Infant botulism results from the absorption of heat-labile neurotoxin produced in situ by ingested Clostridium botulinum. Honey and environmental exposure are the main sources of acquisition of the organism. Clinical manifestations are owing to progressive neuromuscular blockade, initially of muscles innervated by cranial nerves and later of the trunk, extremities and diaphragm. Presynaptic autonomic nerves are also affected. The diagnosis is made on clinical grounds and is confirmed by recovery of the organism or by detection of toxin in the stool. Management includes meticulous supportive intensive care that may include mechanical ventilation and administration of human botulinum immunoglobulin in severe cases.
This is a preview of subscription content, access via your institution
Subscribe to Journal
Get full journal access for 1 year
only $9.92 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Tax calculation will be finalised during checkout.
Get time limited or full article access on ReadCube.
All prices are NET prices.
Long SS . Infant botulism. Pediatr Infect Dis J 2001; 20: 707–709.
Horowitz BZ . Botulinum toxin. Crit Care Clin 2005; 21: 825–839.
Goonetilleke A, Harris JB . Clostridial neurotoxins. J Neurol Neurosurg Psychiatry 2004; 75: iii35–iii39.
Juzans P, Comella JX, Molgo J, Faille L, Angaut-Petit D . Nerve terminal sprouting in botulinum type-A treated mouse levator auris longus muscle. Neuromuscul Disord 1996; 6: 177–185.
Pellizzari R, Rossetto O, Schiavo G, Montecucco C . Tetanus and botulinum neurotoxins: mechanism of action and therapeutic uses. Philos Trans R Soc London B Biol Sci 1999; 354: 259–268.
Jajosky RA, Hall PA, Adams DA, Dawkins FJ, Sharp P, Anderson WJ et al. Summary of notifiable diseases – United States, 2004. MMWR Morb Mortal Wkly Rep 2006; 16: 1–79.
Shapiro R, Hatheway CL, Swerdlow D . Botulism in the United States: a clinical and epidemiologic review. Ann Intern Med 1998; 129: 221–228.
Sobel J . Botulism. Clin Infect Dis 2005; 15: 1167–1173.
Aureli P, Fenicia L, Pasolini B, Gianfranceschi M, McCroskey LM, Hatheway CL . Two cases of type E infant botulism in Italy caused by neurotoxigenia Clostridium butyricum. J Infect Dis 1986; 54: 207–211.
Suen JC, Hatheway CL, Steigerwalt AG, Brenner DJ . Genetic confirmation of identities of neurotoxigenic Clostridium barati and Clostridium butyricum implicated as agents of infant botulism. J Clin Microbiol 1988; 26: 2191–2192.
Hall JD, McCloskey LM, Pincomb BJ, Hatheway CL . Isolation of an organism resembling Clostridium barati which produces type F botulinal toxin from an infant with botulism. J Clin Microbiol 1985; 21: 654–655.
Paisley JW, Lauer BA, Arnon SS . A second case of infant botulism type F caused by Clostridium baratii. Pediatr Infect Dis J 1995; 14: 912–914.
Smith LD . The occurrence of Clostridium botulinum and Clostridium tetani in the soil of the United States. Health Lab Sci 1978; 15: 74–80.
Centers for Disease Control and Prevention. Type B botulism associated with roasted eggplant in Oil – Italy, 1993. MMWR Morb Mortal Wkly Rep 1995; 44: 33–36.
Long SS, Gajewski JL, Brown LW, Gilligan PH . Clinical, laboratory, and environmental features of infant botulism in Southeastern Pennsylvania. Pediatrics 1985; 75: 935–941.
Istre GR, Compton R, Novotny T, Young JE, Hatheway CL, Hopkins RS . Infant botulism: three cases in a small town. Am J Dis Child 1986; 140: 1013–1014.
Schiavo G, Rossetto O, Tonello F, Montecucco C . Intracellular targets and metalloprotease activity of tetanus and botulism neurotoxins. Curr Top Microbiol Immunol 1995; 195: 257–274.
Arnon SS, Damus K, Thompson B, Midura TF, Chin J . Protective role of human milk against sudden death from infant botulism. J Pediatr 1982; 100: 568–573.
Spika JS, Shafer N, Hargrett-Bean N, Collin S, MacDonald KL, Blake PA . Risk factors for infant botulism in the United States. Am J Dis Child 1989; 143: 828–832.
Stark PH, Lee A . The microbial ecology of the large bowel of breast-fed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15: 189–203.
Thompson JA, Glasgow LA, Warpinski JR, Olson C . Infant botulism: clinical spectrum and epidemiology. Pediatrics 1980; 66: 936–942.
Long SS . Epidemiologic study of infant botulism in Pennsylvania: report of the infant botulism study group. J Pediatr 1985; 75: 928–934.
Morris Jr JG, Snyder JD, Wilson R, Feldman RA . Infant botulism in the United States: an epidemiologic study of cases occurring outside of California. Am J Public Health 1983; 73: 1385–1388.
Hentges DJ . The intestinal flora and infant botulism. Rev Infect Dis 1979; 1: 668–673.
