Diagnosis and Treatment of Botulism
Patient Guideline Summary
Publication Date: May 7, 2021
This patient summary means to discuss key recommendations from the Centers for Disease Control and Prevention for the diagnosis and treatment of botulism.
- Botulism is a rare, life-threatening, nerve-poisoning disease.
- Botulism is caused by a toxin (poison) produced by a bacterium, Clostridium botulinum, that can grow in food and wound infections. The poison is also used (carefully) in therapeutic injections. It is possible to disperse it through the air in a terrorist attack.
- Botulism paralysis can progress to respiratory failure and death.
- The most frequent signs and symptoms of patients with confirmed botulism reported in medical charts:
- Afebrile (temperature uncer 100.4°F [<38°C])
- Descending paralysis (inability to use muscles, beginning in the face and neck)
- Dysphagia (difficult swallowing)
- Weakness or fatigue
- Ptosis (drooping of the upper eyelid)
- Blurred vision
- Difficulty speaking
- Diplopia (double vision)
- Change in voice
- Shortness of breath
- Dry mouth
- Thick tongue
- This patient summary focuses on the diagnosis and treatment of botulism.
- The initial evaluation should include possible exposures to the toxin.
- Botulism, myasthenia gravis, and Guillain-Barré syndrome appear similar, so the distinction must be made rapidly.
- Tests such as repetitive nerve stimulation (RNS), electromyography (EMG), and nerve conduction studies (NCSs) may aid in diagnosis.
- Each state’s health department has experts available for consultation.
- (Laboratory tests are too slow to be useful for patient care but should be done to confirm the diagnosis.)
The CDC makes recommendations for conventional, contingency, and crisis management depending on the number of patients involved at a given time and the capacity of available treatment facilities.
- Botulinum antitoxin should be given to all suspected cases as early as possible.
- Allergic reactions are possible and should be anticipated.
- Patients with trouble breathing or swallowing should be hospitalized.
- Close monitoring of breathing, swallowing and muscle strength is essential.
- Serial measurements of breathing, oxygen, blood circulation, and other affected functions add to clinical evaluations.
- General supportive care includes:
- Bladder and bowel care
- Blood clot prevention
- Pressure sore prevention
- Psychological support
- Following successful acute treatment, patients may benefit from one or more of the following:
- Speech, physical, and occupational therapy
- Music and massage therapy
- Reading aloud to the patient
- Educating family members about botulism
- EMG: Electromyography
- NCSs: Nerve Conduction Studies
- RNS: Repetitive Nerve Stimulation
Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021 May 7;70(2):1-30. doi: 10.15585/mmwr.rr7002a1. PMID: 33956777; PMCID: PMC8112830.
The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.