Botulism is a paralytic disease which is caused by potent protein (neurotoxins) produced and released by Clostridium botulinum. Botulism can be divided into 3 categories or types namely food borne botulism, intestinal botulism and wound botulism. Infant botulism is a type of intestinal botulism and occurs from ingestion of spores of Clostridium botulinum and production of toxin in the intestine of infants. Intestinal botulism can also occur in adults.

Food borne botulism occurs due to ingestion of preformed toxin in food contaminated with C. botulinum and wound botulism occurs from toxin produced by the contamination of wounds with C. botulinum. Iatrogenic botulism can occur after cosmetic or therapeutic use of botulinum toxin. Botulism generally starts by involving the creanial nerves, which than spread to extremities.

What are the clinical manifestations of infant botulism?

Infant botulism is the most common form of botulism. It is a type of intestinal botulism and occurs due to production of toxin by the vegetative forms of C. botulinum in the intestine of infants. After germination of spores of C. botulinum in the intestine of infants, the vegetative forms of C. botulinum starts producing botulinum neurotoxin, which is absorbed from intestine of infant and starts producing signs and symptoms of infant botulism. The severity of symptoms of infant botulism ranges from mild illness that can result in failure to thrive to severe botulism which can lead to severe paralysis and respiratory failure and death of infant. Infant botulism is one of the causes of sudden infant death.

The source of infant botulism can sometimes be the honey contaminated with spores of C. botulinum. Due to this finding (a source of spores of C. botulinum) honey is not recommended to infants below 12 months of age. But generally it can not be determined in most of the cases of infant botulism. The most commonly involved in infant botulism are infants below 6 moths of age and the reason may be after 6 months of age the normal intestinal flora starts to develop, which reduces the susceptibility of infant botulism (spores in infant intestine).

How infant botulism is diagnosed?

Diagnosis of infant botulism may be difficult. A high degree of suspicion is essential in diagnosis of infant botulism. The demonstration of toxin in serum by bioassay in mice can give a definitive diagnosis, but unfortunately this test may give negative result in infant botulism (and also wound botulism) and this test is available in only in limited number of laboratories.

The mainstay of laboratory diagnosis of infant botulism (and other forms of botulism) is demonstration of C. botulinum or its toxin in vomitus, gastric fluid, or stool (presence of C. botulinum in stool strongly suggest botulism as carrier state of C. botulinum is very rare) and isolation of organism (C. botulinum) in food without toxin.

How infant botulism is treated?

Neither antitoxin nor antibiotics are beneficial in treatment of infant botulism. Infant botulism is treated by providing supportive care (symptomatic treatment) and by administration of human botulism immune globulin. Human botulism immune globulin can be difficult to obtain and in the United States it can be obtained from California Department of Health Services by calling phone number 510-231-7600.

What is the prognosis status of infant botulism?

With the use of sophisticated respiratory and intensive care, the case-fatality rate of infant botulism is very low at present (approximately 7%). Artificial respiration may be required for several weeks.

How to prevent infant botulism?

Spores of C. botulinum can be inactivated (killed) by exposing them to high temperature 116–121°C and pressure, which are generally attained in pressure cookers if used in accordance with the manufacturer's instructions. The botulinum toxin is heat labile and it can be destroyed by heating it at 85°C for 5 minutes. For prevention the new cases of infant botulism should be reported to local health authorities immediately.

A pentavalent vaccine (types A through E) is also available for use (recommended only among highly exposed individuals).

Related Articles/sites:

1. http://infantbotulism.org/