A Case of Floppy Baby Syndrome

• Published in: The clinical advisor Vol. 21; no. 12; p. 50
• Main Authors: Hauff, Victoria Arasi, Stallings, Judith
• Format: Magazine Article
• Language: English
• Published: Hawthorne Haymarket Media, Inc 01.12.2018
• Subjects: Babies; Botulism; Constipation; Medical diagnosis; Metabolism; Organisms; Pediatrics; Physical therapy; United States > US
• ISSN: 1524-7317

DISCUSSION Infant botulism is a paralytic disease caused by ingestion of Clostridium botulinum, an organism found in soil that releases a neurotoxin after colonizing the gastrointestinal tract.1 In a global study by Koepke et al, the United States was found to have the highest number of infant botulism cases with a total of 2419 from 1976-2006, resulting in an incidence of 2.1 cases per 100,000 live births.2 Approximately 98% of cases of infant botulism occur in patients between 1 and 6 months of age.3 While foodborne botulism occurs after ingestion of toxin, infant botulism differs in that the organisms in the intestines are continually making toxin.3 As botulinum spores can be widely found in the environment, ingestion of the organisms may be a relatively common occurrence in humans; however, normal flora in intestines of adults are able to compete against the botulinum organisms. "6 The main risk factor that has been implicated in infant botulism is honey exposure in children younger than one year of age, as honey has been found to contain botulinum spores. [...]honey consumption among infants younger than one year of age is not recommended.1 Although this is the most well-known risk factor, 85% of patients with infant botulism have no known honey exposure. Honey consumption among infants has declined, yet the incidence of the disease has remained at approximately the same rate in the United States.3 Living in rural areas near construction sites is another risk factor for the disease, as microscopic spores can be ingested from dirt and dust from the environment.2,7 Additionally, constipation is a risk factor because "with fewer bowel movements per day, the gut flora may be disrupted, which could encourage spore growth and colonization. Apnea can occur, as well.1'8 There are several clinical mimics of infant botulism that all present as "floppy baby syndrome": spinal muscular atrophy, metabolic diseases like mitochondrial disease, Guillain-Barré syndrome, and other neurologic infections. [...]it is important to know the appropriate diagnostic studies to perform to lead to an accurate diagnosis.8 Botulinum toxin can be found in stool, gastric aspirate, vomit, and blood; however, these tests have a low sensitivity.