Infant Botulism, Israel, 2007–2021

Goldberg, Bar; Danino, Dganit; Levinsky, Yoel; Levy, Itzhak; Straussberg, Rachel; Dabaja‐Younis, Halima; Guri, Alex; Almagor, Yotam; Tasher, Diana; Elad, D.; Baider, Zina; Blum, Shlomo E.; Scheuerman, Oded

doi:10.3201/eid2902.220991

Cited by 14 publications

(14 citation statements)

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“…Due to the immaturity of the infant microbiome in conjunction with their developing immune systems and relative lack of gastric acidity, infants are thought to be particularly susceptible to intestinal colonization by C. botulinum [ 6 ]. Once the intestinal tract has been colonized, the botulinum neurotoxin travels to the bloodstream and lymphatic circulation and then to motor nerve endings [ 2 – 4 , 8 ]. The neurotoxin irreversibly binds to cholinergic receptors in the presynaptic membranes of autonomic and voluntary neuromuscular junctions, which prevents the release of acetylcholine into the synaptic space, and ultimately leads to a descending flaccid paralysis [ 2 – 6 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…A very low dose of 1 µg/kg can be lethal for an infant [ 3 , 6 ]. The incubation period is thought to be between 3 and 30 days, with rare cases occurring soon after birth [ 2 – 4 ]. A well-known etiology of IB is ingestion of contaminated honey [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

“…IB is the most common form of botulism in the United States, with approximately 70–100 cases occurring annually [ 2 , 3 ], representing about 70% of reported botulism cases per year [ 3 ]. Most cases affect infants under 6 months of age, with a median age of presentation of 3–6 months [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

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That head lag is impressive! Infantile botulism in the NICU: a case report

Wardinger,

Darwish,

Amatya

2024

matern health, neonatol and perinatol

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Background Infantile botulism (IB) is a devastating and potentially life-threatening neuromuscular disorder resulting from intestinal colonization by Clostridium botulinum and the resultant toxin production. It can present with constipation, descending paralysis, and, potentially, respiratory failure. Botulism is a diagnosis that is more commonly seen in the pediatric intensive care unit (PICU) or on the general pediatric wards and would not typically be managed in the neonatal intensive care unit (NICU), and therefore requires high clinical suspicion to ensure prompt diagnosis and treatment. Case presentation We discuss a case where an infant from central Pennsylvania presented to a Level IV NICU rather than to the PICU for an evaluation for sepsis and was uniquely diagnosed with IB. The infant presented with poor oral feeding and reduced oral intake, hypothermia, and lethargy. His symptoms progressed into hypoxia and acute respiratory failure. Interestingly, this infant had no known exposure to honey or any other identifiable sources of botulism contact. The infant’s twin brother and the other infants who attended the mother’s in-home daycare remained asymptomatic. This infant was initially evaluated and managed for a potential infectious etiology. However, a diagnosis of IB was suspected, and was later confirmed through the detection of botulinum toxin in the infant’s stools. A high level of suspicion allowed for timely treatment with Botulism Immune Globulin neutralizing antibodies (BabyBIG), even prior to confirmatory testing. We describe the process of obtaining BabyBIG, as well as the natural course of illness after treatment in our patient who ultimately made a complete recovery. Conclusions This case highlights the importance of considering infantile botulism as a diagnostic possibility even in the absence of risk factors, and the need for vigilance in diagnosing and treating this rare but potentially life-threatening condition. With timely recognition, subsequent treatment with BabyBIG, and supportive care, infants with infantile botulism can be expected to recover completely. This information is particularly important for neonatologists providing care for infants outside the neonatal period, especially during times of high patient census and resulting overflow of pediatric admissions in the NICU.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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That head lag is impressive! Infantile botulism in the NICU: a case report

