What do you need to know to treat infant botulism?
May 10, 2024
Infant botulism is the most common form of human botulism in the United States. The Centers for Disease Control and Prevention reported 152 confirmed infant botulism cases and no deaths in 2019. About 70% of all US botulism cases are infants under the age of one. Although rare, infant botulism is potentially life threatening. Early detection by family, followed by a timely clinical diagnosis and prompt treatment can lead to full recovery without associated sequela.
C. Botulinum spores can be found in soil, air, water and food including honey. According to the American Academy of Pediatrics, avoiding honey in infants less than one year is an important and easy prevention. Although a single exposure to honey or a product containing honey can increase the risk of infection, infant botulism remains a rare and treatable illness.
Clostridium botulinum spores are not usually harmful to people over the age of one. However, the infants’ immature large intestine can allow these spores to germinate and produce botulinum toxin. This neurotoxin is absorbed, distributed systemically and leads to the characteristic, symmetric, descending flaccid paralysis. Typical onset is within 12-48 hours, but can be up to 30 days.
Initial signs may be subtle and overlooked. A parent may report poor feeding, drooling, constipation or,”just not acting right”. Common clinical features could also include lethargy, hypotonia, weak cry, poor head control and hypoventilation. Severe disease can rapidly progress to respiratory arrest.
Treatment includes critical care support and prompt administration of the botulism antitoxin, BabyBIG. The California Department of Public Health (CA DPH), produces, distributes and is the only source for this first-line treatment in the United States.
Acquiring BabyBIG requires a free clinical consultation provided by the Infant Botulism Treatment and Prevention Program, at the CA DPH. Providers who suspect infant botulism should immediately contact the on-call physician and not wait for confirmatory testing. The decision to treat is based solely on presenting symptoms.
A consultation with the on-call physician for the CA DPH, Infant Botulism Treatment and Prevention Program is available by calling (510) 231-7600.
Suspected cases of infant botulism should be promptly reported to the TN State Department of Health (615) 741-3111.
The Poison Control Center is always available for support and resource guidance.
References
Retrieved from: https://www.Healthychildren.org/english/ages-stages/baby/feeding-nutrit… Retrieved from: https://www.infantbotulism.org/physician/obtain.php Retrieved from: CDC.gov/botulism/surv/2019/index.html
Question prepared by: Donna Taylor, RN, CPSI
Comment: A follow-up from last week’s question. Jim Keffer said: Thanks for this. You may want to let folks know that lactmed is available as an iOS app for smartphones. (Great comment! ds)
I am interested in any topics you would like answered in the Question of the Week. Please email me at donna.seger@vumc.org
Donna Seger MD Professor Emerita
Dept of Medicine
VUMC