(See also Botulism Botulism Botulism is poisoning that is due to Clostridium botulinum toxin and that affects the peripheral nerves. Botulism may occur without infection if toxin is ingested, injected, or inhaled... read more , Overview of Anaerobic Bacteria Overview of Anaerobic Bacteria Bacteria can be classified by their need and tolerance for oxygen: Facultative: Grow aerobically or anaerobically in the presence or absence of oxygen Microaerophilic: Require a low oxygen concentration... read more , and Overview of Clostridial Infections Overview of Clostridial Infections Clostridia are spore-forming, gram-positive, anaerobic bacilli present widely in dust, soil, and vegetation and as normal flora in mammalian gastrointestinal tracts. Pathogenic species produce... read more .)
Infant botulism occurs most often in infants < 6 months. The youngest reported patient was 2 weeks, and the oldest was 12 months. Unlike food-borne botulism, infant botulism is caused by ingestion of spores, not by ingestion of a preformed toxin. The source of the spores is usually unknown in most cases, although some have been traced to ingestion of honey, which may contain C. botulinum spores; thus, infants < 12 months should not be fed honey.
Most cases involve type A or B toxin.
Symptoms and Signs of Infant Botulism
Constipation is present initially in 90% of cases of infant botulism and is followed by neuromuscular paralysis, beginning with the cranial nerves and proceeding to peripheral and respiratory musculature. Cranial nerve deficits typically include ptosis, extraocular muscle palsies, weak cry, poor suck, decreased gag reflex, pooling of oral secretions, poor muscle tone (floppy baby syndrome), and an expressionless face.
Severity varies from mild lethargy and slowed feeding to severe hypotonia and respiratory insufficiency.
Diagnosis of Infant Botulism
Stool tests
Initially, infant botulism should be suspected based on clinical findings. Treatment should not be delayed pending test results.
Infant botulism may be confused with sepsis Neonatal Sepsis Neonatal sepsis is invasive infection, usually bacterial, occurring during the neonatal period. Signs are multiple, nonspecific, and include diminished spontaneous activity, less vigorous sucking... read more , congenital muscular dystrophy, spinal muscular atrophy Spinal Muscular Atrophies (SMAs) Spinal muscular atrophies include several types of hereditary disorders characterized by skeletal muscle wasting due to progressive degeneration of anterior horn cells in the spinal cord and... read more , hypothyroidism Hypothyroidism Hypothyroidism is thyroid hormone deficiency. Symptoms include cold intolerance, fatigue, and weight gain. Signs may include a typical facial appearance, hoarse slow speech, and dry skin. Diagnosis... read more 
, and benign congenital hypotonia.
Finding C. botulinum toxin or organisms in the stool establishes the diagnosis of infant botulism.
Treatment of Infant Botulism
Human botulism immune globulin
Infants are hospitalized, and supportive care (eg, ventilatory support) is given as needed. Because the organism and toxin are excreted in the stool for weeks to months after symptom onset, appropriate contact precautions must be followed.
Treatment of infant botulism is started as soon as the diagnosis is suspected; waiting for confirmatory test results, which may take days, is dangerous.
Specific treatment of infant botulism is with human botulism immune globulin (BabyBIG®), which is available from the Infant Botulism Treatment and Prevention Program (IBTPP—call 510-231-7600 or see the IBTPP web site). This antitoxin is derived from pooled human donors who have high titers of antibodies to A and/or B toxin. The dose of human botulinum immune globulin is 50 mg/kg IV, given slowly.
The horse serum heptavalent antitoxin used in adults is not recommended for infants < 1 year of age.
Antibiotics are not given because they may lyse C. botulinum in the gut and increase toxin availability.
More Information
The following are English-language resources that may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Infant Botulism Treatment and Prevention Program: Web site or call 510-231-7600
Centers for Disease Control and Prevention (CDC): Infant Botulism: Information for Clinicians
