Botulism

What causes botulism?

A bacteria called Clostridium botulinum who produces toxin that block the release of neurological neurotransmitters and as a result, causes paralysis. The bacteria can produce spores (a cell that can survive in harsh environment for extended period of time). At the right time and conditions (for example, in small babies’ intestines), the spore can become active and create bacteria.

In addition to the type that harms children (infant botulism), there are several other types of botulism that are worth getting to know:

• Related to food which is dated.
• Related to the reproduction of the bacteria in skin lesions.
• Associated with the bacterium in adult intestines.
• Associated with injecting an overdose of the toxin as a medical treatment (used to treat a variety of medical conditions such as hyperhidrosis (excessive sweating) and muscle cramps), or for cosmetic (Botox for the remove of wrinkles).
• Related to biological warfare.

In this article I will focus on botulism of infants.

How is botulism caused in children?

In most cases by inhalation which leads to digestion of the spores and the growth of the bacteria in the intestine and the production of toxins that burst into the bloodstream. There is no person-to-person contamination.

Its presentation in infants can be rapid within hours or slow over the course of days.

What are the typical clinical symptoms in children with botulism?

In most cases an infant under the age of 6 months (usually up to the age of 12 months), initially will suffer from constipation and decreased mobility. Later, paralysis that starts in the face and spreads to the rest of the body – loss of mimicry, appearance of squint, decreased feeding, weak cry, loss of control of head mobility, weakness and general hypotonia. The baby is wide awake but has difficulty activating the muscles. The infection does not cause fever.

What is the origin of the bacterium in children?

Mostly from inhaling the bacteria spores that multiply in the digestive system. In most cases in children a clear source of the infection could not be found and the assumption is that the spores are carried in the air and are swollen by the child.
In some cases, spores have been found in baby food formula, in some cases in the home vacuum cleaner and in other cases the infection has been associated with the provision of honey to young babies.
That is the reason for the recommendation not to give honey to children under the age of 12 months.
Note that only a small number of cases have been linked to the consumption of honey whilst the majority of cases are most likely caused by inhalation of the spores.

How is botulism diagnosed in infants?

First of all, we should be aware that this is a rare medical condition. However, there might be mild cases that are misdiagnosed.

Once there is awareness and a suspicion arises, the diagnosis is made after having preformed several tests including a molecular test to detect DNA fragments of the bacteria or the toxin (usually in stools), followed by testing mice who have been injected with the toxin from the suspected sick child.

What is the treatment of botulism?

The treatment consists mainly of two components:
Supportive care – providing nutritional support and aspiration if necessary. Usually these infants will be admitted in the intensive care unit.
Antitoxin treatment – specific antibodies against the toxin.

The recovery can take a long time.

In summary, there is need for awareness for this rare medical condition among medical personal, especially pediatricians.
Parents should also have some level of awareness regarding this rare disease.
Honey should not be given to infants under the age of 12 months, even though most cases are not related to this risk factor.