Infant botulism

Definition

Infant botulism is a potentially life-threatening disease in which the bacteria Clostridium botulinum grows within the baby's gastrointestinal tract.

See also: Botulism

Causes, incidence, and risk factors

Clostridium botulinum is a spore-forming organism that is common in nature. The spores may be found in soil and certain foods (such as honey and some corn syrups).

This disease occurs mostly in young infants between 6 weeks and 6 months of age. Onsets as early as 6 days and as late as one year have been reported.

Risk factors include swallowing honey as a baby, being around contaminated soil, breast-feeding, and having less than one stool per day for a period greater than 2 months.

Symptoms

• Constipation
• Infant appears "floppy"
• Tired all the time (lethargy)
• Weak cry
• Poor feeding and weak suckling
• Loss of head control
• Infant doesn't gag
• Respiratory distress
• Eyelids sag or partially close ( ptosis)
• Paralysis that spreads downward
• Respiratory failure

Signs and tests

The doctor will perform a physical exam. Symptoms such as decreased muscle tone (hypotonia), missing or decreased gag reflex, missing or decreased deep tendon reflexes, and eyelid drooping (ptosis) may be noted.

A stool sample from the baby may be examined to check for the botulinum toxin or bacteria.

Electromyography (EMG) can be done to help tell the difference between muscle and neurological problems.

Treatment

Botulism immune globulin (BIG) is the main treatment for this condition. Infants that receive this treatment have shorter hospital stays (3 weeks instead of 5 weeks) and less severe illness. The infants must receive supportive care during their recovery. This includes keeping the airway clear, watching for breathing problems, and making sure the child gets the proper nutrition. If breathing problems develop, respiratory support, including the use of a breathing machine, may be needed.

Antibiotics do not appear to increase the rate of improvement. Antibiotics are not needed unless a secondary infection such as pneumonia develops.

The use of human-derived botulinum antitoxin may also be of benefit.

Expectations (prognosis)

Full recovery is expected with early recognition and supportive treatment. Death or permanent disability may result in complicated cases.

Complications

Respiratory insufficiency can develop, requiring assistance with breathing (mechanical ventilation).

Calling your health care provider

Since infant botulism can be life-threatening, go to the emergency room or call the local emergency number (such as 911) immediately if your infant has one or more of the symptoms of botulism.

Prevention

Theoretically, the disease might be avoided by preventing exposure to spores. Since honey and corn syrup are sources of Clostridium spores, they should not be fed to infants less than12 months (1 year) old.

Although breast-feeding appears to be a risk factor for infantile botulism, the overall risk is very low. The benefits of breast-feeding still greatly outweigh the risks in nearly all cases.