Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • State of the Art
  • Published:

State-of-the-Art

Infant botulism

Journal of Perinatology volume 27, pages 175–180 (2007)Cite this article

Abstract

Infant botulism results from the absorption of heat-labile neurotoxin produced in situ by ingested Clostridium botulinum. Honey and environmental exposure are the main sources of acquisition of the organism. Clinical manifestations are owing to progressive neuromuscular blockade, initially of muscles innervated by cranial nerves and later of the trunk, extremities and diaphragm. Presynaptic autonomic nerves are also affected. The diagnosis is made on clinical grounds and is confirmed by recovery of the organism or by detection of toxin in the stool. Management includes meticulous supportive intensive care that may include mechanical ventilation and administration of human botulinum immunoglobulin in severe cases.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Long SS . Infant botulism. Pediatr Infect Dis J 2001; 20: 707–709.

    Article  CAS  Google Scholar 

  2. Horowitz BZ . Botulinum toxin. Crit Care Clin 2005; 21: 825–839.

    Article  CAS  Google Scholar 

  3. Goonetilleke A, Harris JB . Clostridial neurotoxins. J Neurol Neurosurg Psychiatry 2004; 75: iii35–iii39.

    Article  Google Scholar 

  4. Juzans P, Comella JX, Molgo J, Faille L, Angaut-Petit D . Nerve terminal sprouting in botulinum type-A treated mouse levator auris longus muscle. Neuromuscul Disord 1996; 6: 177–185.

    Article  CAS  Google Scholar 

  5. Pellizzari R, Rossetto O, Schiavo G, Montecucco C . Tetanus and botulinum neurotoxins: mechanism of action and therapeutic uses. Philos Trans R Soc London B Biol Sci 1999; 354: 259–268.

    Article  CAS  Google Scholar 

  6. Jajosky RA, Hall PA, Adams DA, Dawkins FJ, Sharp P, Anderson WJ et al. Summary of notifiable diseases – United States, 2004. MMWR Morb Mortal Wkly Rep 2006; 16: 1–79.

    Google Scholar 

  7. Shapiro R, Hatheway CL, Swerdlow D . Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med 1998; 129: 221–228.

    Article  CAS  Google Scholar 

  8. Sobel J . Botulism. Clin Infect Dis 2005; 15: 1167–1173.

    Article  Google Scholar 

  9. Aureli P, Fenicia L, Pasolini B, Gianfranceschi M, McCroskey LM, Hatheway CL . Two cases of type E infant botulism in Italy caused by neurotoxigenia Clostridium butyricum. J Infect Dis 1986; 54: 207–211.

    Article  Google Scholar 

  10. Suen JC, Hatheway CL, Steigerwalt AG, Brenner DJ . Genetic confirmation of identities of neurotoxigenic Clostridium barati and Clostridium butyricum implicated as agents of infant botulism. J Clin Microbiol 1988; 26: 2191–2192.

    CAS  PubMed  PubMed Central  Google Scholar 

  11. Hall JD, McCloskey LM, Pincomb BJ, Hatheway CL . Isolation of an organism resembling Clostridium barati which produces type F botulinal toxin from an infant with botulism. J Clin Microbiol 1985; 21: 654–655.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Paisley JW, Lauer BA, Arnon SS . A second case of infant botulism type F caused by Clostridium baratii. Pediatr Infect Dis J 1995; 14: 912–914.

    Article  CAS  Google Scholar 

  13. Smith LD . The occurrence of Clostridium botulinum and Clostridium tetani in the soil of the United States. Health Lab Sci 1978; 15: 74–80.

    CAS  PubMed  Google Scholar 

  14. Centers for Disease Control and Prevention. Type B botulism associated with roasted eggplant in Oil – Italy, 1993. MMWR Morb Mortal Wkly Rep 1995; 44: 33–36.

  15. Long SS, Gajewski JL, Brown LW, Gilligan PH . Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania. Pediatrics 1985; 75: 935–941.

    CAS  PubMed  Google Scholar 

  16. Istre GR, Compton R, Novotny T, Young JE, Hatheway CL, Hopkins RS . Infant botulism: three cases in a small town. Am J Dis Child 1986; 140: 1013–1014.

    Article  CAS  Google Scholar 

  17. Schiavo G, Rossetto O, Tonello F, Montecucco C . Intracellular targets and metalloprotease activity of tetanus and botulism neurotoxins. Curr Top Microbiol Immunol 1995; 195: 257–274.

    CAS  PubMed  Google Scholar 

  18. Arnon SS, Damus K, Thompson B, Midura TF, Chin J . Protective role of human milk against sudden death from infant botulism. J Pediatr 1982; 100: 568–573.

    Article  CAS  Google Scholar 

  19. Spika JS, Shafer N, Hargrett-Bean N, Collin S, MacDonald KL, Blake PA . Risk factors for infant botulism in the United States. Am J Dis Child 1989; 143: 828–832.

    CAS  Google Scholar 

  20. Stark PH, Lee A . The microbial ecology of the large bowel of breast-fed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15: 189–203.

    Article  CAS  Google Scholar 

  21. Thompson JA, Glasgow LA, Warpinski JR, Olson C . Infant botulism: clinical spectrum and epidemiology. Pediatrics 1980; 66: 936–942.

    CAS  PubMed  Google Scholar 

  22. Long SS . Epidemiologic study of infant botulism in Pennsylvania: report of the infant botulism study group. J Pediatr 1985; 75: 928–934.

    CAS  Google Scholar 

  23. Morris Jr JG, Snyder JD, Wilson R, Feldman RA . Infant botulism in the United States: an epidemiologic study of cases occurring outside of California. Am J Public Health 1983; 73: 1385–1388.

