Infant Botulism

What is infant botulism?

Infant botulism is caused by consuming the spores of the bacterium Clostridium botulinum, which then grow in the intestines and release nerve toxin. It predominantly affects infants (children under 1 year of age), although it may affect adults who have an altered gastrointestinal environment, either through surgery or antibiotic therapy.

What are the symptoms of infant botulism?

The initial symptoms of infant botulism are constipation, poor feeding, listlessness and lethargy. The weakness is symmetric, and may progress over a period of 1 to 4 days, although sometimes symptoms progress in a matter of hours. There is no fever, unless a secondary infection is present. There is a wide spectrum of severity of symptoms, ranging from mild illness to "floppy baby syndrome" and possible death.

How soon do symptoms appear?

The time period between ingesting the spores and beginning of symptoms is unknown. Symptoms may arise abruptly, in a matter of hours, or they may develop over several days. The progressive weakness usually develops over 1 to 4 days and is often severe enough to bring the baby to medical attention.

Who gets infant botulism?

All reported cases of infant botulism have occurred in children younger than 1 year of age; 95% of affected children are less than 6 months old. Older persons who have an altered gastrointestinal environment may be susceptible to infant-type botulism.

How is infant botulism spread?

Infant botulism is not contagious. No person-to-person transmission has been documented. In order to contract infant botulism, a baby must eat the bacterial spores that then multiply and produce toxin in the digestive tract.

What is the treatment for infant botulism?

Infant botulism can be treated with botulism immune globulin (BIG), which should be started as early in the illness as possible. Intensive supportive care in a hospital is essential. Some infants may require a breathing machine if their respiratory muscles are paralyzed. Antibiotics should not be used to treat infant botulism unless a secondary infection exists.

What happens if infant botulism is not treated?

Infant botulism may result in death due to respiratory failure. Infants with botulism must be monitored closely in the hospital.

How can infant botulism be prevented?

C. botulinum spores are ubiquitous. Identified sources, such as honey, should not be fed to infants younger than 12 months old. Honey is safe for people 1 year of age and older, however.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.