Background:
Patient is a previously healthy 7-week old Hispanic female who presented to an emergency department with cough, congestion and decreased PO intake x 7 days. Baby had an unremarkable prenatal course and normal delivery. Mother was strictly breastfeeding the patient had normal growth and development. One week prior to the ED visit, mother had taken the patient to the PCP for cough and congestion. PCP diagnosed a viral URI and recommended supportive care. Early in the presentation of illness, feedings were shorter in duration but she continued to breastfeed every 2 hours. Throughout the course of the week, the mother became increasingly concerned that her child showed progressive decrease in feeding, had not had a bowel movement in 4 days, and continued to have cough and congestion. When evaluated in the in the emergency department, the baby was fussy but consolable and was noted to have mild dehydration and nasal congestion. Hypoglycemia was noted on the laboratory work. Baby was given an intravenous (IV) dextrose bolus along with continuous (IV) fluids to correct abnormalities. Patient was admitted to the ward with a diagnosis of dehydration and suspected sepsis.
Methods:
Shortly after admission to general pediatrics, the condition of this child quickly deteriorated. A complete screening for sepsis was performed and IV antibiotics were started. After the first day of hospitalization, the patient was unable to take feeds orally, had trouble handling her oral secretions, and muscle tone was noted to be markedly decreased globally. A STAT head ultrasound yielded normal results, which prompted a consult to neurology and transfer to the PICU. With such a rapid deterioration and new presenting symptoms, botulism was suspected. The California Department of Health Services delivered human derived anti-botulism toxin the following morning and the baby was treated empirically. Soon after the administration of the anti-toxin, the condition of this patient improved significantly. Weeks later after sending a stool sample to the Department of Public Health, the diagnosis of infantile botulism was confirmed.
Results:
Infant botulism is a rare disease that is potentially life threatening. Clostridium botulinum is a spore-forming organism that is common in nature and causes this disease by colonizing the infant’s large intestine and produces botulinum neurotoxin. Effects of the toxin in the body produce weakness, constipation, loss of muscle tone, and ultimately, a “floppy” paralysis. Infants affected have trouble nippling, handling oral secretions, and frequently progress to respiratory failure. Spores of C. Botulinum can be found in soil/dirt and in foods such as honey and some corn syrups. Infants between the ages of 6 weeks and 6 months are the most commonly affected. Infantile botulism has been reported to occur as early as 6 days and as late as 1 year of age. When treated early, complete recovery from the disease is obtainable.
Conclusions:
Early diagnosis and prompt treatment of infantile botulism with antitoxin is imperative in the optimal outcome of the disease. Fewer than 100 cases of infantile botulism are reported in the United Sates per year, therefore awareness of its occurrence is of utmost importance. The etiology of infantile botulism is well documented; however, the origin of exposure is often never determined. As is often the case with “rare” diseases, a thorough history and physical examination plays a key role in diagnosis.