The clinical spectrum of infant botulism

Infant botulism is the systemic illness that results when spores of Clostridium botulinum germinate in the infant's intestine and then produce botulinal toxin in vivo. As with other infectious diseases, infant botulism has a spectrum of clinical severity that ranges from a mild, outpatient illness to fulminant, sudden death. Most cases reported to date have been recognized in infants so weak and hypotonic that their need for hospital care was unquestioned; yet even this group of patients displayed a wide range in severity of illness. The outpatients were initially considered to be cases of "failure to thrive," while the fulminant cases were indistinguishable at autopsy from typical instances of the sudden infant death syndrome (SIDS, crib death). This article discusses the observed spectrum of clinical severity, the management of the hospitalized patient, and the manner in which sudden death might result from production of butulinal toxin in the intestine.