Johnson RO, Clay SA, Arnon SS . Diagnosis and management of infant botulism. Am J Dis Child 1979; 133: 586–593.
Arnon SS . Infant botulism: anticipating the second decade. J Infect Dis 1986; 154: 201–206.
Chin J, Arnon SS, Midura TF . Food and environmental aspects of infant botulism in California. Rev Infect Dis 1979; 1: 693–697.
Arnon SS, Midura TF Damus K, Wood RM, Chin J . Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome. Lancet 1978; 1: 1273–1277.
Long SS . Botulism in infancy. Pediatr Infect Dis 1984; 3: 266–271.
Gunn RA, Dowell Jr VR, Hatheway CL . Infant Botulism: Clinical and Laboratory Aspects. Center for Disease Control: Atlanta, 1978.
Woodruff BA, Griffin PM, McCroskey LM, Smart JF, Wainwright RB, Bryant RG et al. Clinical and laboratory comparison of botulism from toxin types A, B, and E in the United States, 1975–1988. J Infect Dis 1992; 166: 1281–1286.
Hurst DL, Marsh WW . Early severe infantile botulism. J Pediatr 1993; 122: 909–911.
L'Hommedieu C, Polin RA . Progression of clinical signs in severe infant botulism. J Pediatr 1981; 20: 90–95.
L'Hommedieu CS, Stough R, Brown L, Kettrick R, Polin R . Potentiation of neuromuscular weakness in infant botulism with aminoglycosides. J Pediatr 1979; 95: 1065–1070.
Paton WDM, Waud DR . The margin of safety of neuromuscular transmission. J Physiol 1967; 191: 59–90.
Arnon SS, Midura TF, Clay SA, Wood RM, Chin J . Infant botulism. Epidemiological, clinical, and laboratory aspects. JAMA 1977; 237: 1946–1951.
Tanzi MG, Gabay MP . Association between honey consumption and infant botulism. Pharmacotherapy 2002; 22: 1479–1483.
Arnon SS, Midura TF, Damus K, Wood RM, Chin J . Intestinal infection and toxin production by Clostridium botulinum as one cause of sudden infant death syndrome. Lancet 1978; 1: 1273–1277.
Takahashi M, Noda H, Takeshita S et al. Attempts to quantify Clostridium botulinum type A toxin and antitoxin in serum of two cases of infant botulism in Japan. Jpn J Med Sci Biol 1990; 43: 233–237.
Lindstrom M, Korkeala H . Laboratory diagnostics of botulism. Clin Microbiol Rev 2006; 19: 298–314.
Brown LW . Differential diagnosis of infant botulism. Rev Infect Dis 1979; 1: 625–629.
Clay SA, Ramseyer JC, Fishman LS, Sedgwick RP . Acute infantile motor unit disorder: infantile botulism? Arch Neurol 1977; 34: 236–243.
Jones Jr HR, Darras BT . Acute care pediatric electromyography. Muscle Nerve Suppl 2000; 9: S53–62.
Graf WD, Hays RM, Astley SJ, Mendelman PA . Electrodiagnosis reliability in diagnosis of infant botulism. J Pediatr 1992; 120: 747–749.
Gutmann L, Bodensteiner J, Gutierrez A . Electrodiagnosis of botulism. J Pediatr (Letter) 1992; 121: 835.
Santos JI, Swensen P, Glasgow LA . Potentiation of Clostridium botulinum toxin by aminoglycoside antibiotics: clinical and laboratory observations. Pediatrics 1981; 68: 50–54.
Cherington M, Ryan DW . Treatment of botulism with guanidine: early neurophysiologic studies. N Engl J Med 1970; 282: 195–197.
Centers for Disease Control and Prevention (CDC). Infant botulism – New York City, 2001–2002. MMWR Morb Mortal Wkly Rep 2003; 52: 21–24.
Pickering LK (ed). Red Book. 27th edn American Academy of Pediatrics: Illinois, 2006.
Arnon SS, Midura TF, Damus K, Thompson B, Wood RM, Chin J . Honey and other environmental risk factors for infant botulism. J Pediatr 1979; 94: 331–336.
Byard RW, Moore L, Bourne AJ, Lawrence AJ, Goldwater PN . Clostridium botulinum and sudden infant death syndrome: a 10 year prospective study. J Pediatr Child Health 1992; 28: 156–157.
About this article
Cite this article
Brook, I. Infant botulism. J Perinatol 27, 175–180 (2007). https://doi.org/10.1038/sj.jp.7211651
- infant botulism
- botulinum toxin
- Clostridium botulinum
This article is cited by
Validation of the Endopep-MS method for qualitative detection of active botulinum neurotoxins in human and chicken serum
Analytical and Bioanalytical Chemistry (2014)
Formes graves de botulisme du nouveau-né et du nourrisson : trois observations récentes et algorithme de prise en charge
World Journal of Pediatrics (2012)
Characterization of selected Gram-negative non-fermenting bacteria isolated from honey bees (Apis mellifera carnica)
Monatsschrift Kinderheilkunde (2010)