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 ETIOLOGY 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 DIAGNOSIS 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