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Differential Diagnosis II Botulism BOTULISM ⢠⢠⢠⢠⢠⢠⢠⢠⢠⢠⢠⢠⢠⢠Learning Objectives Overview Microbiology Transmission Types of Botulism Actions of the toxin Clinical features Differential diagnosis Investigations Treatment Key points Summary References and further reading Questions ⢠⢠⢠⢠⢠Acute bilateral cranial neuropathies and symmetrical descending weakness No fever unless intercurrent infection Only sensory deficit may be blurred vision History of exposure â ingestion IDU or a traumatic wound Guillain-Barre syndrome (GBS) ⢠⢠⢠⢠⢠⢠Antecedent febrile illness Ascending symmetrical paralysis Loss of sensation, parasthesia, pain, loss of reflexes Electromyograph may help differentiate Antiganglioside antibody may be elevated in CSF or serum with GBS or Miller Fisher No augmentation of modified action potential with repetitive nerve stimulation at 20-50 Hz in contrast to botulism
