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Infantile Botulism

What is infant botulism?

Infant 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.

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Causes

What causes infant botulism?

Infant botulism is also called “intestinal toxemia botulism.” This is because when an infant ingests spores produced by C. botulinum, the spores germinate in the intestine and develop into bacteria that produce a neurotoxin. A neurotoxin is a poison that affects nerve cells. Only a few nanograms of the toxin are needed to cause illness.

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 and substances like:

  • soil
  • the bottom of streams, lakes, and coastal waters
  • inside the intestines of fish and mammals
  • honey products

Infants are at highest risk of getting 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. 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.

Foodborne botulism occurs when the toxin itself is present in ill-prepared foods. Wound botulism occurs when C. botulinum infects a wound.

Symptoms

What are the symptoms of infant botulism?

An infected infant may show the following symptoms:

  • constipation
  • 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
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Diagnosis

How is infant botulism diagnosed?

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.

Treatment

How is infant botulism treated?

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.

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Outlook

What can be expected with treatment?

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 2 percent.

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Prevention

How can infant botulism be prevented?

To help prevent infantile botulism, infants under 1 year old should not be given honey. Microbiologic testing has found that up to 25 percent of honey products contain spores.

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.

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