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microbial diseases laboratory

Test Order - Adult Botulism Exam

 ​​Pre-Approval Required

Yes. Physicians seeking testing for their patients should call their local health department to provide case information and review indications for botulism testing. The epidemiologist/health specialist should fax a completed botulism case report form to the MDL with Attention: High Risk Pathogens Section (Select Agents) lab. The local public health lab should phone MDL- High Risk Pathogens Section (Select Agents) to provide information on the samples collected and the approximate date for shipping. Samples (if any) received without prior authorization will not be tested until such authorization is obtained.

Clostridium botulinum toxin detection and isolation are conducted to assist public health decision-making, epidemiological trace-back, regulatory actions, and in a surge capacity for the Laboratory Response Network.

Supplemental Information or Form

Sample submission guidelines: CAHAN-Document Center, Documents, Emergency Response, Diseases by Name, Botulism, Procedures Protocols Policies:
 a. Interfere bot 103107
 b. MDL 182 103107
 c. r5 hosp lab bot instruct 103107
 d. r7 physician bot instr 103107
 e. MDL 176

Submission Form

1. MDL-176 and/or

2. A detailed list and description of items collected by the investigation team, i.e. Environmental Health, Food and Drug, etc.

3. The submittal form(s) should be completed and secured in a water- tight bag and placed outside the secondary containment barrier but within the shipper box

Performed on Specimens From

Human, environmental, and food sources

Acceptable Sample/Specimen Type for Testing

Human cases, age greater than 1 year old

  • Serum, pre-antitoxin and sometimes post-antitoxin (i.e. therapy failure cases)
  • Stool or enema
  • Gastric, if collected < 72 hours from disease onset
  • Other, with lab consult

Food and Environmental

  • Food items in original containers
  • Empty containers
  • Food subsampled to a sterile container
  • Utensils
  • Other, with lab consult

Minimum Volume Required


1. Serum – 15 ml clear serum with no hemolysis

2. Stool, enema, gastric – 25 grams or more

3. Food – leftovers, opened or unopened containers

4. Environmental – utensils, empty containers

Storage & Preservation of Sample/Specimen Prior to Shipping

1. Containers must be sterile and leak-proof
2. Maintain samples at 4-10°C; do not freeze


Refrigerated and room temperature samples should be transported at 4-10°C with cold packs.

Sample/Specimen Labeling

1. Submitter identification number that matches to a sample submittal form
2. Type of sample
3. Date and time collected
4. Collection point

Shipping Instructions which Include Specimen Handling Requirements

Follow approved packaging and shipping regulations for biological samples. Please label the outermost container(s) to clearly indicate the storage temperature. Ship to:

CA Department of Public Health
Microbial Diseases Laboratory
Specimen Receiving - MS B106
Attention: MDL - High Risk Pathogens Section (Select Agents)  - botulism
850 Marina Bay Parkway
Richmond, CA 94804-6403

Test Methodology

Center for Disease Control or Lab Response Network methods

Turnaround Time

Varies with analyte and method

Interferences & Limitations

Samples from patients who have received the “Tensilon test”, are receiving Methadone, or have recently injected "heroin" or "heroin-like" drugs may require special treatment to remove interfering substances. Please record on MDL-176 if the patient has received any of these substances.

Additional Information

Home canned foods, those in glass jars, or fragile containers require extra care in packaging. To prevent contamination of other samples in the same shipper box, please follow the triple containment rule of thumb. Use absorbents under and between large liquid samples and glass jars. Enclose containers in water-tight bags, if available. Glass containers need extra padding beneath and between containers. Add a layer of newspapers to shield the secondary container from direct contact with the cold packs.

Samples are received at the loading dock during normal business hours, M-F. Packages arriving after 5 pm M-F, on weekends or on holidays are placed in a storage shed with a freezer, refrigerator, and a room temperature bench. It is the responsibility of the delivery service staff to observe the package for labeling so they place the package into the appropriate location in the shed, ie. room temp bench, refrigerator, freezer. Submitters need to clearly mark the storage temperature on the outside of the shipper box.

A “hand-off” from collector to lab staff can be arranged with advance consultation.

Contact the Infant Botulism Treatment and Prevention Program for consultation and lab service for patients less than 1 year of age. Go to our Infant Botulism page for details.

MDL Points of Contact

MDL - High Risk Pathogens Section (Select Agents) (510) 412-3903

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