Infant Botulism

Median age of onset is 2 to 4 months of age but may occur up to 1 year of age. The most commonly identified source of botulism spores is honey or com syrup, but these account for less than 50% of cases. Botulism may also occur in breastfed babies. Approximately half of all cases in the United States occur in California, Pennsylvania, and Utah, presumably because of the high spore counts in the soil of these states. Most infants do not have respiratory difficulty, but many eventually require mechanical ventilation. The presentation of infant botulism is similar to that for sepsis, meningitis, and dehydration. Botulism should be considered, but only after a complete septic workup has been done and the patient has received antibiotics.

Causes

Infant botulism is caused by the food poisoning bacterium Clostridium botulinum. This is the same bacterium that causes the food poisoning known as "botulism". Spores of these bacteria are ingested by the infant, grow and produce a neurotoxin in the infant's intestine.

Spores of botulinum may be easily ingested as they are common in soil and dust. This may lead to botulism in children younger than one year. Many infants who develop infant botulism have been fed honey, the only identified food source of C. botulinum spores causing infant botulism. 

Symptoms

• Poor feeding/sucking +++++
• Constipation over 3 days ++++
• Lethargy +++

Signs

• Poor head control +++++
• Hypotonia ++++
• Weak cry ++++
• Expressionless face +++
• Depressed reflexes
• Decreased gag

Treatment

Infant botulism is treated in the hospital, usually in the intensive care unit, where doctors will try to limit the problems the toxin causes in the baby's body. Because the toxin can affect the breathing muscles, for eg. doctors may put the infant on a ventilator. Because the toxin can affect the swallowing muscles, they may give the baby intravenous (IV) fluids to provide nourishment.

With proper medical care, the infant will likely fully recover once the effects of the toxin wear off.