Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review

Dilena, Robertino; Pozzato, Mattia; Baselli, Lucia Augusta; Chidini, Giovanna; Barbieri, S.; Scalfaro, Concetta; Finazzi, Guido; Lonati, Davide; Locatelli, Carlo; Cappellari, A.; Anniballi, Fabrizio

doi:10.3390/toxins13120860

Cited by 12 publications

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“…A study conducted by the California Department of Public Health, which analyzed 1226 patients who received human antitoxin for 10 years, reported that 6.2% of them did not have a laboratory confirmation of IB and established alternative diagnoses in 58% of these patients (spinal muscular atrophy type 1, metabolic disorders, infectious diseases). 25 Electrodiagnostic techniques, such as electromyoneurography (EMNG), may be useful while waiting for the diagnostic confirmation, 26,27 although its sensitivity is variable and, moreover, it is not always available in all facilities. 28,29 In the early years of the study, patients were assessed using an EMNG, but this technique is not currently performed in our hospital.…”

Section: Discussionmentioning

confidence: 99%

Infant botulism: a descriptive study in a pediatric intensive care unit

et al. 2023

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Introduction.Infant botulism (IB) is the most common form of human botulism in Argentina. Our objective was to describe the main aspects of diagnosis and management of patients with IB admitted to the pediatric intensive care unit (PICU).Methods. Observational, descriptive, and retrospective study. The PICU database with IB diagnosis in 2005-2020 period was used. Demographic variables, diagnostic methods, days of conventional mechanical ventilation (CMV), non-invasive ventilation (NIV), length of stay in the PICU and mortality upon hospital discharge were recorded.Results. In total, 21 patients with IB were recorded; 14 were male, their median age was 5 months (IQR: 2-6 m). Diagnosis was made by bioassay, and the toxin was identified in the serum of 12 patients. Only 1 patient did not require CMV; 1 patient had a tracheostomy; 18 patients received antibiotics; 5 received NIV. No patient was administered antitoxin and no patient died. The median length of stay in the hospital was 66 days (IQR: 42-76); in the PICU, 48 days (IQR: 29-78); and the median use of CMV, 37 days (IQR: 26-64). The delay until diagnostic confirmation was 15.8 ± 4.8 days. Conclusions.All patients were diagnosed using the bioassay technique, which resulted in a diagnostic delay that exceeds the recommended period for the administration of a specific treatment. No patient received a specific treatment. IB was related to a low mortality, but also to prolonged use of MV and length of hospital stay, which were associated with cross infections and frequent antibiotic use.

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Section: Discussionmentioning

confidence: 99%

Infant botulism: a descriptive study in a pediatric intensive care unit

et al. 2023

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“…Un estudio del Departamento de Salud Pública de California, que analizó 1226 pacientes que durante diez años recibieron antitoxina humana, reportó que el 6,2 % no tenían BL por laboratorio y estableció diagnósticos alternativos en el 58 % de estos pacientes (atrofia muscular espinal tipo 1, trastornos metabólicos, enfermedades infecciosas). 25 Las técnicas de electrodiagnóstico, como la electroneuromiografía (ENMG), pueden ser de utilidad mientras se aguarda la confirmación diagnóstica, 26,27 aunque la sensibilidad del método es variable y, además, no siempre disponible en todos los centros. 28,29 En los primeros años del estudio, los pacientes fueron evaluados con ENMG, pero en la actualidad esta técnica no se realiza en nuestro centro.…”

Section: Discussionunclassified

Botulismo del lactante: estudio descriptivo en una unidad de cuidados intensivos pediátricos

