Infantile Botulism: A Case Report and Review



      Infantile botulism is the result of ingestion of Clostridium botulinum spores, and is the most common form of infection with botulism in the United States. Ninety percent of cases occur in infants <6 months old. The infants typically present with vague symptoms such as hypotonia and poor feeding. This article reports an infant with confirmed infantile botulism that presented to the Emergency Department (ED) with complaints of decreased feeding and absence of bowel movements for >1 week.


      Review a case of infantile botulism, its diagnosis, and treatment.

      Case Report

      A 4-month-old healthy Caucasian male presented to the ED with a 6-day history of decreased feeding after referral from the pediatrician. He had not had a bowel movement for 9 days, and his parents were also concerned about increasing weakness, as he was no longer able to hold his head up on his own. In the ED, he was minimally interactive. His vital signs were within normal limits, and he had hypoactive bowel sounds and decreased tone throughout. He was admitted to the Children's Hospital and eventually transferred to the Pediatric Intensive Care Unit requiring intubation and mechanical ventilation. The botulism immunoglobulin was administered, and a diagnosis was confirmed with positive botulinum toxin in the stool samples. Full recovery was made by the infant.


      Awareness of the symptoms of botulism and a high degree of clinical suspicion is needed to make a prompt diagnosis.


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        • Cox N.
        • Hinkle R.
        Infant botulism.
        Am Fam Physician. 2002; 65: 1388-1392
        • Arnon S.S.
        Creation and development of the public service orphan drug human botulism immune globulin.
        Pediatrics. 2007; 119: 785-789
        • Thompson J.A.
        • Filloux F.M.
        • Van Orman C.B.
        • Swoboda K.
        Infant botulism in the age of botulism immune globulin.
        Neurology. 2005; 64: 2029-2032
        • Clemmens M.R.
        • Bell L.
        Infant botulism presenting with poor feeding and lethargy.
        Pediatr Emerg Care. 2007; 23: 492-494
        • Francisco A.M.O.
        • Arnon S.S.
        Clinical mimics of infant botulism.
        Pediatrics. 2007; 119: 826-828
        • Long S.S.
        Infant botulism and treatment with BIG-IV (BabyBIG).
        Pediatr Infect Dis J. 2007; 26: 261-262