Infant botulism: a case report

Infant botulism is an uncommon neuromuscular condition that is the result of neurotoxins that block smooth muscle and skeletal function and autonomic function from colonization of intestinal Clostridium botulinum. The majority of those infected are often less than six months old who present with poor feeding, weight loss, constipation, and hypotonic. A 7-week-old male was brought to the Emergency Department (ED) for complaints of poor feeding. The mother stated that the baby had not been acting normally, had been feeding poorly, and had weight loss over a one-week period. On examination, the patient appeared to be lethargic and floppy. The initial workup included a complete blood count (CBC), complete metabolic panel (CMP), urinalysis, brain MRI, and lumbar puncture which all were within normal limits. Due to symptoms, BIG-IV therapy was initiated. A stool sample was obtained and was positive for Clostridium botulinum toxin A. The infant started to show improvement in feeding and muscle tone over the next several days and was discharged home on day ten. Frequently patients with infant botulism may not show all of these symptoms at once, which can make it difficult for providers to diagnose correctly. Although infant botulism does occur worldwide it has a higher prevalence in North American from ingestion of dust near activities that disrupts the soil such as agriculture or ingestion of raw honey. The treatment for infant botulism is an orphan drug, BIG-IV, which has significantly reduced the mortality and morbidity of this disease.