2023

Arch Argent Pediat

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Introducción. El botulismo del lactante (BL) es la forma más frecuente de botulismo humano en Argentina. El objetivo es describir aspectos esenciales del diagnóstico y tratamiento de pacientes con BL internados en el servicio de terapia intensiva pediátrica (STIP).Métodos. Estudio observacional, descriptivo y retrospectivo. Se utilizó la base de datos del STIP con diagnóstico de BL en el período 2005-2020. Se registraron variables demográficas, métodos de diagnóstico, días de asistencia respiratoria mecánica convencional (ARMC), de ventilación no invasiva (VNI), estadía en STIP, mortalidad al alta hospitalaria. Resultados.Se registraron 21 pacientes con BL; 14 pacientes fueron varones, con una mediana de edad de 5 meses (RIC 2-6 m). El diagnóstico se realizó mediante técnica de bioensayo y se detectó la toxina en suero en 12 pacientes. Uno solo no requirió ARMC; 1 paciente fue traqueostomizado; 18 pacientes recibieron antibióticos; 5 recibieron VNI. Ningún paciente recibió antitoxina y no hubo fallecidos. La mediana de estadía hospitalaria fue 66 días (RI: 42-76); de internación en STIP, 48 días (RI: 29-78); y de ARMC, 37 días (RI: 26-64). La demora en la confirmación diagnóstica fue 15,8 ± 4,8 días. Conclusiones.La totalidad de los pacientes fueron diagnosticados con la técnica de bioensayo, que generó un tiempo de demora diagnóstica que excede los lapsos recomendados para la administración del tratamiento específico. Ningún paciente recibió tratamiento específico. El BL presentó baja mortalidad, pero tiempos de ARM e internación prolongados, que se asocian a infecciones sobreagregadas y uso frecuente de antibióticos.

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“…The toxin is absorbed via lymphatic into the blood and transported to the neuromuscular junction, where it binds with soluble N-ethylmaleimide-sensitive factor attachment protein receptor, blocks acetylcholine release, and leads to flaccid paralysis (Arnon et al, 2006;Payne et al, 2018). Infant botulism is the major form of botulism in the United States (CDC, 2012) and has been found across the world (Drivenes et al, 2017;Dilena et al, 2021;Jeon et al, 2021;Avila et al, 2022;Douillard et al, 2022;Nga et al, 2022;Oliveira et al, 2022;Goldberg et al, 2023). Infant botulism was first reported in China in 1990 (Wu et al, 1990) and more cases have been reported in recent years with better diagnostic technologies (Xin et al, 2019;Ge et al, 2020;Zhang et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Dissecting and tracing the gut microbiota of infants with botulism: a cross sectional and longitudinal study

Wang,

Li,

Wang

et al. 2024

Front. Microbiol.

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BackgroundInfant botulism is caused by botulinum neurotoxin (BoNT), which is mainly produced by Clostridium botulinum. However, there is a lack of longitudinal cohort studies on infant botulism. Herein, we have constructed a cross-sectional and longitudinal cohort of infants infected with C. botulinum. Our goal was to reveal the differences in the intestinal microbiota of botulism-infected and healthy infants as well as the dynamic changes over time through multi-omics analysis.MethodsWe performed 16S rRNA sequencing of 20 infants’ stools over a period of 3 months and conducted whole genome sequencing of isolated C. botulinum strains from these laboratory-confirmed cases of infant botulism. Through bioinformatics analysis, we focused on the changes in the infants’ intestinal microbiota as well as function over time series.ResultsWe found that Enterococcus was significantly enriched in the infected group and declined over time, whereas Bifidobacterium was significantly enriched in the healthy group and gradually increased over time. 18/20 isolates carried the type B 2 botulinum toxin gene with identical sequences. In silico Multilocus sequence typing found that 20\u00B0C. botulinum isolates from the patients were typed into ST31 and ST32.ConclusionDifferences in intestinal microbiota and functions in infants were found with botulism through cross-sectional and longitudinal studies and Bifidobacterium may play a role in the recovery of infected infants.

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Infant Botulism: Checklist for Timely Clinical Diagnosis and New Possible Risk Factors Originated from a Case Report and Literature Review

Cited by 12 publications

References 64 publications

Infant botulism: a descriptive study in a pediatric intensive care unit

Infant botulism: a descriptive study in a pediatric intensive care unit

Botulismo del lactante: estudio descriptivo en una unidad de cuidados intensivos pediátricos

Dissecting and tracing the gut microbiota of infants with botulism: a cross sectional and longitudinal study

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