Let's switch to a less devastating
condition such as infant botulism.
So, Infant Botulism is caused by
the ingestion of spores of the bacteria
The classic test question is
a parent who adminsters honey
to their infant
under a year of life.
Infants are more prone to the effects
of the botulinum toxin
because they are simply
And a lower ingestion is required.
So, honey is contraindicated
because of a risk of botulism.
The botulinum toxin can be
However, in reality, and not so much
on the tests,
most cases in the United States
are not from honey.
Most cases in the United States
are from living near construction sites.
In areas where c. botulinum
is found in the soil.
Typically, what may happen
is because of a construction site
the c. botulinum is aerosolized
floats in the window
and affects the child.
It doesn't affect the adults because
again, adults would need a much higher
concentration of c. botulinum.
The classic for adults is
eating canned old foods.
So, in the infant, the child ingests
breathing them in and swallowing them.
air or by ingesting honey.
That child then incubates these
bacteria in the colon.
And the bacetria secretes a toxin
The botulinum toxin is absorbed and
goes throughout the body
and it essentially blocks acytocholine
in the presynaptic cleft of the motor
In other words, the nerves that are
about to innovate the muscle
is not able to get its
Infant botulism will present
in a number of different ways.
An infant would often have a flat
Whereas the infant previously was
smiling, the child is smiling no longer.
The child would often have a weak cry.
They can't generate the energy to cry loudly.
They often present with poor feeding.
Parents will say, my child isn't just eating
as much as it used to.
They may have difficulty swallowing
or maybe drooling or choking on their feeds.
You may notice Ptosis or drooping
of the eyelids.
They will become hypotonic over time.
Although that is a later finding.
A key finding in these children
is that they may have constipation.
The decreased energy that they have
or ability to constrict
their abdominal muscleture
makes it harder to generate the
required to expulse the stool.
As a result, these infants
frequently develop constipation.
They will gradually proceed to a flaccid
and would proceed to respiratory failure
unless they are treated.
So, if we suspect Infant Botulism,
we can test the stool for the toxin.
Theraphy; because the test can take a while
should be initiated
in the classic case
even if the testing is pending.
In reality, the vast majority of Infant
Botulism cases take place
in certain areas around the country
such as Philadelphia
where there is endemic
presence of c. botulinum
in the soil.
As a result,
these centers are used to seeing
these patients and can often identify
them clinically and may
prior to the tests
coming back if the child is progressing
The therapy is immunoglobulin
but specifically what we call BabyBIG
which is Botulism immunoglobulin
is directed against the toxin.
It dramatically reduces
the severity of illness.
And will shorten hospitalization
and significantly reduce
the need for ventilation.
About half of the patients picked up
eventually need to be intubated
and ventillated while waiting for the
resolution of the illness.
So we give the immunoglobulin.
We support them respiratorily.
And in time, they should return to normal.
However, we don't want to give antibiotics
against the botulism.
The reason being, especially Aminoglycosides
are contraindicated because they can
potentiate the effects of neurotoxin.