We report a case of infant botulism admitted to the Children’s Hospital “Giovanni XXIII”, Bari, Italy. After a week of constipation, hypotonia, lethargy, ptosis, reduction of suction and cry, a 2-month-old infant male, the first kid of unrelated parents was taken to the closest hospital, after being born normotrophic, at term, without a prenatal, perinatal, or postnatal medical history or neurodevelopmental delay. The patient was referred to the pediatric center for an undiagnosed progressive worsening of awareness and he was intubated for bradypnea and desaturation. The toxicologic panel, cerebrospinal fluid exam, radiological imaging, and laboratory results were negative. Only after neurological instrumental analysis, we found a normal EEG but a positive EMG that is associated with the history of raw honey intake (revealed only later by his mother). We were allowed to define the hypothesis of infant botulism earlier than the confirmation of the standard mouse bioassay. So, as a result, Botulism Immune Globulin-Intravenous IgG over 3 hours in a single recommended dose of 0.1 mL/kg/min was injected. The infant showed a gradual improvement and after 10 days he was extubated. The Preterm Oral Feeding Readiness Scale showed an improvement through the rehabilitation program with physiotherapy and parents’ stimuli. After one month he was discharged. Frequently, infant botulism is not the first hypothesis but it is the result of a strict differentiation from other diseases characterized by hypotonia such as sepsis, infectious, genetic, autoimmune, or metabolic diseases through the use of history, and laboratory tests and radiological imaging. At first, toxin detection can be useful for early diagnosis. In the later stages, the neurological instrumental support can help the clinician to elucidate the cause of muscle weakness. In fact, the EEG and the EMG could be positive when toxins are unlikely to be detectable in the serum and other data are negative. A minimum of one arm and one leg should be examined for motor and sensory nerve conduction velocity along with two distal muscles for 2-Hz nerve stimulation and a needle EMG with an adequate sample. We suggest that the neurological instrumental support can help the clinician to elucidate the cause of muscle weakness, in particular in the later stages. Honey shouldn’t be provided to infants under one-year-old children because the majority of instances still have a good history of exposure to it.
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Jul 31, 2024
Seham Mousa + 3
Open Access
