The diagnosis of botulism is primarily clinical. Descending paralysis with prominent cranial nerve involvement and autonomic dysfunction (especially the gastrointestinal (GI)) should raise suspicion [15] . CSF and routine blood studies are typically normal, as are imaging studies of the brain, and thus they have limited value in the acute setting [83] . Definitive diagnosis requires detection of botulinum toxin in serum or stool, gastric aspirate, and if possible the suspected source [78] . For serum confirmation, testing must be done on ≥30 ml of blood in adults before therapy with antitoxin. However, toxin in serum or stool is identified in less than half of clinically diagnosed cases [79] . A mouse bioassay is the standard laboratory diagnostic method, in which the toxin type is identified by protecting mice with specific antitoxins against individual strains. The test takes days to be arranged and performed; therapy and notification of public health authorities must be based on clinical suspicion [78] . An antibody response is not mounted in most patients, because the amount of toxin required to produce a clinical syndrome is not large enough to generate an immunological response [8] .