This is a type of botulism in which bacteria, Clostridium botulinum , grow within an infant's gastrointestinal tract and produce a toxin which can cause a potentially life-threatening disease.

Causes, incidence, and risk factors

Clostridium botulinum is a spore-forming organism that is common in nature. The spores may be found in soil, foods (such as honey and some corn syrups), and elsewhere. This disease occurs mostly in young infants between 6 weeks and 6 months of age. Onsets as early as 6 days and as late as one year have been reported. Risk factors include the ingestion of honey, young age, contact with soil, breast-feeding, and having less than one stool per day for a prolonged period (greater than 2 months).

Signs and tests

Physical examination shows the symptoms described above, such as decreased muscle tone ( hypotonia ), an absent or decreased gag reflex, absent or decreased deep tendon reflexes, and eyelid drooping ( ptosis ). Laboratory testing consists of checking a stool sample to demonstrate the presence of botulinum toxin in the stool or demonstration of Clostridium botulinum in the stool. A special muscle test known as electromyography (EMG) can help differentiate between muscle abnormalities and neurologic abnormalities.

Treatment

The mainstay of treatment is supportive and may include keeping the airway clear, observing for respiratory difficulty, and ensuring adequate nutrition. If respiratory distress develops, respiratory support including use of a ventilator may be indicated. Antibiotics do not appear to increase the rate of improvement. The use of human-derived botulinum antitoxin may also be of benefit. Antibiotics are not needed unless a secondary infection, such as pneumonia, develops.

Expectations (prognosis)

Full recovery is expected with early recognition and supportive treatment. Death or permanent disability may result in complicated cases.

Complications

Respiratory insufficiency can develop, requiring assistance with breathing (mechanical ventilation).

Calling your health care provider

Since infant botulism can be life-threatening, go to the emergency room or call the local emergency number (such as 911) immediately if your infant has one or more of the symptoms of botulism.

Prevention

Theoretically, the disease might be avoided by preventing exposure to spores . Since honey and corn syrup are sources of Clostridium spores, they should not be fed to infants under 12 months of age. Although breast-feeding appears to be a risk factor for infantile botulism, the overall risk is very low -- for that reason, the benefits of breast-feeding still greatly outweigh the risks in nearly all cases.