PP10.13 - 2944: An unusual case of infantile botulism: Clostridium botulinum Bf (C. botulinum Bf) infection in UK

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• 作者：D.S.T. Kariyawasam ; K. Grant ; G. Godbole ; R. Knight ; D. Kelly ; S. Jayawant ; S.R. Chandratre
• 刊名：European Journal of Paediatric Neurology
• 出版年：2015
• 出版时间：May 2015
• 年：2015
• 卷：19
• 期：supp_S1
• 页码：S73
• 全文大小：80 K

文摘

We discuss a rare case of infantile Clostridium botulinum Bf infection, the associated diagnostic pitfalls and paediatric-specific management strategies.

Methods

A retrospective review of the patient's medical notes was undertaken.

Results

A previously well, weaned infant presented at 6 months with two days of reduced feeding and salivary pooling. There was no history of honey exposure. Initially, gag-reflex was absent, with preservation of other cranial nerves. Antigravity movements of limbs, reflexes, and respiratory effort, were maintained. Symptoms progressed within a week to reveal hypotonia, absent antigravity movements, with preservation of reflexes, within upper limbs. Lower limb examination was normal. Eye-movements were preserved, however pupils were slowly and asymmetrically reactive. Respiratory decompensation led to intubation and subsequent tracheostomy. Lumbar puncture, metabolic screens, and MRI brain were normal. Neurophysiology showed diffuse, severely attenuated motor nerve amplitude consistent with axonal variant Guillian-Barre Syndrome, thus IVIG was commenced. Due to the atypical presentation of descending paralysis, infantile botulism was considered. Stool specimens were positive for C. botulinum Bf. Botulinum antitoxin therapy (Baby BIG) was initiated, leading to rapid recovery. Public health investigation did not show a reservoir for this infection.

Conclusion

C. botulinum Bf is rare, with eight previous international cases. Our case is only the second recent presentation in UK. The case confirms that dual C.botulinum neurotoxins should be considered in diagnoses for infants presenting with isolated cranial nerve palsies, including bulbar signs. Furthermore, rapidly descending paralysis involving pupillary mydriasis and poorly reactive pupils are consistent features of infantile botulism. Additionally this case highlights that neurophysiology interpretation in infants is unreliable, with clinical suspicion of botulism guiding investigation. Treatment for infantile botulism centres on Baby BIG therapy. This immunoglobulin is specifically selected for high titres of type A and B “neutralising antibodies”, which combat the most common strains of infantile botulism.