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Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania
Insights
Infant botulism cases in Pennsylvania were primarily caused by Clostridium botulinum type B. Intestinal flora changes, particularly during weaning, may allow C. botulinum colonization, leading to illness.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Botulism is a rare but serious illness caused by toxins from Clostridium botulinum.
- Infant botulism is a distinct clinical syndrome characterized by descending muscle paralysis.
Purpose of the Study:
- To describe the clinical features, complications, and potential risk factors of infant botulism in Southeastern Pennsylvania.
- To investigate the association between intestinal flora and Clostridium botulinum colonization.
Main Methods:
- Retrospective review of 44 infant botulism cases from 1976 to 1983.
- Clinical data collection including symptoms, complications, and outcomes.
- Environmental and fecal flora sampling in a subset of patients.
Main Results:
- Clostridium botulinum type B caused 43 of 44 cases, requiring ventilatory support in 39 infants.
- Common complications included otitis media, aspiration pneumonia, and autonomic dysfunction.
- Clostridium botulinum was isolated from environmental samples; fecal flora showed a predominance of enterobacteriaceae.
Conclusions:
- Infant botulism in this cohort was predominantly type B, with significant morbidity requiring intensive care.
- Autonomic nervous system dysfunction was a notable feature.
- Alterations in infant intestinal flora, especially during weaning, may predispose to Clostridium botulinum colonization.
Abstract:
Forty-four cases of botulism occurred in infants in Southeastern Pennsylvania between 1976 and 1983. Forty-three were caused by Clostridium botulinum type B. Progressive weakness necessitated ventilatory support in 39 infants. Complications during hospitalization included otitis media in 13 patients and aspiration pneumonia in 11. Eight infants developed the syndrome of inappropriate secretion of antidiuretic hormone and two developed adult respiratory distress syndrome. One infant died of progressive bradycardia despite adequate control of ventilation. Manifestations of autonomic nervous system dysfunction recognized on admission to the hospital were constipation, distention of the urinary bladder, and decreased salivation and tearing. During hospitalization, some infants had unexpected fluctuations of skin color, blood pressure, and heart rate. Infants' strength improved despite persistent intestinal elaboration of toxin. C botulinum was isolated from seven of nine home or work environments sampled. All 44 infants were white and were receiving breast milk at the time of onset of symptoms. The majority had first feedings of nonhuman food substances within 4 weeks prior to onset of symptoms. Delineation of fecal flora in seven infants revealed predominance of enterobacteriaceae. Perturbations of intestinal flora during infancy, especially at weaning, may cause transient permissiveness to colonization by C botulinum.