The most frequent admission diagnoses of infants later found to have IB include sepsis, viral syndrome, dehydration, cerebrovascular accident, failure to thrive, myasthenia gravis, poliomyelitis, Guillain-Barre syndrome, encephalitis, and meningitis. Several hereditary-endocrine or metabolic disorders considered are amino acid metabolism disorder, Werdnig-Hoffmann disease, and drug or toxin ingestion. Diagnoses less frequently considered include subdural effusion, infectious mononucleosis, brain stem encephalitis, animal bite or sting, organopho-sphate poisoning, carbon monoxide intoxication, methemoglobinemia, myoglobinuria, glycogen or lipid storage diseases, benign congenital hypotonia, congenital muscular dystrophy, myotonic dystrophy, congenital myopathy, anterior horn cell syndrome, atonic cerebral palsy, and diffuse cerebral degenerative disease.
Even though sepsis may be considered in the differential diagnosis, infants with botulism are afebrile, alert, have robust skin color, but are hypotonic or paralyzed.
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