Wardinger,

Darwish,

Amatya

2024

matern health, neonatol and perinatol

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“…Botulism is a rare and potentially fatal syndrome of diffuse flaccid paralysis caused by neurotoxins produced by some Clostridia species , most commonly Clostridium botulinum [ 1 ]. Clostridium botulinum is a spore-forming, obligate, anaerobic, gram-positive bacillus widely distributed in the environment [ 2 , 3 ]. Botulinum neurotoxins (BoNTs) are considered one of the most potent toxins known to target motor neurons; they act by blocking the cholinergic innervation of muscles in various tissues [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Clostridium botulinum is a spore-forming, obligate, anaerobic, gram-positive bacillus widely distributed in the environment [ 2 , 3 ]. Botulinum neurotoxins (BoNTs) are considered one of the most potent toxins known to target motor neurons; they act by blocking the cholinergic innervation of muscles in various tissues [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

A Challenging Case: Botulism in a Toddler

Castro,

Machado Morais,

Correia

et al. 2023

Cureus

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Botulism is a life-threatening, rapidly progressive neuroparalytic disease caused by one of the most potent toxins known, botulinum toxin. It manifests as flaccid and symmetrical descending paralysis that can affect both cranial and peripheral nerves. The only specific treatment available is the administration of botulinum antitoxin. We present the case of a three-year-old boy who had gastrointestinal symptoms and had ingested garden soil/dust at a construction site before the onset of cranial nerve palsy, which manifested as dysphagia in swallowing liquid and solid food and bilateral progressive ptosis. Early suspicion of botulism and treatment with botulinum antitoxin resulted in complete neurologic recovery. This case highlights the importance of a careful history and neurologic examination to avoid misdiagnosis. Administration of botulinum antitoxin should not be delayed until the diagnosis is confirmed and clinicians should be aware that this approach can be life-saving.

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Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal

Goh,

Siu,

Philteos

et al. 2024

The Laryngoscope

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ObjectiveEvaluate implementation of an institutional protocol to reduce the time to removal of esophageal button battery (BB) and increase use of mitigation strategies.MethodsWe developed a protocol for esophageal BB management [Zakai's Protocol (ZP)]. All cases of esophageal BB impaction managed at a tertiary care center before and after implementation from 2011 to 2023 were reviewed. Time to BB removal, adherence to critical steps, and use of mitigation strategies (honey/sucralfate, acetic acid) were evaluated.ResultsFifty‐one patients (38 pre‐ZP, 13 post‐ZP) were included. Median age was 2.3 years (IQR 1.3–3.4). After implementation, the time from arrival at the institution to arrival in the operating room (OR) reduced by 4.2 h [4.6 h (IQR 3.9–6.5) to 0.4 h (IQR 0.3–0.6), p < 0.001] and there was improvement in all management steps. The number of referrals direct to otolaryngology increased from 51% to 92%, arrival notification increased from 86% to 100%, avoidance of second x‐ray increased from 63% to 100%, and direct transfer to OR increased from 92% to 100%. Adherence to mitigation strategies such as preoperative administration of honey or sucralfate increased from 0% to 38%, intraoperative use of acetic acid from 3% to 77%, and nasogastric tube insertion from 53% to 92%.ConclusionImplementation of ZP substantially reduced the time to BB removal and the use of mitigation strategies in our tertiary care institution. Additional strategies focused on prevention of BB ingestion, and shortening the transfer time to the tertiary care hospital are required to prevent erosive complications.Level of EvidenceLevel 3 Case‐series Laryngoscope, 2024

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Infant Botulism, Israel, 2007–2021

Abstract: cases indicate a stronger link to soil transmission, possible seasonal variation, and a milder course of disease.

Cited by 14 publications

References 29 publications

That head lag is impressive! Infantile botulism in the NICU: a case report

That head lag is impressive! Infantile botulism in the NICU: a case report

A Challenging Case: Botulism in a Toddler

Pediatric Esophageal Button Battery Protocol Reduces Time From Presentation to Removal

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