Infantile botulism is a rare, but serious condition. It occurs when an infant under 12 months of age accidentally eats spores from the bacterium Clostridium botulinum (C. botulinum). The spores turn into bacteria in the infant’s intestine and produce a neurotoxin. The toxin is absorbed into the infant’s body and causes damage to the infant’s nerve cells.
The infant might accidentally ingest the spores by eating honey or playing in contaminated soil. Infants with botulism appear tired and sluggish. They feed poorly, have constipation, and may have a weak cry and poor muscle tone.
With early detection and treatment, infants typically make a full recovery in several weeks. Left untreated, the disease can lead to paralysis (complete loss of muscle function) and respiratory failure. It is estimated that about 250 cases are diagnosed in the United States each year (Cox, et al., 2002).
Definition and Causes
Infantile botulism is also called “intestinal toxemia botulism.” This is because when an infant ingests spores produced by C. botulinum, the spores are absorbed by the intestine and develop into bacteria that produce a neurotoxin. A neurotoxin is a poison that affects nerve cells.
Nerve cells are cells in the body that coordinate movement, sense the environment, and send signals from the brain to other parts of the body. Only a few nanograms of the toxin are needed to cause illness. (FDA)
C. botulinum is an anaerobic bacterium, which means that it can only grow in environments without oxygen, such as inside the intestine. C. botulinum is found all over the world in places like:
- the bottom of streams, lakes, and coastal waters
- inside the intestines of fish and mammals
- honey products
Infants are at highest risk of getting infantile botulism if they eat honey, or if they play or live near contaminated soil. Honey is the only food definitively linked to botulism thus far, and infants who live in rural farming areas are at highest risk of being near contaminated soil.
According to the World Health Organization (WHO), most adults and children older than six months have developed natural defenses that prevent the growth of C. botulinum in their intestines (WHO). However, adults, infants, and children are at risk of getting other types of botulism poisoning. Foodborne botulism occurs when the toxin itself is present in ill-prepared foods. Wound botulism occurs when C. botulinum infects a wound.
An infected infant may show the following symptoms:
- loss of appetite
- weakness and tiredness
- weak or altered cry
- remarkable loss of head control
- lack of gag reflex
- drooping eyelids
- slow breathing that eventually leads to respiratory failure
- paralysis that spreads downward
A doctor may diagnose and begin treatment for infantile botulism based on a physical examination and symptoms. The condition is typically confirmed by testing for C. botulinum and toxins in the infant’s stools.
The main treatment for infantile botulism is an intravenous drug called botulism immune globulin. This treatment reduces a hospital stay and results in less severe illness. However, the infant may need several weeks to recover. Antibiotics do not help this condition, and are unnecessary unless other bacterial infections are present.
During recovery, infants will need special care and attention, including:
- ensuring proper nutrition
- ensuring that the infant’s airway is clear
- watching for breathing problems
In some cases, breathing problems may develop that require the support of a breathing machine. According to a 2002 study published in American Family Physician, if the infant needs a machine to help him or her breathe, the average duration is 23 days (Cox, et al., 2002).
If the condition is detected and treated quickly, infants typically make a full recovery. In very complicated cases, or in cases where botulism is left untreated, death and permanent paralysis can occur. However, the fatality rate is less than two percent (Cox, et al., 2002).
To help prevent infantile botulism, honey should not be given to infants under one year of age. Up to 25 percent of honey products have been found to contain spores according to microbiologic testing (Cox, et al., 2002).
Since the illness can be life-threatening, always seek medical attention if an infant is experiencing any of the signs or symptoms of infantile botulism.