What is the role of lab tests in the workup of botulism?

Updated: Feb 15, 2019
  • Author: Kirk M Chan-Tack, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Laboratory tests are not helpful in the routine diagnosis of botulism.

WBC counts and erythrocyte sedimentation rates are normal.

Cerebrospinal fluid is normal, except for occasional mild elevations in protein concentration.

A mouse neutralization bioassay confirms botulism by isolating the botulism toxin.

Toxin may be identified in serum, stool, vomitus, gastric aspirate, and suspected foods. C botulinum may be grown on selective media from samples of stool or foods. Note that the specimens for toxin analysis should be refrigerated, but culture samples of C botulinum should not be refrigerated.

Because intestinal carriage is rare, identifying the organism or its toxin in vomitus, gastric fluid, or stool strongly suggests the diagnosis. Isolation of the organism from food without toxin is insufficient grounds for the diagnosis. Only experienced personnel who have been immunized with botulinum toxoid should handle the specimens. Because the toxin may enter the blood stream through the eye or via small breaks in the skin, precaution is warranted.

Wound cultures that grow C botulinum suggest of wound botulism.

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