Abstract P-506: INFANTILE BOTULISM IN SINGAPORE

Abstract

Aims & Objectives: Infantile botulism is rare worldwide. We present the first case in Singapore. Methods A 9 month old developmentally normal and appropriately immunized boy was admitted to our hospital with a 3 day history of severe lethargy, poor suck and constipation. He was unable to sit without support or lift his head. Examination revealed generalized hypotonia, marked head lag, ptosis and drooling. There was symmetrical hypo-reflexia of all four limbs with minimal anti-gravity movements. He developed respiratory insufficiency from neuromuscular weakness on day 2 of hospitalisation. The following tests did not reveal a diagnosis; neuroimaging of brain, cerebrospinal fluid studies, electrolytes, thyroid function, muscle enzymes, metabolic and toxicology work up and antibody studies for myasthenia gravis. Stool studies were later confirmed positive for botulinum toxin A. He required non invasive ventilation, meticulous nursing care and chest physiotherapy in the intensive care unit. 50mg/kg of Botulinism Immune Globulin (BabyBIG®) procured from the Infant Botulism Treatment and Prevention Program California Department of Public Health was administered on day 16 of hospitalisation. Results Infantile botulism occurs when ingested spores of Clostridium botulinum germinate in the infant’s colon and release neurotoxins that prevent the release of acetylcholine at the synaptic cleft of motor neurons resulting in paralysis. Treatment is supportive but BabyBIG®, a human derived immunoglobulin against botulinum toxin has been shown to reduce length of hospital stay. Conclusions Botulism should be considered in any infant presenting with acute symmetrical flaccid paralysis and treated promptly with BabyBIG®.