Botulism

Abstract

A 6-month-old infant is hospitalized with mild dehydration secondary to poor oral intake. His mother reports that the baby seems hungry but when she offrs a bottle, instead of drinking, he just moans and whimpers. She has tried rice cereal, and a few kinds of baby foods, but he won’t eat anything. The baby was not fed honey or any homeopathic or medicinal products. He has not had fever, cough, congestion, vomiting, or diarrhea. His mother notes that his last bowel movement was “several days ago,” but he used to stool two or three times every day. On physical examination, his vital signs are normal. He weighs 16.5 pounds (7.5 kg), 1.5 pounds less than when seen as an outpatient 8 days ago. He appears lethargic, mildly dehydrated, but well nourished. He has a weak suck, a soft, hoarse, cry, and generalized hypotonia. The diagnosis of infant botulism is suspected. Blood is collected to test for the presence of botulinum toxin in the serum, and a saline enema is performed to collect stool to test for the presence of toxin. The local health department is contacted to facilitate testing and to assist in obtaining human botulism immune globulin (Baby BIG) from the California Department of Public Health to use for treatment. Baby BIG is delivered to the hospital late the following day and is administered to the infant immediately. Twelve days later, the stool sample is reported by the state health department as positive for the presence of botulinum toxin A. During his 4 months of hospitalization, the infant received meticulous supportive care, gradually re-gaining the strength to eat and hold his head up without support. When seen by his primary care provider for his 12-month well-child care visit, his physical examination and developmental evaluation were normal indicating that he had recovered completely.