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Lab Manual for Moffitt-Long and Mount Zion

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Botulism Toxin, Children < 12 months old

Item Value
Approval req'd? Physicians seeking testing for their patients should contact the infant Botulism Treatment and Prevention Program (IBTPP) physician-on-call prior to submission of specimens. Any specimens received without prior authorization will not be tested until such authorization is obtained. Call (510) 231-7600 24 hours/day, 7 days/week.
Available Stat? No
Test code P319
Test group Botulism
Performed by California State Public Health Reference Laboratory
Sendout? Yes
In House Availability Sent out Monday-Friday, day shift only
Collection Instructions Physicians seeking testing for their patients should contact the Infant Botulism Treatment and Prevention Program (IBTPP) physician-on-call prior to submission of specimens. Any specimens received without prior authorization will not be tested until such authorization is obtained. Call (510) 231-7600 24 hours/day, 7 days/week.

If passed stool is difficult to obtain due to constipation, an attempt to collect stool in the rectal vault should be made by gentle digital examination by the team member with the smallest fifth finger. If no stool can be obtained digitally, do not wait for a spontaneous bowel movement. Instead, please follow the enema collection procedure outlined below.

Important: Note that glycerin suppositories yield an unsatisfactory specimen and should not be used. The procedure described below will yield the best specimen for diagnostic purposes.

Enema Collection Procedure
1. Attach a 12 to 16 French red rubber (Robinson) catheter to a tapered, catheter-tip syringe.
2. Trim catheter tip to enlarge hole.
3. Lubricate the catheter tip with petroleum jelly or equivalent and insert into distal colon.
4. The volume of sterile, non-bacteriostatic water to use should be a bedside clinical decision based on the patient's body mass.
5. Inject up to 30 ml of sterile, non-bacteriostatic water slowly into distal colon and maintain catheter in rectum. Please note that a minimum volume of 5 ml is required to enable the most accurate diagnostic analysis.
6. Wait approximately 3 minutes, and then draw enema effluent into the syringe.
7. Have an assistant hold a sterile urine container under the anus during this time to collect any expelled material.
8. Expel all fluid collected in the syringe into the same sterile urine container.
9. Tightly seal the lid. Properly label the container with patient's name, date and time of collection.
10. If more than 5 ml of water is retained in the colon, exert gentle pressure onto left lower abdomen (with your hand or with infant's knee to abdomen) to aid in excretion and to minimize intestinal absorption of water.

An SFPH laboratory request form must be printed out, completed and sent with a Microbiology requisition and sample to lab Click here for form
Container type Urine cup (Do not use fixatives or preservatives)
Amount to Collect 15 mL Stool or enema fluid
Sample type Stool or enema fluid
Preferred volume 15 mL stool or enema fluid
Min. Volume 5 mL stool or enema fluid
UCSF Rejection Criteria No prior approval from Public health authorities. Inadequate or improperly collected sample(s).
Processing notes Speciems will be processed by Microbiology. If received after hours refrigerate sample.

Send the enema specimen to Microbiology along with a completed SFPH Laboratory Request form with an order to keep the sample refrigerated and to expedite shipment to the appropriate botulism diagnostic laboratory.
Normal range Negative
Synonyms Botulism immune globulin; BIG
Turn around times 2-4 days typically but may take up to 2 weeks.
Additional information For more information on Infant botulism Click here
LOINC code 29257-3
Last Updated 3/24/2013 8:15:16 PM
Entry Number 1152
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