Neonatal Botulism: A Case Series Suggesting Varied Presentations

Horvat, David; Eye, Philip; Whitehead, Matthew T.; Bharucha‐Goebel, Diana; Roth, E.; Anwar, Tayyba; Tsuchida, Tammy N.; Kousa, Youssef A.

doi:10.1016/j.pediatrneurol.2023.06.004

Cited by 2 publications

(9 citation statements)

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“…The presentation of IB may be confounded by non-specific symptoms such as lethargy and hypothermia [ 3 ], which can be suggestive of a serious bacterial infection, as was the case in our patient. Our initial diagnosis was encephalitis/meningitis, in addition to REV bronchiolitis and superimposed pneumonia.…”

Section: Discussionmentioning

confidence: 83%

“…IB typically affects children under 12 months of age and was first recognized in 1976 [ 2 ]. IB is the most common form of botulism in the United States, with approximately 70–100 cases occurring annually [ 2 , 3 ], representing about 70% of reported botulism cases per year [ 3 ]. Most cases affect infants under 6 months of age, with a median age of presentation of 3–6 months [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Within the United States, subtypes A and B are responsible for IB, with most cases on the West Coast, specifically in California, occurring secondary to subtype A, and on the Northeast Coast, specifically in the Pennsylvania-New Jersey-Delaware area, occurring secondary to subtype B [ 2 , 6 ]. Infants at the highest risk for contracting botulism seem to live in rural or farm environments, likely due to increased exposure to dust particles [ 2 , 3 ]. Additionally, exposure to soil or dust from active construction sites also appears to increase the risk of contracting botulism [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Infants at the highest risk for contracting botulism seem to live in rural or farm environments, likely due to increased exposure to dust particles [ 2 , 3 ]. Additionally, exposure to soil or dust from active construction sites also appears to increase the risk of contracting botulism [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…IB is commonly described as the ‘floppy baby’ syndrome in medical literature. However, botulism is not a diagnosis that would typically be on a neonatologists differential as it is a disease usually managed in the pediatric intensive care unit (PICU) or on the pediatric in-patient unit, and therefore has the potential to be misdiagnosed, or even missed if it were to present in the neonatal intensive care unit (NICU) [ 3 ]. Herein, we present an interesting case of an infant admitted to our NICU from an outside hospital to rule out sepsis and was found to have IB.…”

Section: Introductionmentioning

confidence: 99%

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That head lag is impressive! Infantile botulism in the NICU: a case report

Wardinger,

Darwish,

Amatya

2024

matern health, neonatol and perinatol

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Background Infantile botulism (IB) is a devastating and potentially life-threatening neuromuscular disorder resulting from intestinal colonization by Clostridium botulinum and the resultant toxin production. It can present with constipation, descending paralysis, and, potentially, respiratory failure. Botulism is a diagnosis that is more commonly seen in the pediatric intensive care unit (PICU) or on the general pediatric wards and would not typically be managed in the neonatal intensive care unit (NICU), and therefore requires high clinical suspicion to ensure prompt diagnosis and treatment. Case presentation We discuss a case where an infant from central Pennsylvania presented to a Level IV NICU rather than to the PICU for an evaluation for sepsis and was uniquely diagnosed with IB. The infant presented with poor oral feeding and reduced oral intake, hypothermia, and lethargy. His symptoms progressed into hypoxia and acute respiratory failure. Interestingly, this infant had no known exposure to honey or any other identifiable sources of botulism contact. The infant’s twin brother and the other infants who attended the mother’s in-home daycare remained asymptomatic. This infant was initially evaluated and managed for a potential infectious etiology. However, a diagnosis of IB was suspected, and was later confirmed through the detection of botulinum toxin in the infant’s stools. A high level of suspicion allowed for timely treatment with Botulism Immune Globulin neutralizing antibodies (BabyBIG), even prior to confirmatory testing. We describe the process of obtaining BabyBIG, as well as the natural course of illness after treatment in our patient who ultimately made a complete recovery. Conclusions This case highlights the importance of considering infantile botulism as a diagnostic possibility even in the absence of risk factors, and the need for vigilance in diagnosing and treating this rare but potentially life-threatening condition. With timely recognition, subsequent treatment with BabyBIG, and supportive care, infants with infantile botulism can be expected to recover completely. This information is particularly important for neonatologists providing care for infants outside the neonatal period, especially during times of high patient census and resulting overflow of pediatric admissions in the NICU.

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Section: Discussionmentioning

confidence: 83%