[Food-born botulism in children in Morocco: report of 5 cases]

Botulism is a rare but serious disease; it affects both the peripheral nervous system, causing diffuse paralysis, and the autonomous nervous system, inducing vegetative disturbances which worsen the vital prognosis. In Morocco, botulism is exceptional, except some sporadic cases. The authors present a series of food-born botulism in 5 infants, out of 45 cases of strong suspicion of botulism during an epidemic in Morocco in August 1999. They analyze epidemiological, clinical, neurophysiological, toxicological and evolutionary aspects. Within the 15 cases included in the protocol, 5 were infants, aged 3 to 12 years. The clinical presentation was complete and severe in 1 case (peripheral motor deficit in 4 limbs, vegetative disturbances), complete and of mild severity in 3, and benign in the last case. Electrophysiological investigation found a constant incrementation at high frequency. Botulinum neurotoxin was found in 3 cases. Evolution was favourable in 3 cases, with total recovery; but severe in the others, with motor sequelae in 1 case and 1 death in the other. This work underlines the severity of botulism, the limits of serology, which constitutes currently the only available tool for confirmation, but it is negative in half of all cases. They also point out the diagnostic value of neurophysiology, especially high frequency incrementation, which may be a diagnostic alternative, especially in cases of negative serology.