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Updated: Dec 25 2021

Infantile Botulism

  • Snapshot
    • A 6-month old infant is brought to the pediatric emergency room for poor feeding, reduced suck, and lethargy. She reports that her mother recently the infant her locally sourced honey a few weeks ago. On physical exam, the infant is afebrile. There is also symmetrically reduced muscle tone and diminished suck. She is admitted immediately and given a special type of antitoxin.
  • Introduction
    • Classification
      • Clostridium botulinum
        • anaerobic gram + rod
        • produces botulinum exotoxin
      • transmission
        • ingestion of spore
    • Prevention
      • avoid ingestion of honey in infants
  • Epidemiology
    • Demographics
      • infants
    • Risk factors
      • ingestion of old or expired bottles or cans of food or honey
    • Pathogenesis
      • forms spores
        • highly resistant to heat and chemicals
        • ingestion of spores causes infantile botulism
          • toxin is then produced in infant’s gut
          • most commonly from ingestion of contaminated honey
      • forms heat-labile exotoxin
        • irreversibly inhibits acetylcholine release at the neuromuscular junction
      • botulinum toxin is absorbed into bloodstream from mucosal surface
    • Associated conditions
      • foodborne botulism
      • wound botulism
      • inhalation botulism
  • Presentation
    • Symptoms
      • generalized weakness
        • inability to control the head
      • weak cry
      • drooling
      • poor feeding
        • diminished suck
      • constipation
        • usually the first sign
    • Physical exam
      • flaccid paralysis (floppy baby)
      • drooping eyelids
  • Studies
    • Labs
      • typically normal
      • toxin may be detected from serum, stool, or wound
        • process takes a few days, so this is only used as confirmatory testing
  • Differential
    • Bacterial meningitis in neonates
      • distinguishing factor
        • besides poor feeding or diminished suck, patients may have bulging fontanelle, nuchal rigidity, and abnormal labs
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Treatment
    • Management approach
      • immediate treatment with antitoxin and respiratory support as needed
    • Medical
      • bivalent human-derived antitoxin (BabyBIG)
        • indication
          • patients < 1 years of age
  • Complications
    • Respiratory paralysis
    • Permanent paralysis
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