Physicians may consider the diagnosis of botulism based on a patient's clinical presentation, which classically includes an acute onset of bilateral cranial neuropathies and symmetric descending weakness. Other key features of botulism include an absence of fever, symmetric neurologic deficits, normal or slow heart rate and normal blood pressure, and no sensory deficits except for blurred vision. A careful history and physical examination is paramount in order to diagnose the type of botulism, as well as to rule out other conditions with similar findings, such as Guillain-Barre syndrome, stroke, and myasthenia gravis. Depending on the type of botulism considered, different tests for diagnosis may be indicated. Foodborne botulism: serum analysis for toxins by bioassay in mice should be done, as the demonstration of the toxins is diagnostic. Wound botulism: isolation of<unk>  from the wound site should be attempted, as growth of the bacteria is diagnostic. Adult enteric and infant botulism: isolation and growth of<unk>  from stool samples is diagnostic. Infant botulism is a diagnosis which is often missed in the emergency room. Other tests that may be helpful in ruling out other conditions are: * Electromyography (EMG) or antibody studies may help with the exclusion of myasthenia gravis and Lambert-Eaton myasthenic syndrome (LEMS). * Collection of cerebrospinal fluid (CSF) protein and blood assist with the exclusion of Guillan-Barre syndrome and stroke. * Detailed physical examination of the patient for any rash or tick presence helps with the exclusion of any tick transmitted tick paralysis.
Clostridium botulinum
Clostridium tetani
Clostridium perfringens
Clostridium innocuum
Neisseria mucosa
Pasteurella
Prevotella bivia
Clostridium ramosum