5px; text-align: center;" | Adult Botulism | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | | style="background: #F5F5F5; padding: 5px text-align:center" | - | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | | style="background: #F5F5F5; padding: 5px text-align:center" | - | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | | style="background: #F5F5F5; padding: 5px text-align:center" | - | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | - | | style="background: #F5F5F5; padding: 5px text-align:center" | - | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | + | | style="background: #F5F5F5; padding: 5px text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]] | | style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]] | ||
|style="background: #F5F5F5; padding: 5px; text-align:center"| + | | style="background: #F5F5F5; padding: 5px; text-align:center" | + | ||
|style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | | style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref> | ||
|style="background: #F5F5F5; padding: 5px;" |MRI | | style="background: #F5F5F5; padding: 5px;" |MRI | ||
|style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | | style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms | ||
|- | |- | ||
|style="background: #DCDCDC; padding: 5px; text-align: center;"|Infant Botulism | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Infant Botulism | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|style="background: #F5F5F5; padding: 5px text-align:center" | | | style="background: #F5F5F5; padding: 5px text-align:center" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Guillian-Barre syndrome]] | ||
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| style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | | style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | ||
| style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | | style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]] | ||
|- | |||
|[[Hypothyroidism]] | |||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Eaton lambert syndrome|Eaton Lambert syndrome]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]] | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |Clinical assesment | |||
| style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]] | |||
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|[[Myasthenia gravis]] | |||
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|[[Hypermagnesemia]] or [[Hypocalcemia]] | |||
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|[[Organophosphate poisoning|Organophosphate toxicity]] | |||
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|[[Tick paralysis]] ([[Dermacentor andersoni|Dermacentor tick]]) | |||
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|[[Tetrodotoxin]] poisoning | |||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]] | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | - | |||
| style="background: #F5F5F5; padding: 5px text-align:center" | | |||
| style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]] | |||
| style="background: #F5F5F5; padding: 5px; text-align:center" | + | |||
| style="background: #F5F5F5; padding: 5px;" | - | |||
| style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]] | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref> | ||
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Abnormal [[gait]] | Abnormal [[gait]] | ||
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|[[Muscular dystrophy]] | |||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation | ||
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| style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]] | | style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]] | ||
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|[[Amyotrophic lateral sclerosis]] | |||
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| style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] | | style="background: #DCDCDC; padding: 5px; text-align:center;" | [[Myositis]] | ||
Revision as of 16:16, 22 May 2017
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Botulism Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Botulism differential diagnosis On the Web |
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American Roentgen Ray Society Images of Botulism differential diagnosis |
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Risk calculators and risk factors for Botulism differential diagnosis |
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 | |||||||||||||||
| Eaton Lambert syndrome | + | - | + | + | - | - | + | - | - | Family history of migraine | - | - | Clinical assesment | Presence of aura, nausea, vomiting | |
| Myasthenia gravis | |||||||||||||||
| Hypermagnesemia or Hypocalcemia | |||||||||||||||
| Organophosphate toxicity | |||||||||||||||
| Tick paralysis (Dermacentor tick) | |||||||||||||||
| Tetrodotoxin poisoning | |||||||||||||||
| Stroke | + | + | + | + | + | + | + | + | - | Hypertension | + | - | CT scan without contrast[3][4] | Neck stiffness | |
| Neurosyphilis[5][6] | + | - | + | + | + | + | - | + | - | STIs | + | ↑ Leukocytes and protein | CSF VDRL-specifc
CSF FTA-Ab -sensitive[7] |
Blindness, confusion, depression,
Abnormal gait | |
| Muscular dystrophy | |||||||||||||||
| 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 | |||||||||||||||
| Myositis | |||||||||||||||
References
- ↑ 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.
- ↑ Lee MC, Heaney LM, Jacobson RL, Klassen AC (1975). "Cerebrospinal fluid in cerebral hemorrhage and infarction". Stroke. 6 (6): 638–41. PMID 1198628.
- ↑ 3.0 3.1 Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ 4.0 4.1 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.
- ↑ 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.
- ↑ Berger JR, Dean D (2014). "Neurosyphilis". Handb Clin Neurol. 121: 1461–72. doi:10.1016/B978-0-7020-4088-7.00098-5. PMID 24365430.
- ↑ 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.
- ↑ 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.