I. See Also

II. Epidemiology

  1. Incidence: Estimated at 250 cases in U.S. per year
    1. More cases than foodborne or wound Botulism
  2. States with highest rates
    1. California (50%)
    2. Utah
    3. Pennsylvania
  3. Age of Onset
    1. Age 6 weeks to 9 months
    2. Peaks at 2-3 months (90% are under 6 months of age)

III. Pathophysiology

  1. Sources
    1. Contaminated soil
    2. Contaminated honey (10% of samples)
    3. Contaminated corn syrup (0.5% of samples)
  2. Other related factors
    1. Infants under 2 months living in rural farming area
    2. Infants over 2 months are typically Breast fed
      1. Nursing infants account for 70-90% Infant Botulism
      2. Nursing may be protective and delay severity
      3. Non-nursing infants may have fatal undiagnosed case

IV. Symptoms and Signs

  1. See Botulism
  2. Early symptoms and Signs
    1. Constipation (65%)
      1. May precede weakness by weeks
    2. Cranial Nerve Dysfunction
      1. Weak cry and weak sucking
      2. Decreased oral intake (79%)
      3. Decreased Gag Reflex
      4. Cranial Nerve 6 palsy (unable to abduct eye)
      5. Mydriasis with sluggish pupil reaction
      6. Ptosis
    3. Autonomic changes
      1. Hypotension
      2. Neurogenic Bladder
  3. Later Symptoms and Signs
    1. Weakness or hypotonia (88%)
    2. Decreased activity or lethargy (60%)
    3. Irritability
    4. Respiratory difficulties

V. Differential Diagnosis

  1. See Hypotonia in Infants (Floppy Infant)
  2. See Pediatric Constipation Causes

VI. Labs

  1. See Botulism
  2. Serum sample for Botulinum toxin
  3. Stool for toxin and culture
    1. Passed stool is preferred
    2. Sample (25 g or 25 ml) via colonic irrigation
  4. Possible sources sent for Botulinum toxin
    1. Dust or soil from clothing
    2. Honey, Corn syrup and other foods

VII. Diagnostic Testing

VIII. Management

  1. Supportive care with close supervision
    1. Anticipate Mechanical Ventilation
  2. Avoid Aminoglycosides (may increase toxin levels)
  3. Consider Botulinum Immune globulin
    1. Efficacy
      1. Reduces hospitalization duration
      2. Reduces Mechanical Ventilation duration
    2. Source: California Department of Health Services
      1. Phone (24 hours): 510-540-2646
  4. Botulinum antitoxin
    1. Botulinum Immune Globulin is preferred over antitoxin
    2. Controversial in Infant Botulism
      1. May not be beneficial in Infant Botulism
    3. Anaphylaxis rate is high (9 to 20%)
      1. Test for Horse Serum Sensitivity prior to use

IX. Prognosis

  1. Case fatality rate of treated patients: <2%
  2. Excellent long-term prognosis without residual changes

X. Course

  1. Mechanical Ventilation: 23 days
  2. Hospital stay on average: 44 days
  3. Relapses, if they occur, usually do so within 13 days

XI. References

  1. (2000) AAP Red Book, 25th edition, p. 212-13
  2. Schechter in Behrman (2000) Nelson Pediatrics, p. 875-8
  3. Cox (2002) Am Fam Physician 65(7):1388-92
  4. Muensterer (2000) Pediatr Rev 21(12):427

Images: Related links to external sites (from Google)

Ontology: Botulism, Infantile (C0238027)

Concepts Disease or Syndrome (T047)
MSH D001906
ICD9 040.41
ICD10 A48.51
SnomedCT 414488002, 230680004
English BOTULISM, INFANTILE, Neonatal botulism, infant botulism (diagnosis), infant botulism, Infantile Botulism, Infant botulism, Botulism, Infantile, Infant Botulism, Botulisms, Infant, Infant Botulisms, Botulism, Infant, botulism; infant, infant; botulism, Infantile botulism, Infantile botulism (disorder)
Spanish botulismo de la lactancia, botulismo de la lactancia (trastorno), Botulismo Infantil, botulismo infantil (trastorno), botulismo infantil
Portuguese Botulismo Infantil
French Botulisme infantile, Botulisme de l'enfant
German Botulismus, infantiler
Dutch botulisme; kind, kind; botulisme, Botulisme bij kinderen