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Clinical Microbiology Reviews, April 2006, p. 298-314, Vol. 19, No. 2
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.2.298-314.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Laboratory Diagnostics of Botulism

Miia Lindström* and Hannu Korkeala

Department of Food and Environmental Hygiene, University of Helsinki, Helsinki, Finland

Botulism is a potentially lethal paralytic disease caused by botulinum neurotoxin. Human pathogenic neurotoxins of types A, B, E, and F are produced by a diverse group of anaerobic spore-forming bacteria, including Clostridium botulinum groups I and II, Clostridium butyricum, and Clostridium baratii. The routine laboratory diagnostics of botulism is based on the detection of botulinum neurotoxin in the patient. Detection of toxin-producing clostridia in the patient and/or the vehicle confirms the diagnosis. The neurotoxin detection is based on the mouse lethality assay. Sensitive and rapid in vitro assays have been developed, but they have not yet been appropriately validated on clinical and food matrices. Culture methods for C. botulinum are poorly developed, and efficient isolation and identification tools are lacking. Molecular techniques targeted to the neurotoxin genes are ideal for the detection and identification of C. botulinum, but they do not detect biologically active neurotoxin and should not be used alone. Apart from rapid diagnosis, the laboratory diagnostics of botulism should aim at increasing our understanding of the epidemiology and prevention of the disease. Therefore, the toxin-producing organisms should be routinely isolated from the patient and the vehicle. The physiological group and genetic traits of the isolates should be determined.

* Corresponding author. Mailing address: Department of Food and Environmental Hygiene, University of Helsinki, P.O. Box 66, 00014 University of Helsinki, Finland. Phone: 358-9-191 57107. Fax: 358-9-191 57101. E-mail: miia.lindstrom{at}helsinki.fi.

Clinical Microbiology Reviews, April 2006, p. 298-314, Vol. 19, No. 2
0893-8512/06/$08.00+0     doi:10.1128/CMR.19.2.298-314.2006
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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