Dry and dusty outback: infant botulism

Infant botulism is a rare but life-threatening neuroparalytic syndrome caused by intestinal colonisation of Clostridium botulinum resulting in a symmetrical descending flaccid paralysis. This gram-positive, rod-shaped anaerobic bacillus is universally found in soil with previous links to ingestion of honey and dust contaminated with C. botulinum spores. We present a case of a baby boy with this rare condition eventually linked to dust on a rural outback property. This young patient was ventilated for 90 days. Initial serology for botulism toxin was negative, although C. botulinum spores were eventually grown in the stool. The patient did not receive early treatment with Human Botulism Immune Globulin Intravenous (BIG-IV) as there was a low index of suspicion and a delay in obtaining a stool sample for nearly 6 weeks due to constipation. This case highlights the importance of early treatment with BIG-IV when clinical features and environmental conditions in the remote Australian outback favour persistence of C. botulinum spores in soil without awaiting confirmatory tests.