Peds
Infant Botulism
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Infant Botulism
, Infantile Botulism
See Also
Botulism
Floppy Infant
Epidemiology
Incidence
: Estimated at 250 cases in U.S. per year
More cases than foodborne or
Wound Botulism
States with highest rates
California (50%)
Utah
Pennsylvania
Age of Onset
Age 6 weeks to 9 months
Peaks at 2-3 months (90% are under 6 months of age)
Pathophysiology
See
Botulism
Botulinum Toxin
binds at presynaptic membrane and prevents
Acetylcholine
release
Results in a functional denervation of skeletal and
Smooth Muscle
Sources
Contaminated soil (e.g. construction site, farm, earthquake)
Contaminated honey (10% of samples)
Contaminated corn syrup (0.5% of samples)
Other related factors
Infant gastric acid and gastric motility fails to prevent botulinum spore germination and toxin release
Infants under 2 months living in rural farming area
Infants over 2 months are typically
Breast
fed
Nursing infants account for 70-90% Infant Botulism
Nursing may be protective and delay severity
Non-nursing infants may have fatal undiagnosed case
Findings
Symptoms and Signs
See
Botulism
Early symptoms and Signs
Constipation
(65%)
May precede weakness by weeks
Cranial Nerve
Dysfunction
Weak cry and weak sucking
Decreased oral intake (79%)
Decreased
Gag Reflex
Cranial Nerve 6 Palsy
(unable to abduct eye)
Mydriasis
with sluggish pupil reaction
Ptosis
Autonomic changes
Hypotension
Neurogenic
Bladder
Later Symptoms and Signs
Descending weakness, flaccidity,
Floppy Infant
or hypotonia (88%)
Decreased activity or lethargy (60%)
Irritability
Respiratory difficulties
Differential Diagnosis
See
Hypotonia in Infants
(
Floppy Infant
)
See
Pediatric Constipation Causes
Sepsis
Guillain Barre
Labs
See
Botulism
Serum sample for
Botulinum Toxin
Stool
for toxin and culture
Passed stool is preferred
Sample (25 g or 25 ml) via colonic irrigation
Possible sources sent for
Botulinum Toxin
Dust or soil from clothing
Honey, Corn syrup and other foods
Diagnosis
See
Botulism
Electromyogram
(EMG)
Management
Supportive care with close supervision
Monitor respiratory function closely
Anticipate
Mechanical Ventilation
Antibiotic
s are not recommended
Penicillin G
(or
Metronidazole
) is used only for
Wound Botulism
(older children and adults)
Consider Botulinum Immune globulin (Baby BIG)
Efficacy
Reduces hospitalization duration
Reduces
Mechanical Ventilation
duration
Source: California Department of Health Services
Phone (24 hours): 510-540-2646
Botulinum antitoxin
Not recommended in infants
Botulinum Immune Globulin is preferred over antitoxin
May not be beneficial in Infant Botulism
Anaphylaxis
rate with trivalent
Vaccine
was very high (9 to 20%)
Prognosis
Case fatality rate of treated patients: <2%
Excellent long-term prognosis without residual changes
Course
Mechanical Ventilation
: 23 days
Hospital stay on average: 44 days
Relapses, if they occur, usually do so within 13 days
References
(2019) Sanford Guide, acccessed 6/5/2019
(2000) AAP Red Book, 25th edition, p. 212-13
Schechter in Behrman (2000) Nelson Pediatrics, p. 875-8
Cox (2002) Am Fam Physician 65(7):1388-92 [PubMed]
Muensterer (2000) Pediatr Rev 21(12):427 [PubMed]
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