Infant botulism

Infant botulism - Acute

 

Definition  

Infectious neuroparalytic disease of infants under 12 months of age caused by intestinal absorption of toxin produced by ingested Clostridium botulinum spores

 

Medical History  

* Breast fed

* Constipation

* Ingestion of Honey

* Environmental Exposure

 

Findings  

* Apnea

* Constipation

* Decreased pupillary reflex

* Decreased tendon reflex

* Difficulty sucking

* Feeding poor

* Hypoactive gag reflex

* Muscle weakness

* Ophthalmoplegia

* Paralysis

* Poor muscle tone

* Ptosis of eyelid

* Shallow breathing

* Unable to control head posture

* Weak cry

* Dysphagia

* Urinary retention

* Reduced salivation

* Scanty tear production

 

Tests  

 

Suspected infant botulism in patients less than 12 months  

* Clostridium botulinum culture: Clinical diagnosis of infant botulism can be confirmed by isolation of Clostridium botulinum in stool specimens .

 

Suspected infant botulism in patients less than 12 months  

* Arterial blood gas analysis: As ventilatory failure occurs secondary to muscle weakness, retention of carbon dioxide can lead to respiratory acidosis followed by hypoxia.

 

Suspected infant botulism in patients less than 12 months  

* Clostridium botulinum toxin assay: Diagnosis is confirmed when botulinum toxin is demonstrated in a sterile filtrate by mouse lethality and neutralization tests.

 

Differential Diagnosis  

* Bacterial meningitis - Acute

* Community acquired pneumonia - Acute

* Hypothyroidism

* Poliomyelitis, acute - Acute

* Diphtheria - Acute

* Reye's syndrome

* Disorder of amino acid metabolism

* Lead poisoning

* Hepatic porphyria

* Metabolic encephalopathy

* Guillain-Barré syndrome - Acute

* Myasthenia gravis - Acute

* Hirschsprung's disease - Acute

* Benign congenital hypotonia

 

Treatment  

 

Drug Therapy  

 

Infant botulism caused by toxin type A or B  

 

BOTULISM IMMUNE GLOBULIN  

Infants: 1 mL/kg (50 mg/kg) as a single IV infusion over 1-2 hours as soon as clinical diagnosis of infant botulism is made; administer at 0.5 mL/kg/hour (25 mg/kg/hour); if no untoward reactions occur after 15 minutes, rate may be increased to 1 mL/kg/hour (50 mg/kg/hour)

 

Procedural Therapy  

 

Dehydration  

* Intravenous fluid replacement: Intravenous fluid replacement is indicated for patients with dehydration when oral replacement cannot be accomplished .

 

Respiratory distress  

* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .

 

Nutritional support in at-risk patients less than 12 months with infant botulism  

* Tube feeding of patient: Gavage feedings (formula or breast milk) can provide nutritional support; maintain until the infant is able to swallow and has an intact gag reflex .