    Article  Google Scholar 

  24. Hentges DJ . The intestinal flora and infant botulism. Rev Infect Dis 1979; 1: 668–673.

    Article  CAS  Google Scholar 

  25. Johnson RO, Clay SA, Arnon SS . Diagnosis and management of infant botulism. Am J Dis Child 1979; 133: 586–593.

    CAS  PubMed  Google Scholar 

  26. Arnon SS . Infant botulism: anticipating the second decade. J Infect Dis 1986; 154: 201–206.

    Article  CAS  Google Scholar 

  27. Chin J, Arnon SS, Midura TF . Food and environmental aspects of infant botulism in California. Rev Infect Dis 1979; 1: 693–697.

    Article  CAS  Google Scholar 

  28. Arnon SS, Midura TF Damus K, Wood RM, Chin J . Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome. Lancet 1978; 1: 1273–1277.

    Article  CAS  Google Scholar 

  29. Long SS . Botulism in infancy. Pediatr Infect Dis 1984; 3: 266–271.

    Article  CAS  Google Scholar 

  30. Gunn RA, Dowell Jr VR, Hatheway CL . Infant Botulism: Clinical and Laboratory Aspects. Center for Disease Control: Atlanta, 1978.

    Google Scholar 

  31. Woodruff BA, Griffin PM, McCroskey LM, Smart JF, Wainwright RB, Bryant RG et al. Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975–1988. J Infect Dis 1992; 166: 1281–1286.

    Article  CAS  Google Scholar 

  32. Hurst DL, Marsh WW . Early severe infantile botulism. J Pediatr 1993; 122: 909–911.

    Article  CAS  Google Scholar 

  33. L'Hommedieu C, Polin RA . Progression of clinical signs in severe infant botulism. J Pediatr 1981; 20: 90–95.

    CAS  Google Scholar 

  34. L'Hommedieu CS, Stough R, Brown L, Kettrick R, Polin R . Potentiation of neuromuscular weakness in infant botulism with aminoglycosides. J Pediatr 1979; 95: 1065–1070.

    Article  CAS  Google Scholar 

  35. Paton WDM, Waud DR . The margin of safety of neuromuscular transmission. J Physiol 1967; 191: 59–90.

    Article  CAS  Google Scholar 

  36. Arnon SS, Midura TF, Clay SA, Wood RM, Chin J . Infant botulism. Epidemiological, clinical, and laboratory aspects. JAMA 1977; 237: 1946–1951.

    Article  CAS  Google Scholar 

  37. Tanzi MG, Gabay MP . Association between honey consumption and infant botulism. Pharmacotherapy 2002; 22: 1479–1483.

    Article  Google Scholar 

  38. Arnon SS, Midura TF, Damus K, Wood RM, Chin J . Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome. Lancet 1978; 1: 1273–1277.

    Article  CAS  Google Scholar 

  39. Takahashi M, Noda H, Takeshita S et al. Attempts to quantify Clostridium botulinum type A toxin and antitoxin in serum of two cases of infant botulism in Japan. Jpn J Med Sci Biol 1990; 43: 233–237.

    Article  CAS  Google Scholar 

  40. Lindstrom M, Korkeala H . Laboratory diagnostics of botulism. Clin Microbiol Rev 2006; 19: 298–314.

    Article  CAS  Google Scholar 

  41. Brown LW . Differential diagnosis of infant botulism. Rev Infect Dis 1979; 1: 625–629.

    Article  CAS  Google Scholar 

  42. Clay SA, Ramseyer JC, Fishman LS, Sedgwick RP . Acute infantile motor unit disorder: infantile botulism? Arch Neurol 1977; 34: 236–243.

    Article  CAS  Google Scholar 

  43. Jones Jr HR, Darras BT . Acute care pediatric electromyography. Muscle Nerve Suppl 2000; 9: S53–62.

    Article  Google Scholar 

  44. Graf WD, Hays RM, Astley SJ, Mendelman PA . Electrodiagnosis reliability in diagnosis of infant botulism. J Pediatr 1992; 120: 747–749.

    Article  CAS  Google Scholar 

  45. Gutmann L, Bodensteiner J, Gutierrez A . Electrodiagnosis of botulism. J Pediatr (Letter) 1992; 121: 835.

    Article  CAS  Google Scholar 

  46. Santos JI, Swensen P, Glasgow LA . Potentiation of Clostridium botulinum toxin by aminoglycoside antibiotics: clinical and laboratory observations. Pediatrics 1981; 68: 50–54.

    CAS  PubMed  Google Scholar 

  47. Cherington M, Ryan DW . Treatment of botulism with guanidine: early neurophysiologic studies. N Engl J Med 1970; 282: 195–197.

    Article  CAS  Google Scholar 

  48. Centers for Disease Control and Prevention (CDC). Infant botulism – New York City, 2001–2002. MMWR Morb Mortal Wkly Rep 2003; 52: 21–24.

  49. Pickering LK (ed). Red Book. 27th edn American Academy of Pediatrics: Illinois, 2006.

    Google Scholar 

  50. Arnon SS, Midura TF, Damus K, Thompson B, Wood RM, Chin J . Honey and other environmental risk factors for infant botulism. J Pediatr 1979; 94: 331–336.

    Article  CAS  Google Scholar 

  51. Byard RW, Moore L, Bourne AJ, Lawrence AJ, Goldwater PN . Clostridium botulinum and sudden infant death syndrome: a 10 year prospective study. J Pediatr Child Health 1992; 28: 156–157.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA

    I Brook

Authors
  1. I Brook
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I Brook.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Brook, I. Infant botulism. J Perinatol 27, 175–180 (2007). https://doi.org/10.1038/sj.jp.7211651

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211651

Keywords

This article is cited by

Search

Advanced search

Quick links