Global Occurrence of Infant Botulism, 1976–2006

Abstract

Most countries have not yet reported cases of infant botulism. This limited reporting of the disease to date contrasts with the known global occurrence of Clostridium botulinum spores in soils and dust and suggests that infant botulism may be under-recognized, underreported, or both. When bulbar palsies, hypotonia, and weakness are present, physicians should consider the possibility of infant botulism even if the patient has not been fed honey. Publication of additional case reports and surveillance summaries will enhance understanding of the occurrence and extent of this under-recognized disease.

Infant Botulism: Is There an Association With Thiamine Deficiency?

“…C botulinum consists of 4 groups (I-IV), which sufficiently differ by phylogenetic analysis and in their biochemical properties to be considered as 4 different species. 21 C botulinum group I strains include all 7 subtypes of serotype A (A1-A7), all but 1 subtype of serotype B (B1-B3, B5-B7), most subtypes of serotype F (F1-F5), and serotype H, whereas C botulinum group II strains include only subtype B4 of serotype B, most subtypes of serotype E (E1-E3, E6-E7), and subtype F6 of serotype F. 9,11 In the randomized BIG-IV study by Arnon et al, 13 botulinum toxin type A was found in 60% and type B in 39% of the study patients. However, from the data published, it is not clear how many cases of infant botulism are caused by C botulinum group I and group II strains.…”

“…Although subtype B4 is frequently found in food-borne botulism cases in Europe, to our knowledge no case of infant botulism by this subtype has been reported. 9,11,13,23 Thus, it is likely that almost all cases caused by serotype A and serotype B in Europe originate from C botulinum group I strains. This conclusion encourages us to suggest thiamine supplementation as a potentially beneficial factor in infant botulism because all C botulinum group I strains can produce thiaminases.…”

“…10 Often, however, there is no history of honey ingestion and other relevant sources have to be explored (eg, household dust, infant formula). 11 Typical symptoms of infant botulism are constipation, dysphagia, external ophthalmoplegia, and ptosis. Sucking reflex, pupil reaction, and facial expression are diminished or lacking and finally flaccid muscle paralysis leads to respiratory failure.…”

Infant botulism in Costa Rica: first report from Central America

“…Worldwide epidemiology of IB was described recently [5]. In that report, 524 IB cases from 25 countries in Asia, Australia, Europe, North America, and South America were found.…”

“…Honey consumption as a risk factor for IB has been reported in as much as 60% of cases in Europe and outside the United States; however, an important percentage has not been associated with honey consumption. Microscopic dust is another source of spore ingestion [4,5]. Intravenous Botulism Immune Globulin (BIG-IV) has been shown to be a safe and effective treatment.…”