The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey

Abstract

Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.

Botulism in Spain: Epidemiology and Outcomes of Antitoxin Treatment, 1997–2019

“…The absence of infant botulism cases related to honey from 2010 may show the success of information campaigns carried out by local public health authorities and pediatricians [ 44 ]. However, we should note that honey was among the components of an enema that was the main suspected source of infection in a recent case in Spain (out of the study period), and in a previous case included in this paper, which resembles another possible case reported in Malaysia and published recently, in which the author considers the topical application of medical-grade honey on a wound as the most likely cause of infection [ 45 ]. In our series, the suspected food item most mentioned was herbal tea, even if C. botulinum was not detected in this food vehicle.…”