Infantile botulism in British Columbia: A case report

Infantile botulism is a rare condition in children under 1 year of age caused by ingestion of Clostridium botulinum spores. The growing organism colonizes the intestinal tract and releases toxins that cause an acute flaccid paralysis. Many of the complications that occur in infantile botulism are respiratory in nature and include aspiration, acute respiratory distress syndrome, recurrent atelectasis, and pneumothorax. Gastrointestinal complications such as Clostridium difficile colitis can also occur. Two infants admitted to our pediatric centre approximately 2 months apart in 2017 and 2018 were both eventually diagnosed with infantile botulism. These cases illustrate the presentation, clinical course, and management approach typically seen in infantile botulism. Each patient presented with constipation and poor oral intake followed by diminishing strength and flaccid paralysis with respiratory compromise. In both cases the patients were treated with botulism immune globulin in the form of a product called BabyBIG that had to be ordered from the supplier in California. Diagnosis of infantile botulism is challenging because of the low prevalence of the disease in Canada and the large number of possible conditions that must be considered when generating a differential diagnosis for a hypotonic infant. A high index of suspicion is required to detect infantile botulism and treat affected patients early in the clinical course of the infection. The cost of BabyBIG and the need to order the antitoxin product from an out-of-country supplier must be taken into account when treating infantile botulism.