What is Infantile Botulism?
Infantile botulism is a disease caused by the bacteria Clostridium botulinum, which is typically found in soil, water, and air. Even small amounts of their lethal toxins can make a person sick. People can get infected with botulism in various ways:
– Foodborne botulism: This happens when someone eats food containing the toxins from these bacteria.
– Infant botulism: In a few cases, babies under the age of one can get botulism if these bacteria grow in their digestive system.
– Wound botulism: This happens when wounds get infected with these bacteria, and they produce toxins.
– Iatrogenic botulism: This happens when medical and cosmetic procedures that use the botulinum toxin cause the disease.
– Intestinal colonization: This refers to cases where people over the age of one have these bacteria in their digestive system (this can happen to older children and adults just like infant botulism).
While botulism can be contracted in many ways, generally, only three main types of these bacteria are responsible for these infections:
– Type A: Mainly found west of the Mississippi River
– Type B: Mainly found east of the Mississippi River
– Type E: Mostly found in the Pacific Northwest and Alaska
In the United States, around 100 cases of infant botulism are reported each year. About one in five cases is associated with eating raw honey, typically in immigrant families. The source of the bacteria in most cases is still unknown, but it’s thought they might come from contaminated soil and dust from construction sites. Other possible sources include powdered milk, natural sweeteners, corn syrup, and medicinal herbs.
What Causes Infantile Botulism?
Infantile botulism, a form of botulism infection, is the most common type and accounts for 70% of all new cases of botulism each year. This condition happens when babies consume food or milk contaminated with a certain harmful substance (neurotoxin), which then sets up shop and multiplies in the baby’s large intestine. Infantile botulism can be caused by two types of serotypes (different variations of the disease): Type A and Type B.
On the other hand, Foodborne botulism, another form of this infection, is rarely seen in children and usually occurs in groups. So it is less frequently diagnosed in pediatric patients.
Risk Factors and Frequency for Infantile Botulism
Infantile botulism is a condition that accounts for about 70% of all new botulism cases each year. In the United States alone, about 77 new cases per year are seen, equivalent to 1.9 cases per 100,000 live births. Interestingly, the condition affects males and females equally. Certain factors increase the risk of infantile botulism, including infants with higher birth weights, the children of older mothers, and infants who are breastfed. Over the past 30 years, more than half of all new cases of this condition have occurred in California.
The C. botulism toxin, often found in contaminated food and dust, is usually to blame for such infections. This toxin is especially linked with home-canned or poorly refrigerated foods. In fact, about 20% of all cases are related to the consumption of honey or corn syrup. However, it’s still unclear how spores manage to travel within these foods. On another note, conditions like living close to construction sites with abundant dust or within contact of vacuum cleaner debris have also been traced as potential factors of infection.
Furthermore, it is seen that Hispanic and Asian families have a higher chance of infantile botulism. This is primarily because of their consumption of herbal medications and raw honey.
Signs and Symptoms of Infantile Botulism
Infants with botulism illness typically show symptoms between 10-30 days of exposure, often around 3-4 months old. They primarily experience stomach-related issues such as nausea, vomiting, and diarrhea.
Many parents report their babies having difficulty eating, seeming unusually tired, weak cries, and constipation. There might also be visible droopiness in their face or eyes, excessive drooling because they can’t suck effectively, and shallow breathing. A distinguishing feature of this illness often seen in babies is what’s referred to as the “floppy baby” syndrome.
As the infection progresses, more serious symptoms can arise due to the effects of the botulism toxin. These can include:
- Paralysis that starts from the top and moves downwards on both sides of the body symmetrically
- Dysfunction of the nerves controlling muscles involved in vision, speech, and swallowing, leading to issues like double vision, speech difficulties, voice changes, and trouble swallowing
Mothers who breastfeed might notice that their breasts are unusually full because their baby is unable to feed properly. Although these symptoms can seem confusing since issues like constipation, difficulty feeding, and drooling are common in infants. However, in this condition, the baby’s anal muscle tone will be relaxed and decreased. Deep tendon reflexes can be either diminished or normal, with sensation intact. The baby’s thinking abilities are usually unaffected.
Some symptoms might not become apparent until the baby starts to show signs of muscle fatigue. Doctors often do tests to check for this, such as observing how quickly the baby’s pupils react to light shone into a dark room several times over a few minutes, or monitoring how the baby’s sucking reflex diminishes over time.
Indicators of botulism sickness include weakened muscle tone, constipation, weakened sucking ability, hoarse crying, symmetric descending weakness. In addition, babies may also have a marked head lag and a diminished gag reflex. It’s important for parents to urgently seek medical attention if they notice any of these symptoms as breathing problems can arise suddenly.
Testing for Infantile Botulism
If your child appears physically weak or “floppy,” it may be a sign of botulism. This is often diagnosed based on a combination of medical history and physical examination. However, routine lab tests often show normal results, so more specific tests are needed to confirm the diagnosis.
