A Case of Infant Botulism Treated with Human-Derived Antitoxin

Abstract

Background: Infant botulism is a severe and rare illness due to the ingestion of the neurotoxin secreted by Clostridium botulinum and is a neuroparalytic descendant acute disease which is reversible, treatable and preventable. Symptoms vary from mild hypotonia to respiratory failure and sudden death. Clinical Observation: A four-months-old female baby taken to the Emergency Room because of hypoactivity and failure to eat. Parents reported constipation for the last 5 days. The physical examination showed a hypoactive baby with sleep tendency and mild axial hypotonia. During the next 48 hours there is a progressive worsening of the clinical condition with severe axial hypotonia, generalized weakness, weak cry, increasing difficulty in sucking and swallowing and increase of respiratory secretions together with weak cough reflex. An electromyogram was performed with normal results. Parents denied giving the baby honey, infusions or any other food other than milk or cereals. Although there was no clear epidemiological history, infant botulism was suspected, and contact was made with the local Health Department and a direct toxin analysis was requested from blood and fecal samples. She received treatment with human derived botulism antitoxin (BabyBIG®) with a favorable outcome. The diagnosis was confirmed by the detection of the botulism toxin B in the patient's stools. Comments: Infant botulism, although it is a rare disease in our environment, requires a high level of suspicion to make an early diagnosis and initiate a timely and specific treatment and thus reduce complications and the course of the disease. Keywords: Botulism, Hypotonia, Antitoxin, BabyBIG