Botulismo infantil: Comunicación de un caso y revisión del tema

Abstract

Infant Botulism: Case-report and literature review Background: Infant botulism is a rare and potentially lethal neurological disease produced by the ingestion of a neurotoxin secreted by Clostridium botulinum, causing diffuse paralysis. Objective: Describe the first case in Chile since the establishment of an obligatory report and describe the diagnosis, clinical presentation and outcome. Case-report: A 2 months-old male with 48 hours of poor feeding and swallowing, weak cry, listlessness and constipation. He was admitted for hospitalization with probable sepsis and required tracheotomy due to apnea with failed endotracheal intubation, requiring mechanical ventilation for 150 days and hospitalization during 180 days. The diagnosis was confirmed by isolating Clostridium botulinum toxin from stool. Conclusion: The diagnosis of infant botulism requires a high suspicion index and the treatment includes intensive care monitorization with general support.

A Case of Infant Botulism Treated with Human-Derived Antitoxin

“…Electromyography can be helpful although it is not diagnostic by itself and can be normal at early stages of the illness (15) and there are several confirmed cases of infant botulism with normal electromyogram (16,17). Electromyography often discloses a pattern of brief, small and abundant motor unit potentials.…”

“…Also, antibiotics could disrupt the intestinal flora which would favour the growth of C. Botulinum. Antibiotic is indicated only for the treatment of complications such as pneumonia or sepsis (4,16). Specific treatment of botulism is based on the administration of intravenous botulinum antitoxin as soon as possible, preferably within the first 48 hours (13).…”

“…It has a half-life of 28 days, and it can neutralize the toxin during a period of 6 months (3). The economic cost of the human-derived antitoxin is very high hence not every country can afford it (5,16).…”

Epidemiologia e fatores de riscos relacionados à intoxicação alimentar causada por Clostridium Botulinum: uma revisão narrativa

“…Caracteriza-se como uma doença grave, de evolução aguda, e que provoca alterações digestivas e neurológicas, podendo levar a falência respiratória seguida de óbito. O Clostridium botulinum é uma bactéria gram-positiva, esporulada e encontra-se naturalmente em diversos ambientes, como solo, água, mel, pólen, legumes frescos e especiarias, se desenvolvendo bem em condições de anaerobiose e elevada atividade de água 1,2 .…”

“…Trata-se de uma doença associada à Síndrome de Morte Súbita do Recém-Nascido, em função do consumo de mel contendo esporos botulínicos, o qual é germinado no intestino grosso e produz a toxina in vivo 12 . O tipo de toxina e a quantidade de esporos ingeridos pela criança determinam a gravidade do quadro clínico, devendo-se evitar o consumo de mel no primeiro ano de vida 1 .…”