Constellation of findings that should prompt consideration of botulism

At least one of the following symptoms of cranial neuropathy:

Blurred vision

Double vision

Difficulty speaking, including slurred speech

Any change in sound of voice, including hoarseness

Dysphagia/pooling of secretions/drooling

Thick tongue sensation

PLUS at least one of the following signs of neuropathy:

Ptosis

Signs suggestive of extraocular neuropathy

Extraocular palsy

Decreased tracking of objects

Fatigability manifested by avoiding light shining in the eye

Signs suggestive of facial neuropathy

Facial paresis

Loss of facial expression

Poor feeding or poor suck using pacifier

Fatigability while eating

Fixed pupils (not including abnormally or sluggishly reactive pupils)

Descending paralysis, beginning with cranial nerves

PLUS lack of fever (temperature ≤37.8°C or ≤100.4°F)

These clinical criteria have been proposed as a tool to improve identification of patients with botulism. When all three are present, the sensitivity for botulism is approximately 78 to 89%. The specificity is unknown.

Adapted from: Rao AK, Lin NH, Griese SE, et al. Clinical Criteria to Trigger Suspicion for Botulism: An Evidence-Based Tool to Facilitate Timely Recognition of Suspected Cases During Sporadic Events and Outbreaks. Clin Infect Dis 2018; 66:S38.

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Constellation of findings that should prompt consideration of botulism