Question

You are an EMT and are called to the home of an 11 week old infant boy who has become listless and is having trouble breathing. The parents state that the infant has not been smiling lately, nor has he had other noticeable facial expressions in the last couple of days. The baby's eyes are open when you arrive but he does not seem to be able to focus. You place your outstretched finger under his fingers and he is not able to grasp it. You lift his foot and it falls back down onto the mattress. The parents also state that he has not had a bowel movement in the past 3 days.

1. What is your suspicion, based on what seem to be nervous system symptoms?

2. If your suspicion is correct, should you start treatment here or should he be trasnported to the hospital?

3. What should be administered to the baby at the earliest opportunity?

4. How do babies acquire this condition?

5. Is this same condition seen in adults? If so, explain any similiarities or differences in the symptoms.

Answer 1

1. I suspect to be an infant botulism which has occured in this baby.

Infant botulism is the infectious (intestinal) form of botulism, which results when swallowed spores of a particular bacterium (Clostridium botulinum) colonize the baby's large intestine and produce botulinum toxin in it. Botulinum toxin causes weakness and loss of muscle tone because it blocks the nerve ending's ability to signal the linked muscle to contract. The illness often begins with constipation but is usually first noticed as difficulty feeding (sucking and swallowing), a weak and altered cry and diminished facial expression.
In this baby, nervous system symptoms were trouble in breathing, muscle weakness, lack in eye focus, lack of bowel movement, flat facial expression.

2. The baby need to be cared for in a hospital for days or weeks. Close attention is paid to proper nutrition and pulmonary aid. Approximately one in four infants affected requires mechanical ventilation. Neither antibiotics nor antitoxin are usually administered. A complete recovery is made in nearly every case.

3. Infant botulism is treated in the hospital, usually in the intensive care unit (ICU), where doctors will try to limit the problems the toxin causes in the baby's body. The toxin can affect the breathing muscles, so doctors may put the infant on a ventilator. Because the toxin can affect the swallowing muscles, they may give the baby intravenous (IV) fluids or feedings through a tube to provide nourishment.

An antitoxin is now available for the treatment of infant botulism, called botulism immune globulin intravenous (BIGIV), which should be given as soon as possible. Babies with botulism who have received BIGIV recover sooner and spend less time in the hospital.

With early diagnosis and proper medical care, a baby should fully recover from the illness.

4. Infant botulism is caused by the food poisoning bacterium Clostridium botulinum. This is the same bacterium that causes the food poisoning known as "botulism". Spores of these bacteria are ingested by the infant, grow and produce a neurotoxin (i.e. poison) in the infant's intestine.

Spores of C. botulinum may be easily ingested as they are common in soil and dust. This may lead to botulism in children younger than one year. Many infants who develop infant botulism have been fed honey, the only identified food source of C. botulinum spores causing infant botulism.

5. Yes, its the same condition seen in adults.

Botulism is a rare but serious condition caused by toxins from bacteria called Clostridium botulinum.

Three common forms of botulism are:

Foodborne botulism:

The harmful bacteria thrive and produce the toxin in environments with little oxygen, such as in home-canned food. Signs and symptoms of foodborne botulism include:

Difficulty swallowing or speaking
Dry mouth
Facial weakness on both sides of the face
Blurred or double vision
Drooping eyelids
Trouble breathing
Nausea, vomiting and abdominal cramps
Paralysis

Wound botulism:

If these bacteria get into a cut, they can cause a dangerous infection that produces the toxin. Signs and symptoms of wound botulism appear about 10 days after the toxin has entered the body. Wound botulism signs and symptoms include:

Difficulty swallowing or speaking
Facial weakness on both sides of the face
Blurred or double vision
Drooping eyelids
Trouble breathing
Paralysis

Infant botulism:

This most common form of botulism begins after Clostridium botulinum bacterial spores grow in a baby's intestinal tract. It typically occurs in babies between the ages of 2 months and 8 months.

All types of botulism can be fatal and are considered medical emergencies.