To definitively confirm botulism, doctors need to conduct a stool culture and a toxin test. The toxin test is done using a stool, blood sample, or stomach contents, while a stool culture is usually collected with the help of an enema. It’s important not to use preservatives or glycerin suppositories in the collection process, as these can influence the results. The sample can be refrigerated prior to testing, but should not be frozen.
The results from the direct toxin test usually come back the morning after the sample has been received. Stool culture results can take longer, typically around one week to one month, and they’re not always conclusive, with only 60% yielding a positive result. The most accurate test is a mouse inoculation test, which is performed by the Centers for Disease Control and Prevention (CDC). Nowadays, a method called polymerase chain reaction (PCR) can detect spores in a sample in about 24-72 hours, but it may not be available everywhere.
Doctors don’t usually use imaging, like X-rays or MRIs, to diagnose botulism. They can try to test food that may have been the source of the infection, but these results are often inconclusive or delayed. Still, it’s crucial for doctors to rule out diseases with similar symptoms — like meningitis, which requires a lumbar puncture, or spinal tap. This helps ensure they’re providing the most appropriate treatment.
Treatment Options for Infantile Botulism
If your child is sick and tests confirm they are suffering from infantile botulism, the first step doctors will take is to make sure they are stable. This includes checking their airway, breathing, and circulation.
About half of babies with this condition might need a breathing tube being inserted (a process called intubation), regardless of whether they’re given a treatment called human botulism immune globulin intravenous (human BIG-IV). If the child isn’t treated with human BIG-IV, they might need a machine to help them breathe for an extended period. Thus, if medical professionals suspect botulism, they may decide to intubate the child if they see necessary.
If your child needs help breathing, doctors will use a special monitor to measure the carbon dioxide levels they breathe out. This will determine if the child’s lungs are working properly. To help make breathing easier, they’ll position the child with their head slightly lower than their feet (a 20-degree angle), a position known as the Trendelenburg position. They will also put a support under their neck to keep it stable. If the child’s gag reflex is weak, they could be at a higher risk of aspiration, meaning they could accidentally inhale food or liquids into the airways.
A treatment called human BIG-IV can reduce the time your child spends in the hospital and the duration they may need breathing help from a ventilator. It is administered through an IV (a tube that goes into their vein) over 30 minutes. While the risk of a severe allergic reaction is low, this treatment can be quite expensive.
There is also antitoxin available which can quickly improve your child’s symptoms, especially if administered within the first 24 hours of the onset of symptoms.
Generally, for infantile botulism, antibiotics aren’t needed. What’s more important is that your child gets the right supportive care. This can include helping them with breathing, providing appropriate nutrition, and ensuring they are positioned properly.
It’s also important that the child doesn’t receive certain antibiotics (all aminoglycosides) which can worsen muscle weakness. If botulism has resulted from an infected wound, other types of antibiotics like Penicillin G and metronidazole could be used.
What else can Infantile Botulism be?
There are several conditions or disorders that might be mistaken for each other because they present with similar symptoms. These include but are not limited to:
- Sepsis: a life-threatening response to an infection
- Electrolyte imbalance or dehydration conditions, such as low blood sugar (hypoglycemia), low sodium (hyponatremia), or high potassium (hyperkalemia)
- Metabolic disorders and encephalopathy: a category of conditions that affect how your body’s metabolic processes work
- Congenital myopathy: a group of muscle disorders that appear at birth or in infancy, typically making the muscles weak
- Leigh disease: a severe neurological disorder that usually becomes apparent in the first year of life
- Myasthenia gravis: a condition causing weakness and rapid fatigue of muscles under voluntary control
- Guillain-Barre syndrome: a serious health problem that occurs when the body’s immune system mistakenly attacks part of its peripheral nervous system
What to expect with Infantile Botulism
The outlook is generally good once the condition is identified and treated with a medication called human BIG-IV. After a hospital stay, it’s important for patients to continue seeing a neurologist and engaging in physical therapy. Most instances of a condition called infantile botulism, which affects infants, will fully heal within a timeframe of several months up to a year.
Compared to 100 years ago, when nearly 90% of patients died from this condition, today the death rate has decreased dramatically to less than 15%.
Possible Complications When Diagnosed with Infantile Botulism
Possible Side Effects:
- Difficulty or inability to breathe properly (Respiratory failure)
- Inability to empty the bladder (Urinary retention)
- Inhaling food, stomach acid, or saliva into the lungs (Aspiration)
- Temporary stop in breathing (Apnea)
- Potential death
Preventing Infantile Botulism
Parents need to handle and prepare food safely – this is especially important if you are canning foods at home. It’s also important that you refrain from giving infants raw honey and corn syrup. If your child has been treated for a condition called infantile botulism, it’s essential that all family members wash their hands thoroughly and often. Extra care also needs to be taken when handling the soiled diapers of these infants, as they can still release the harmful substance that causes botulism for a period of several weeks to even months.
